Dr. Chapa’s OBGYN Clinical Pearls

Dr. Chapa’s Clinical Pearls

Relevant, evidence based, and practical information for medical students, residents, and practicing healthcare providers regarding all things women’s healthcare! This podcast is intended to be clinically relevant, engaging, and FUN, because medical education should NOT be boring! Welcome...to Clinical Pearls.

  1. 20h ago

    Intro to REVI EXTEND IMPLANT (Not a sponsor)

    Urge urinary incontinence (UUI) places a significant emotional and physical burden on women affected. Sacral neuromodulation has been and remains a well-established implant-based therapy for UUI. The concept originated in the early 1970s from sacral anterior root stimulation research for neurogenic bladder, with human clinical trials beginning in 1982. Medtronic's InterStim device received FDA approval in 1997 for UUI, and in 1999 for urgency-frequency and nonobstructive urinary retention. This was a game changer for affected women. Now, as of August 5, 2026, the FDA has granted 510(k) clearance for a new, less invasive neuromodulation implant- placed in the ANKLE. This is the Revi Extend Implant system (BlueWind Medical). What was the phase 3 data on this? What does the “wearable controller device” look like? Listen in for details. 1. Lukacz ES, Santiago-Lastra Y, Albo ME, Brubaker L. Urinary Incontinence in Women: A Review. JAMA. 2017;318(16):1592–1604. doi:10.1001/jama.2017.12137 2. Amundsen CL, Sutherland SE, Heesakkers JPFA, et al. Three-year efficacy and safety of Revi implantable tibial neuromodulation from the pivotal OASIS study. J Urol. 2026;216(2):219-229. doi:10.1097/JU.0000000000005062 3. BlueWind Medical receives FDA 510(k) clearance for Revi Extend implant. News release. BlueWind Medical Ltd. August 5, 2026. Accessed August 5, 2026. https://www.businesswire.com/news/home/20260805290667/en/BlueWind-Medical-Receives-FDA-510k-Clearance-for-Revi-Extend-Implant

  2. 3d ago

    The QBL Paradox: Precision vs. Performance in OB Hemorrhage

    Today, we are taking a deep dive into an intervention that almost every labor and delivery unit in North America has adopted over the last decade: Quantitative Blood Loss, or QBL. ACOG first recommended quantitative blood loss assessment in Committee Opinion Number 794, published in December 2019. This opinion recommended that every birthing facility implement a standardized, quantitative method for measuring cumulative blood loss at all deliveries, replacing visual estimation as the default approach. This built on earlier ACOG efforts, including the 2015 reVITALize initiative, which standardized obstetric data definitions and defined postpartum hemorrhage using cumulative measured blood loss thresholds (≥1,000 mL regardless of delivery route, or blood loss accompanied by signs/symptoms of hypovolemia). We’ve all weighed sponges, measured calibrated drapes, and run the math. But here’s the million-dollar question: Does measuring blood loss accurately, on its own, actually improve outcomes for patients? The answer is YES….and NO at the same time. Listen in for details as we discuss new data (July 2026 in AJOG) on this topic. 1. White A, Burns RN, Pruszynski JE, Ravindra D, Fin KX, Montgomery T, Jestes E, Ambia AM, Anyaehie B, Duryea EL. Establishing Normal Blood Loss Thresholds at the Time of Delivery Based on Quantitative Blood Loss. Am J Obstet Gynecol. 2026 Jul. DOI: 10.1016/j.ajog.2026.07.028. S0002-9378(26)00395-9. YMOB 16849. 2. Quantitative Blood Loss in Obstetric Hemorrhage: ACOG COMMITTEE OPINION, Number 794.Obstetrics and Gynecology. 2019. Committee on Obstetric Practice 3. Coomarasamy A, Devall AJ, Bell S, et al. Diagnosis and Treatment of Postpartum Haemorrhage: A Race Against Time. Lancet. 2026.

  3. Aug 5

    Routine US for RPOC After 2nd Trimester Loss?

    Today, we’re stepping into one of the most clinicallydelicate and emotionally heavy scenarios you can encounter in women's healthcare: a mid-pregnancy loss, say right around that 18 to 20-week mark. It’s a situation where the clinical room feels still, the emotional weight is immense, and every decision you make as a clinician carries profound gravity. Picture the scenario: The delivery has occurred. Both the fetus and the placenta have delivered, and upon gross visual examination on the delivery tray, the placenta appears intact. The immediate crisis of delivery has passed. But as theattending provider, you’re now standing at a critical management fork in the road. Do you routinely order an ultrasound before discharge to confirm the uterine cavity is truly clear? Or do you take a selective, symptom-driven approach, reserving uterine US imaging for patients who present with post-delivery warning signs like unexpected hemorrhage, severe pain, or fever? It sounds like a straightforward question, but in practice, it sparks intensedebate. Listen in, as we review professional society guidelines and the latest published data. 1.     Fox CE, et al. Mid‐trimester Pregnancy Loss GuidelineConsensus Panel. Triage and care for women with symptoms or diagnosis of pregnancy loss between 14 + 0 and 21 + 6 weeks' gestation. Int J Gynaecol Obstet. 2026 Jan;172(1):25-50. doi: 10.1002/ijgo.70621. 2.     Incognito GG, et al. Ultrasound Assessment ofRetained Products of Conception (RPOC): Insights from the Current Literature. J Clin Med. 2025 Aug 19;14(16):5864. doi: 10.3390/jcm14165864. 3.     ACOG PB 135: Second Trimester Abortion 4.     Sundararajan S, Roy S, Polanski LT. The accuracyof ultrasound scan in diagnosing retained products of conception: a systematicreview and meta-analysis. Am J Obstet Gynecol. 2024 May;230(5):512-531.e3.

  4. Aug 2

    A Mechanic’s Vision: The OdonAssist™ Device (Not Ready for US Approval)

    Today, I want to tell you a story that sounds like it was completely made up for a movie script, but it’s 100% real. Imagine an automotive mechanic in Argentina. He has zero medical training, no background in obstetrics, and no clinical degree. One night, he sees a simple party trick on YouTube: how to get a lost cork out of the inside of an empty wine bottle using nothing more than an inflated plastic bag. Most people would laugh, finish their glass of wine, and move on. But this mechanic, Jorge Odón, looked at that plastic bag and had a radical thought: Could this same basic physics principle be used to safely deliver a trapped baby during second-stage labor? Fast forward through years of engineering refinements, global partnerships, and early clinical pilots, and we get the Odón device- or OdonAssist™. It is, without a doubt, one of the most creative and innovative mechanical concepts to hit the field of operative vaginal delivery in generations. Instead of rigid metal blades applying direct compression, or high-pressure suction cups on the scalp, it uses an inflatable pneumatic cuff wrapped inside a lubricated, double-layered polyethylene sleeve. The inner layer grips the fetal vertex, while the outer layer glides smoothly against the vaginal walls, replacing high friction with plastic-on-plastic sliding action. But, and this is a big "but", as clinicians, we don't practice medicine based on good ideas or clever engineering alone. We practice based on rigorous, reproducible evidence on efficacy and safety. And that’s where the narrative gets complicated. Although the device recently secured CE mark approval in Europe, it is not FDA approved in the United States. Why? Because despite nearly two decades of development, it is still facing a major shortage of large-scale Phase 3 comparative data (non-inferiority data). And the data it does have is not quite as impressive as its design would imply. Listen in for details. 1. Mottet N, et al. Safety and efficacy of the OdonAssist inflatable device for assisted vaginal birth: the BESANCON ASSIST study. American Journal of Obstetrics & Gynecology, 2023; 230, S947-S958 2. Hotton EJ, Lenguerrand E, Wade J, et al. The OdonAssist inflatable device for assisted vaginal birth—the ASSIST II study (United Kingdom). Am J Obstet Gynecol. 2024;230(3S):S932-S946.e3. 3. https://www.mnhi.com/odonassist (CE approval)\ 4. ACOG PB 219; 2020.

  5. Jul 30

    When Data Gaps Exist: OB HSV Suppression?

    ACOG first recommended antiviral suppressive therapy at 36 weeks of gestation for women with a history of genital herpes in 2007, with the publication of Practice Bulletin No. 82 ("Management of Herpes in Pregnancy," June 2007). This was the first ACOG practice bulletin specifically dedicated to genital herpes management in pregnancy, and it established the 36-week suppressive therapy recommendation based on the RCTs available at that time (including the Watts 2003, Sheffield 2006, and Andrews 2006 trials). The recommendation was subsequently reaffirmed and updated in Practice Bulletin No. 220, published in May 2020, which is the current version. However, these trials had patients who ultimately delivered at/after 38 weeks. In a patient with a history of genital HSV for whom suppression is recommended but who will have a medically indicated delivery at 37 weeks, say for a hypertension disorder of pregnancy, is 36 week initiation of HSV antiviral medication enough time for suppression? There is a gap in high quality data on this. In this episode, we will review the published data and reach a clinical decision as to whether one week suppression is enough, or if initiation earlier is reasonable. 1. ACOG PB 82 2. ACOG PB 220

  6. Jul 27

    (MIPI) Multidose Ibuprofen Prior to IUD?

    Today, we’re diving straight into a topic that hits close to home for millions of patients and providers alike: IUD insertion pain, and more importantly, how we can actually make it better. Now, if you’ve been practicing or following clinical guidelines for a while, you know the frustrating backstory here. For years, the standard advice was simple: "Just take 800 milligrams of ibuprofen an hour before your appointment." But a 2015 double-blinded, randomized placebo-controlled clinical trial showed that taking a single dose of 800 mg within an hour before insertion did not relieve procedural pain. That was published in the journal Contraception in 2015. This left clinicians wishing for better options. Fast forward to 2024, when the CDC updated its guidelines to formally recommend local analgesia, like lidocaine blocks or topical use, to help manage insertion pain. That was a huge, long-overdue win for patient-centered care. But local numbing isn't the only tool we should be looking at. What if the issue with oral NSAIDs wasn't the medication itself, but how and when we dosed it? That brings us to a brand-new study published in the American Journal of Obstetrics and Gynecology (AJOG), August 2026. Researchers looked at a preemptive, multidose ibuprofen regimen- starting the day before insertion to reach sustained, therapeutic blood levels ahead of time. And the results? They offer some new insights into how we can stack our pain control strategies. So, let's break down what this study found, how it builds on our CDC guidance, and what it means for our clinical practice starting at our next IUD placement. Let’s jump in. 1. Bednarek PH, Creinin MD, Reeves MF, et al. Contraception. 2015;91(3):193–197. 2. Ouyang C, Lamvu G, Quach H, et al. Multidose Ibuprofen Prior to Intrauterine device insertion (MIPI): a triple blinded randomized controlled trial. American Journal of Obstetrics & Gynecology, August 2026; 235, 330-337 3. Management of Premenstrual Disorders: ACOG Clinical Practice Guideline No.7 Obstetrics and Gynecology. 2023. Committee on Clinical Practice Guidelines–Gynecology 4. McKenna KA, Fogleman CD. Dysmenorrhea.American Family Physician. 2021.

  7. Jul 24

    Ferritin at iOB: Told Ya! (Aug 2026 Data)

    Podcast family, we pride ourselves on this show on being avant-garde and forward thinking on the topics we choose. For example, on February the 20th, 2026, we released an episode called “New Data: Screen Maternal Ferritin with Prenatal Care?” In that episode we reviewed a publication from the previous month (January 2026) that was released in Lancet Hematology. This study made the case for screening for early iron deficiency, even without anemia, with serum ferritin at the initiation of prenatal care. This was a multicenter, 2-arm, randomized controlled trial. Earlier identification of low serum ferritin prevented iron deficiency anemia in the third trimester. That's a win! Back then, we also stated how Australia has been leading the charge on this with the Australian HOW. That stands for Hematology in Obstetrics and Women's Health. This Australian consensus committee now recommends screening for iron deficiency, not just iron deficiency anemia, at the initiation of prenatal care, at 24 to 28 weeks, and then again at the third trimester when necessary. And now, as of August 2026, we have additional supportive data that including serum ferritin at the initial OB visit is evidence-based and best for the patient! In this episode we will review this brand-new, prospective cohort study published as a Research Letter in the AJOG August 2026. 1. Australian HOW: Iron optimisation in pregnancy: a Haematology in Obstetric and Women's Health Collaborative consensus statement; https://onlinelibrary.wiley.com/doi/10.1111/imj.16602 2. Konecke N, Jackson T, Angeles I. et al. The association between first trimester iron deficiency without anemia and the development of iron-deficiency anemia prior to childbirth. American Journal of Obstetrics & Gynecology, 2026; 235, e36-e38 3. ACOG Clinical Practice Update: An Update to Clinical Guidance for Delayed Umbilical Cord Clamping After Birth in Preterm Neonates. Obstet Gynecol. 2025 Jul 24;146(3):442-444.

  8. Jul 21

    IUDs Cause Uterine Adhesions & Infertility?

    If you’ve scrolled through your feeds recently, you’ve probably seen the video that’s causing a stir: a prominent infertility doctor sharing her “Hot Take” personal observations on social media, claiming that IUDs are a hidden cause of intrauterine adhesions- or severe uterine scar tissue. Now, Listen. It is completely natural to see a specialist standing in a white coat making a passionate claim and think, "Wow, should I be worried about my birth control?" But here is the reality we need to establish right out of the gate: a handful of individual cases shared online is the very definition of anecdotal evidence. It does not fulfill the criteria of rigorous scientific observation. When we pull back from the algorithm and look at the actual clinical data involving millions of IUD users worldwide, the science shows us something completely different. In fact, large-scale studies demonstrate that IUDs do not cause this scarring—and historically, certain models have actually been used to prevent the uterine walls from sticking together during post-surgical healing. So today, we are separating the scrolling panic from the actual science. We have REA data from the recent FACT (Fertility After Contraceptive Termination) study from 2021 (AJOG). We’re breaking down what the data really says, why the internet loves a medical scare, and the true, proven causes of intrauterine adhesions. 1. Abel MK, Wald K, Cedars MI, Noel M. Uterine Synechiae After Intrauterine Device Use: A Case Series. Journal of Assisted Reproduction and Genetics. 2021. 2. Chung E, Wang F, Zhang J, Strug M, Aghajanova L, Lathi R. The impact of prior hormonal intrauterine device (IUD) use on endometrial lining thickness in the fertility clinic setting: a retrospective cohort study. J Assist Reprod Genet. 2026 Jun 25. doi: 10.1007/s10815-026-03950-x. Epub ahead of print. PMID: 42347902. 3. Peipert JF, Zhao Q, Schreiber CA, Teal S, Turok DK, Natavio M, Cordon S, Daggy J. Intrauterine device use, sexually transmitted infections, and fertility: a prospective cohort study. Am J Obstet Gynecol. 2021 Aug;225(2):157.e1-157.e9. doi: 10.1016/j.ajog.2021.03.011. Epub 2021 Mar 11. PMID: 33716075.

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Relevant, evidence based, and practical information for medical students, residents, and practicing healthcare providers regarding all things women’s healthcare! This podcast is intended to be clinically relevant, engaging, and FUN, because medical education should NOT be boring! Welcome...to Clinical Pearls.

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