Dr. Chapa’s Clinical Pearls.

OASIS (3rd and 4th degree perineal lacerations) occur at a rate of 4-11% (average around 5.5%). OASIS lacerations have both short term and ling term potential morbidities. Practice Bulletin 198, from 2018, briefly discusses counseling patients following OASIS on subsequent mode of delivery options. Now, in a soon to be released AJOG publication, authors have provided a wonderful and comprehensive review on "patient-centered" guidance regarding mode of delivery in a subsequent pregnancy following OASIS. This is a detailed episode, so listen in for the update!

Ladies and gentlemen, welcome back to another addition of “You asked, We answered”! In this brief episode, we will tackle 2 very appropriate clinical questions:1. Why do cervical psychology reports still state the presence or absence of endocervical cells/TZ component if it does not change management, and 2. Does continued magnesium sulfate infusion during C-section increased blood loss? We have done similar “you asked, we answered” episodes in the past and we will continue to do them as questions arise. Listen in for details.

The Bishop Score was originally developed in 1964 by Dr. Edward Bishop and remains the central assessment tool for determining the appropriateness of cervical ripening for labor induction. We have covered pharmacologic and mechanical methods of cervical ripening for labor induction many times in prior episodes. Ut now, in July 2025, there will be a new clinical practice guideline (#9) from the ACOG which has some notable items. Does the ACOG recognize COMBINATION mechanical and pharmacologic agents for cervical ripening for labor induction? What about outpatient cervical ripening? What are the recommended protocols for oral and vaginal prostaglandins? Listen in for details.

Second and/or Third trimester vaginal bleeding is a common reason for L&D Triage patient assessment. The evaluation starts with determining the status of maternal hemodynamic stability. This together with IV access are key first steps. This is followed by an assessment of fetal-placental status. Typically this includes bedside ultrasound for fetal position, visual confirmation of FHTs, amniotic fluid determination, and placental location. At the same time, lab data is obtained to guide care: CBC, fibrinogen, type and RH, and possibly type and cross. Do you order a KB test as part of the STANDRAD evaluation for suspected placental abruption? In this episode, we will review a new study released ahead of print on June 8, 2025 in the European J of Obstetrics, Gynecology, and Repro Biology. Listen in for details.

Antenatal Corticosteroids (ACS) for Fetal Lung Maturation (and more) is an ever evolving saga. This is how science and medicine evolve, by always seeking more information. The effect of antenatal corticosteroids on neonatal/child neurodevelopmental outcomes is controversial and may be influenced by the gestational age at which exposure occurred. In this episode we will highlight TWO recent publications, one from May 2025 (JAMA Netw) and the other from June 2025 (Obstet Gynecol). The first adds data to the "Dose to Delivery interval" question for ACS benefit, and the second article relates to neurodevelopmental outcomes after exposure. Listen in for details.

Innovation in medicine is happening. In our immediate past episode, we summarized how AI is improving standard mammography to now PREDICT breast cancer rather than just diagnosing it once it was appeared. In a past episode, we covered a new and novel “first in class” oral medication for uncomplicated UTIs in women called Blujepa. This is innovation! Well now, as of June 10, 2025, the FDA has granted a New Drud Application for a new and noval oral antibiotic against gonococcal (GC) infection! In this episode, we will review the current CDC treatment protocols for GC and highlight what this new medication's MOA is and what to expect from this FDA process.

Each year, more than 2.3 million women worldwide are diagnosed with breast cancer—including over 370,000 in the United States alone. For more than 60 years, mammograms have saved lives by detecting early-stage cancers. Now, advancements in AI have lead to a first of its kind breast imaging algorithm that can PREDICT future (5-year) breast cancer risk in the patient (CLARITY BREAST). This is GROUNDBREAKING. Yes, there has been other new tools, like the recent contrast enhanced mammography data, for early detection of breast cancer, but this is the first technology to help PREDICT it in the future. Nonetheless, questions remain. Listen in for details. (CLARITY is not a sponsor)

It's interesting how, at times, different medical societies can look at the same data and arrive at different recommendations. It happens! In April 2025, the Society of Family Planning (SFP) released its new clinical recommendations for the medical management of early pregnancy loss (EPL), AKA miscarriage. This clinical guidance has 4 remarkably interesting differences when compared to the ACOG practice bulletin # 200 on early pregnancy loss. In this episode, we will review these 4 key differences and summarize the latest recommendations for the medical management of miscarriage. Listen in for details.

The white-coat effect is a measure of blood pressure change from before to during the visit in office/clinic when the blood pressure is recorded by a physician or nurse; this was first described in 1983 by Mancia et al, and was initially thought to represent a benign process. But it was unclear what this actually meant for pregnancy. Ambulatory blood pressure monitoring (ABPM) has been used in pregnancy for about 20 years now. Use of this monitoring option has revealed a subgroup of patients who have persistently high blood pressure (BP) in the presence of health care providers, but a normal ambulatory or self-measured BP. This phenomenon has been termed “White Coat Hypertension” (WCH). In 2013, The International Society for the Study of Hypertension in Pregnancy (ISSHP) published the revised classification for hypertensive disorders in pregnancy, that included WCH, not previously included. The ISSHP guidelines also emphasize that a diagnosis of white coat hypertension in pregnancy should only be considered before 20 weeks of gestation. We now know that WCH, outside of pregnancy, is not an entirely benign process. The role of metabolic risk factors in patients with white-coat hypertension was first outlined in 2000 by Kario and Pickering. When metabolic risk factors are present in association with white-coat hypertension, the increased risk of target organ damage is determined not only by the blood pressure characteristics but also by the metabolic abnormalities. Recognizing the potential risks of white coat hypertension was also published in a commentary in 2016 out of the European Society of Cardiology. That article's title was, “White-coat hypertension: not so innocent”. But what is the latest data on WCH in pregnancy? Is WCH linked to poor obstetrical outcomes? Does WHC need medication therapy? We have data from 2024 to help us. Listen in for details.

Uterine incarceration in pregnancy, is a rare but troublesome complication. This occurs when a retroverted uterus becomes trapped in the pelvic cavity during pregnancy. This happens when the uterus fails to move forward as it grows, becoming stuck between the sacral promontory and pubicsymphysis. It's more common in women with prior pelvic issues or uterine anomalies. Urinary retention is the most common symptom that occurs because of elongation of the urethra by displacement of the cervix, loss of the urethro-vesical angle, and mechanical compression of the bladder neck. It is estimated to occur in 1 in 3000 patients. How do we release an incarcerated uterus? Is laparoscopy an option? And how can an ultrasound probe help (April 2025publication)? Listen in for details.

In May 2024, the FDA approved vaginal self-collection for HPV as a cervical cancer screening tool. This was limited to health care settings. While this self collection option can help address some of the emotional deterrents to a speculum examination, it fails to overcome the remaining substantial clinic access barriers cited among those who are underscreened, including time off work, arrangement of child or elder care, and transportation. Then, the FDA approved the first at-home cervical cancer screening test on May 9, 2025. This test, called the Teal Wand (FDA-approved prescription device), allows individuals to self-collect vaginal samples at home to test for Human Papillomavirus (HPV). But is at-home testing valid? Does this work? A new publication in JAMA Network Open (May 19, 2025) answers this important question. Listen in for details.

In the US, an estimated 70-75% of women who give birth use an epidural for pain relief during labor. Epidural anesthesia during labor can affect bladder function by delaying the return of bladder sensation and potentially leading to urinary retention. This can be due to the nerves that control bladder function being affected by the epidural, reducing the sensation of bladder fullness and the urge to urinate. Intrapartum, there is no universal guidance regarding bladder management with labor epidural analgesia (LEA). Does one method of bladder care intrapartum affect mode of delivery more than the other? Is it better to have an indwelling catheter or to perform intermittent caths. What about patient self-voiding with a bedpan. Let's summarize the data.

At the end of April 2025, we released an episode summarizing the ERAS update for 2025. In that episode/update, we summarized the data on extended spectrum prophylactic antibiotics at cesarean section in patients living with obesity. The ERAS protocol recognized the value of oral cephalexin and metronidazole for 48 hours in patients with obesity who receive single agent Cephalosporin prophylaxis preop. Now, a new (RCT) publication soon to be released in the Green Journal, evaluates whether using dual agent pre-op prophylaxis (ancef and zithromax) together with post op oral cephalexin and metronidazole has benefit in reduction of SSI composite risk. Does this help? When is too much prophylactic antibiotics, just too much? Listen in for details.

We have covered menopause on this show on various occasions. That's fitting and non-surprising as we are a women's health education podcast! While vaginal dryness and hot flashes get most of the attention in menopause, and they should, less attention often is given to skin changes. Nonetheless, these dermal manifestations of perimenopause and menopause can be just as disturbing to those affected. Estrogen helps skin produce oil and hold onto water, so extremely dry skin during menopause is common. Plus, according to the American Academy of Dermatology, collagen production drops 30% in the first 5 years of menopause and approximately 2% each year for about the next 20 years. Collagen gives skin its plumpness and structure. The direct-to-consumer market is replete with a variety of over-the-counter estrogen containing products, formulated as facial creams, which are meant to fight the battle of skin aging. But is topical estrogen applied to the face effective? What are the data? You'd be surprised to learn that there is published data on this- even level I data. Are there any safety concerns? We will summarize it in this episode. PLUS, as a “two-for one” special, we will also briefly highlight a brand new publication in the journal JAMA Network Open regarding antenatal corticosteroid dose to delivery interval and fetal benefits.

In 2014, the International Society for the Study of Women's Sexual Health together with the North American Menopause Society introduced the term “Genitourinary syndrome of menopause” to replace the prior term vulvovaginal atrophy. Ten years after that, in 2024, a related term “Genitourinary Syndrome of LACTATION, was introduced to better capture the genitourinary issues lactating women may experience. A new systematic review, soon to be released in the journal obstetrics and gynecology, provides new data on GSL prevalence and characteristics. This is a good reminder for any clinician who evaluates postpartum/lactating women to ask about GSL. How does sexual dysfunction fit into this question? Listen in to the next episode of Dr. Chapa's Clinical Pearls Podcast for more details.

Endometriosis is a prevalent gynecologic condition that affects approximately 10–15% of women of reproductive age worldwide. For endometriosis related pelvic pain, continuous combination birth control pills have long been the first-line pharmacologic intervention of choice. But new data published May 15, 2025 (ahead of print) in Obstetrics and Gynecology is challenging that tradition. In this episode , we will summarize the key findings of this brand new network systematic review and metanalysis. Plus, we will also review what is missing from the ACOG PB 114 regarding the management of endometriosis. Listen in for details.

In August 2024, the CDC updated its MEC. This included a recommendation for local anesthesia for IUD/S placement and also had guidance regarding misoprostol for that procedure. Coming up in July 2025, the ACOG will officially release a new clinical consensus on “Pain Management for In-Office Uterine and Cervical Procedures”. Are these recommendations similar to the CDC's? What about misoprostol? Was the non-use of local anesthesia for these office-based procedures rooted in racism and sexism? Listen in for details.

Asthma is more prevalent in adult women than in adult men. Specifically, data from the National Health Interview Survey (NHIS) indicates that 9.7% of adult women had asthma, compared to 5.5% of adult men. This higher prevalence is observed across various racial and ethnic groups within the adult female population. At the end of April 2025, new population-level data was published (UK) describing an alarming association between progastrin only pills and asthma exacerbations. Is this a new finding? Recently, it seems that there has been a barrage of negative press towards progestin only contraceptives: depo provera and brain tumors, progestin releasing IUS and breast cancer, and the progestin IUS and rosacea. What is happening here?! We'll break it all down in this episode.

Female Genital Mutilation (FGR) is condemned by the WHO, Unicef, and the US. Nonetheless, it is still being performed worldwide, and in North America. In this episode, we will recently published data (April 2025) from BMC regarding this practice. This episode's topic was brought to me by one of our podcast family members who currently has a pregnant patient with FGR. Does this patient require a cesarean section? What are the 4 types (classifications) of FGR? Listen in for details.

(Topic Requested): Serum Magnesium and Calcium have an intimate and complex relationship best described as “love-hate”. One of our podcast family members sent me this fascinating question: “Should we be following serum calcium levels in patients undergoing IV Mag Sulfate use in obstetrics, in order to identify dangerous hypocalcemia?...Should we be giving these patients prophylactic calcium?” Thera are indeed published case reports of hypocalcemia induced tetany in patients. However, are there national guidelines which call for “calcium surveillance”? Do you remember what the Chvostek's and Trousseau's signs are? Listen in for details.

Some debates in medicine and in OBGYN are “the same ol' thing”. Like the debate on when to remove the urinary catheter after a “routine” cesarean section. In the original 2019 ERAS publication, the authors stated that “immediate” removal of the urinary catheter was “strongly recommended”. This drew concern and criticism as being too early in the recovery process. Not, in the UPDATED ERAS guidelines (as of end of April 2025), this recommendation has once again changed! In this episode, we will review the new guidance from the ERAS Society regarding post cesarean section care focusing on when to stop IV fluids and urinary drainage.

The term "genitourinary syndrome of menopause" (GSM) was introduced in 2014 by the International Society for the Study of Women's Sexual Health and the North American Menopause Society (now the Menopause Society). This new term was created to replace older terms like vulvovaginal atrophy, urogenital atrophy, and atrophic vaginitis, and it encompasses the range of symptoms related to hormonal changes in the vulvovaginal and urinary tract areas that can occur during menopause. Recurrent UTIs are more likely in postmenopausal women not on vaginal estrogen therapy. IN this episode, we will highlight new data from the recent AUA meeting which looked at surprising benefits on postmenopausal vaginal estrogen in women with recurrent UTIs. Nonetheless, questions on the data remain. Listen in for details.

The ERAS (Enhanced Recovery After Surgery) concept was initially developed for colorectal surgery in 1997 to standardize surgical protocols. The ERAS Society then first published a guideline for cesarean section (ERAC) in 2018-2019. Now, as of April 28, 2025, the ERAS Society has released a NEW UPDATE for ERAS-CS. In this episode we will focus on 2 main areas: 1. Vaginal prep at CS, and 2.Extended antibiotic prophylaxis in patients with obesity! Medicine moves fast, and this data exemplifies that. PLUS, we will relate these 2 points back to the ACOG PB 199 which focused on prophylactic antibiotics at cesarean section.

I know this sounds braggadocious, but I'm going to say it anyway: I work with some incredible people! We recently released a podcast on updated TOLAC uterine rupture data. One of our former residents reached out to me with a question about this: “Did they include interdelivery interval in their assessment?” You see, I work with really smart people! There's an answer to that question, and we're going to cover that in this episode. PLUS, a current resident, Spencer, had a great question about proof of immunity to rubeola (measles) in pregnancy. Can we assume that if a patient is rubella immune that she is also immune to rubeola? That's a great question, and we will explain in this episode!

Spontaneous twin pregnancies occur in about 1 out of every 250 pregnancies. A real world clinical question has to do with dating a spontaneous twin gestation: Do we use the smaller crown rump length or the larger for dating in the 1st trimester? Do we use the smaller or larger measurement of biometry in the 2nd trimester? We had this discussion today in our prenatal clinic, and in true form and fashion, I turned it into an episode! PLUS, there is practice guidance from Jan 2025 (ISUOG) to settle the debate. Listen in for details.

In the ACOG Practice Bulletin 205 (Reaffirmed August 2025), the stated risk of uterine rupture with TOLAC is stated as 0.7% (after 1 prior LTCS). However, as our podcast tag list holds true, "Medicine Moves Fast". In an new upcoming publication from Obstet Gynecol (The Green Journal), May 2025, authors looked at the rate of uterine rupture with TOLAC over a 12 year interval. The rate of uterine rupture was NOT close to the national quoted rate in the Practice Bulletin. This information, which was also presented at the Jan-Feb 2025 Pregnancy Meeting, can be very helpful in counseling patients desiring TOLAC. Listen in for details.

As healthcare professions we are often pulled in different directions ALL AT ONCE. It happens. We "multitask" every day. Or do we? Neuroscience actually states that we don't multitask at all; rather, we "task-switch" and that may lead to increased physiologic and mental stress and patient error. Yep, there is a MYTH about multitasking. In this brief episode, we remind ourselves that its OK to put somethings off, as able, until one task is completed. As the famed stoic philosopher Publilius Syrus wrote, "To do two things at once is to do neither". Listen in for details.

I love my home state of TEXAS. I am definitely full of Texas pride. We have Texas barbecue, Texas, hospitality, and of course, the Texas music scene! Our state definitely has some issues to improve on, mainly access to maternity care. We have a HUGE state and 50% of our counties are maternity care deserts. It's a vast vast Land to cover! Texas has also received a lot of criticism regarding its heartbeat law originally named SB8, which was passed in 2021. Commentaries since then have stated that OBGYNs are leaving the state by the droves! Is that accurate? A new publication from JAMA network open (April 21, 2025) seems to contradict these commentaries. Listen in for detail details.

There have been various publications and commentaries published on “evidence-based” cesarean section techniques. Still, one of the persistent controversies on abdominal wall closure relates to the rectus. With transverse fascial entries, should we close/reapproximate the rectus or not? In June 2025, a new RCT looking at this very issue will be printed in the European J Obstetrics Gynecology and Reproductive Biology. Listen in for details.

On December 13, 2022, we released an episode describing a new concept in prenatal care, called the PATH model. This was to “redesign” prenatal care, as needed, for those who may have limitations for the “traditional” model of prenatal care visits. Well, what we covered 2.5 years ago is NOW an OFFIICAL guidance from the ACOG and will be out in May 2025. Similarly, the SMFM released their vision for redesigned maternal care teams on 16 April 2025 (J Pregnancy). We will BRIEFLY summarize these 2 publications in this episode.

Pelvic congestion syndrome is a controversial entity that does not currently have validated diagnostic criteria. In the ACOG PB 218 (2020), it states, “Pelvic congestion syndrome is a proposed etiology of chronic pelvic pain related to pelvic venous insufficiency. Although venous congestion appears to be associated with chronic pelvic pain, evidence is insufficient to conclude that there is a cause-and-effect relationship. In addition, there is no consensus on the definition of this condition, and diagnostic criteria are variable. Further research is needed to establish greater consistency in diagnosis and homogeneity in treatment studies”. Is that it? Is that all there is? NO! There has been great interest in the diagnosis of this enigmatic condition and in potential new treatment options. The last publication on this was just released in March 2025 as a “pilot study”. In this episode, we will combine multiple sources and explain this controversial condition and offer hope to patients who may indeed have this real disorder.

On Monday April 7, 2025, the UK's publication The Guardian wrote, “Surgeons are hailing an ‘astonishing' medical breakthrough as a woman became the first in the UK to give birth after a womb transplant. Grace Davidson, 36, who was a teenager when diagnosed with a congenitally absent uterus, said she and her husband had been given ‘the greatest gift we could ever have asked for'. Grace's sister donated her own womb during an eight-hour operation in 2023. Davidson said she felt shocked when she first held her daughter, who was born by planned NHS caesarean section on 27 February. She was first UK womb transplant recipient to give birth”. Since the first successful uterine transplant in 2011, there have been over 70 live births worldwide. These births have occurred following more than 100 uterine transplant procedures. This episode, we will review the fascinating history of this procedure. We will also answer some questions regarding uterine transplant like can the patient has vagina sex after this? How is this procedure done? Are these babies born vaginally? And which location in TEXAS become a world-renowned uterine transplant center? Listen in for details.

On March 19. 2025, The American College of Clinical Pharmacy published, "A review of antibiotic safety in pregnancy- 2025 Update". In this episode, we will review some of the confusion surrounding aminoglycosides, sulfa, and nitrofurantoin in pregnancy. Its interesting how different professions view certain medications in pregnancy. Does ACOG say you can use Sulfa in the third trimester? Can you use nitrofurantoin in the first trimester? Listen in for details. (SHOUT OUT to our partner podcast, CLINICAL PEARLS LATINO, for the topic idea. GRACIAS AMIGOS)

Well Podcast Family, in this VERY BRIEF episode, we will highlight a patient's perspective on IUS insertion with lidocaine jelly pre-insertion prep. As we have stated in past episodes, I am a BIG ADVOCATE of lidocaine jelly for IUD/IUS insertion. This patient agreed to share her experience of the EASY BREEZY IUS placement. (NOTE: HIPAA protected, patient agreed to participate in this episode).

Animal bites in humans are a common problem in the United States, with two to five million occurring each year. The vast majority of animal bites are caused by dogs (85 to 90 percent), with the remainder caused by cats (5 to 10 percent) and rodents (2 to 3 percent). Children are bitten more often than adults. The most feared complication of an animal bite is rabies, although skin infection is the most common complication. In our community high risk clinic, we recently saw a pregnant patient, who also has diabetes, who had a “cat bite” reported to our nursing staff. On examination, it was more like she was mauled by the cat! Both her feet had significant scratches and bite marks. Are you up to date in your animal bite care algorithm? It's one of those occurrances that are low frequency but have potential high morbidity. So in this episode I thought we would review the care plan for a patient who has suffered a cat bite, or animal bite in general. Meow Meow.

VVC is second to BV in vaginitis type, here in the USA. data indicate that 75% of women have experienced at least one episode of genital candida throughout their lives . VVC is currently classified as uncomplicated (sporadic infection with mild-to-moderate clinical symptoms in non-immunocompromised women) or complicated (recurrent or clinically severe infection that eventually affects immunocompromised women or is caused by non-Albican species). What is the best course of action for these patients? Topical therapy or oral? Single or multiple dosages? In this episode, we will highlight a new publication from the AJOG which was just released ahead of print that looks at this issue. PLUS, we will revisit a 2001 multicenter study on single Diflucan vs sequential dosing every 3 days. As a little bonus, as the AJOG new publication is Italian, we will have sporadic interludes from ITALIA's best! Listen in for details.

Postural Orthostatic Tachycardia Syndrome (POTS), first described in the 1940s, is a heterogeneous and often debilitating condition affecting the autonomic nervous system, estimated to affect between 0.3% and 1% of the U.S. population. Its incidence is believed to be rising among people with a prior COVID-19 infection, as a likely component of so-called long COVID. The condition is characterized by chronic orthostatic intolerance in the absence of orthostatic hypotension manifested as excessive increased heart rate upon standing. The etiology is not well understood but is thought to be complex. One recent publication described the complex etiology of POTS as, “A multitude of pathophysiologic mechanisms including but not limited to disproportionate sympathoexcitation, volume depletion, autoimmune dysfunction, cardiac and physical deconditioning point to a heterogeneously complex etiology”. Other POTS symptoms include fatigue, headaches, cognitive impairment, palpitations, chest pain and gastrointestinal symptoms. These symptoms can significantly reduce quality of life. Interestingly, most people with POTS are under age 50. In this episode we will review POTS in pregnancy. What therapies are available? Does anxiety have a role within this process? Listen in for details.

Hematuria remains one of the most common urologic diagnoses, estimated to account for over 20% of urology evaluations. Women with hematuria have been especially prone to delays in evaluation, often due to practitioners ascribing hematuria to a urinary tract infection (UTI) or gynecologic source, resulting in inadequate evaluation and delay in cancer diagnosis. In this episode, we will review the recently released joint guidance form the AUA and SUFU regarding microhematuria. What defines this condition? If a UTI is also diagnosed, does that end the investigation? And what are the 3 risk profiles for microhematuria? Listen in for details!

HOT HOT HOT Off the News CycleL The FDA has just approved (1 hour ago) a new at-home STI test kit. Does this work? What is the data on accuracy? What does this test for? This is a developing story... Listen in for details!

Metabolic syndrome (MetSyn) is a cluster of conditions, such as increase in waist circumference, dyslipidemia (elevated triglyceride levels and reduced HDL), increased blood pressure, and increased fasting blood sugar levels that is related to insulin resistance, diabetes, and elevated risk of cardiovascular disease. Women with PCOS have a significantly higher prevalence of metabolic syndrome (MetS) compared to the general population, with studies indicating a prevalence of around 43-47% in PCOS women. PLUS, there is a high prevalence of moderate to severe depressive symptoms and depression in adults and adolescents with PCOS; therefore, screening for depression in all adults and adolescents with PCOS is encouraged. In this episode, we will review a new publication for the J Clinical Endo & Metabolism discussing this combination (PCOS and depression/anxiety) and the MetSyn, and we will review the EXPANDED indications for metformin for metabolic syndrome prevention/treatment according to the 2023 PCOS updated guidance.

Throughout their lifetime, over 50% of women experience uUTIs, with recurrent infection reported in approximately 30%. Today, on March 25, 2025, the FDA approved a new first-in-class oral antibiotic for uncomplicated UTIs in women! This is Blujepa! In this episode, we will review the EAGLE clinical trial data and review the main side effects reported in the study population. How does this new antibiotic work? Will it be approved for pregnancy? And, what other genital condition could it likely be approved for? Listen in for details!

Medicine has traditionally been practiced “in silos”. But compartmentalization of medical practice/interventions can leave gaps in patient care. Patients win when they have increased access to a variety of medical therapies or contraceptive options. In this episode, we will review a brand new publication (released ahead of print) from the AJOG. We've decided to call this episode, “Internists, IUDs, and Inspiration”. Listen in for details.

TWICE BEFORE, we have covered Pitocin use intrapartum: 1. On Oct 24, 2022 we covered, “Save the Pitcoin! Safe to Stop Pit Once in Active Phase?”, and 2. On Sept 24, 2024 we covered, “Labor Hacks: Pit Breaks”. Nonetheless, today's episode yet again focuses on pitocin in labor. On March 18, 2025, a new systematic review and meta-analysis was released ahead of print in the AJOG. This looks at cesarean delivery rates with discontinuation of pitocin in the active phase. Although the title of this new publication states, “Reduced risk of cesarean delivery with oxytocin discontinuation in active labor”, the devil is in the details! There's lots to review here, so listen in for details.

Fresh off the heels of our immediate last episode, we bring you a perspective from the trenches! Sarah, a Clinical Pearls podcast family member, is a health professional who works with autistic individuals. Sarah has provided clear and evidence-based data which helps to explain the rise of autism in the US over the last decades. Our podcast community is Incredible! Her noted and data driven perspective are the core concepts highlighted in this episode. Listen in for details.

Autism Spectrum Disorder (ASD) has an alarming trend of rise in the US. Currently, 1 in 36 (or 1 in 40 in some reports) have an ASD diagnosis. For this reason, ASD remains in the spotlight as researchers remain dedicated in explaining its origin. Over the last few years, there have been publications suggesting a link between one of the most common symptoms of pregnancy (nausea and/or nausea together with vomiting) and autism spectrum in the child. This is obviously a point of concern for those suffering with nausea slash vomiting in pregnancy. Is this association solid? What does the data show? It's controversial, but we will drive through it in this episode. PLUS, we will also highlight 2 recent publications (January 2025, February 2025 ) that provide some comfort for those suffering with these common symptoms. Listen in for details!

Fasting during the lunar month of Ramadan (Feb 28 to March 30, 2025) is a core practice for Muslims across the world. During Ramadan, Muslims abstain from food and drink from dawn to sunset. However, during a singleton pregnancy, the ACOG recommends adding approximately 340 extra calories per day in the second trimester and 450 extra calories per day in the third trimester. Does fasting during Ramadan have negative perinatal outcomes due to the potential caloric restriction? In this episode, we will highlight a Clinical Opinion publication from AJOG (June 2023) to examine the data.

Infants born by vaginal birth are exposed to maternal vaginal bacteria, which are one of the contributing influences on the subsequent development of the infant's microbiome. This process is altered by cesarean delivery, which changes the initial microbiome of the neonate. It is theorized that infants born by cesarean delivery have an increased risk of chronic inflammatory conditions due to altered early-life microbiome colonization, with associated aberrant immune and metabolic development. Vaginal seeding is the practice of inoculating an infant born by cesarean section with a sampling of fluid, with the use of a guaze, from the vagina of the mother over the child's face, mouth, and nares. This is performed to introduce the neonate to the mother's vaginal flora for presumed better health outcomes. Although cautionary statements have been published about this practice, it remains very popular. In Feb 2025, a “viewpoint” was published in JAMA Pediatrics which has brough vaginal seeding back into the limelight. Does this work? What are the official statements about this from the ACOG and AAP? Is there a way to do this “safely”? We will cover this new publication, review the official professional society's statements….and more, in this episode.

On Feb 24, 2025, the FDA granted approval for MIUDELLA®, a hormone-free, low-dose copper IUD developed by US manufacturer Sebela Women's Health Inc (Georgia) for contraceptive use in females of reproductive potential for up to 3 years. MIUDELLA® utilizes a small, flexible nitinol frame and contains less than half the copper of currently available copper IUD. Where have we seen nitinol before?? How does this compare with the traditional ParaGard IUD? Can this be used for emergency contraception? In this episode, we will review this novel design, low-dose copper IUD with a summary of its new published article released March 2025 (Contraception).

BV is a vaginal dysbiosis resulting from replacement of normal hydrogen peroxide and lactic-acid producing Lactobacillus species in the vagina with high concentrations of anaerobic bacteria. Recurrent BV can occur in 50-70% of women after an initial diagnosis. The concept of treating the male partner for BV recurrence prevention is not new, and the results have been conflicting. However, a new publication from Australia (released 03/5/25, in NEJM) has sparked new interest and new conversations about male partner BV therapy. Listen in for details!

Thank you to our GREAT podcast family members who fixed by history regarding "Hollyweird" ! And thank you DANNY Thomas for your legacy at SJCRH. Go Memphis!

Screening for spinal muscular atrophy (SMA) should be offered to all women who are considering pregnancy or are currently pregnant. SMA is an autosomal recessive disease characterized by degeneration of spinal cord motor neurons that leads to atrophy of skeletal muscle and overall weakness. Once identified, oral therapy may be started in the neonatal interval for those with the most severe phenotype (SMA-1). However, on Feb 19, 2025, a medical team piloted an investigational PRENATAL protocol as treatment starting in utero! While more data is needed, the results have been incredible. In this episode we will highlight this fascinating therapy which was "parent proposed". Listen in for details!