Dr. Chapa’s Clinical Pearls.

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.166022. 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-e383. 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.

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.

Antenatal corticosteroids are a MAJOR win in the management of preterm labor. An initial course of antenatal corticosteroids has been shown to reduce morbidity and mortality in patients with preterm prelabor rupture of membranes. For patients who remain undelivered after the initial course of antenatal corticosteroids, it is uncertain whether a booster course of antenatal corticosteroids reduces neonatal morbidity or increases the infection risk. The ACOG, in its current guidance, has concluded that the current evidence is insufficient to make a recommendation. Corticosteroids, especially at the doses given, are also powerful immunosuppressants. When you administer that first course, you accept a minor, calculated risk for a massive, proven benefit. But when you introduce a second course of steroids into a uterine environment that has already been ruptured and exposed to vaginal flora for weeks, you are pouring fuel on the fire. PLUS, the environment for the fetus with prolonged preterm prelabor rupture of membranes is unique. PPPROM, the chronic exposure to ruptured membranes and the resultant oligohydramnios is theorized to trigger a kind of stress response in the fetus- so the baby may make their own endogenous corticosteroid flare. So, rescue steroids after an initial course of steroids in PPROM cases has remained controversial but we have updated data that has provided new insights. In this episode, we will highlight an RCT from 2023 and a more recent systematic review and meta-analysis from May 2026 on this very subject. Listen in for details. 1. Garite TJ, Kurtzman J, Maurel K, Clark R; Obstetrix Collaborative Research Network. Impact of a 'rescue course' of antenatal corticosteroids: a multicenter randomized placebo-controlled trial. Am J Obstet Gynecol. 2009 Mar;200(3):248.e1-9. doi: 10.1016/j.ajog.2009.01.021. Erratum in: Am J Obstet Gynecol. 2009 Oct;201(4):428. PMID: 19254583.2. Tenbrink E, Quain A, Rone V, Harris K, Hadley E, Haas D, Shanks A. Risk of Neonatal Sepsis With Rescue Steroids in Preterm Premature Rupture of Membranes. Cureus. 2023 Apr 6;15(4):e37207. doi: 10.7759/cureus.37207. PMID: 37159785; PMCID: PMC10163895.3. Melamed N, Murphy KE, Pylypjuk C, et al. Timingof Antenatal Corticosteroid Administration and Neonatal Outcomes. JAMA Netw Open. 2025;8(5):e2511315. 4. Porreco R, Garite TJ, Combs CA, Maurel K, Huls CK, Baker S, Fortner KB, Longo SA, Nageotte M, Lewis D, Tran L; Obstetrix Collaborative Research Network. Booster course of antenatal corticosteroids after preterm prelabor rupture of membranes: a double-blind randomized trial. Am J Obstet Gynecol MFM. 2023 May;5(5):100896. doi: 10.1016/j.ajogmf.2023.100896. Epub 2023 Feb 14. PMID: 36796641.5. Da Costa Y, Ramanathan V, Oliveira JA, Brito J, Yousif A. Repeat versus Single Course of Antenatal Corticosteroid in Management of Preterm Premature Rupture of Membranes: A Systematic Review and Meta-analysis. Am J Perinatol. 2026 May;43(7):925-932. doi: 10.1055/a-2708-5314. Epub 2025 Oct 9. PMID: 41067234

The Bakri Postpartum Balloon was described and first used clinically in 1999 by Dr. Younes N. Bakri (Georgia, USA). It is intended to treat postpartum hemorrhage (PPH). In the United States, it received its first major FDA clearance (via 510(k) for commercial marketing) on April 17, 2002. Manufacturer guidelines for the Bakri (Cook Medical) state that the balloon may be left indwelling for a maximum of 24 hours, but the determination of removal time is left to the clinician once “bleeding is controlled and the patient is stable.” However, the optimal duration of intrauterine balloon tamponade placement remains unclear. One retrospective cohort study from AJOG (Einerson et al) of 274 women found no significant difference in PPH outcomes when intrauterine balloon tamponade was left in place for 2–12 hours, compared with more than 12 hours. However, only 30 women had the intrauterine balloon tamponade placement for 10 hours or less. And remember, this was not a prospective trial looking at a minimum of 2 hours, 2 hours was just the lower margin of the “short duration” group. Now, a new RCT (with authors from Denver and Vermont) published in the July 2026 Green Journal provides new data. In this first of its kind pragmatic, randomized trial of noninferiority, a 6-hour duration of intrauterine balloon tamponade usage for postpartum hemorrhage (PPH) control was compared with an 18-hour duration. Listen in for details. 1. Durfee, J., Adkins, K., Heyborne, K., Larrea, N., & Schultz, C. (2026). Intrauterine Balloon Tamponade Duration for Postpartum Hemorrhage: A Randomized Controlled Trial. Obstetrics & Gynecology, 148(1), 113–120. https://doi.org/10.1097/AOG.00000000000062952. Garabedian C, Prats C, Seco A, Deneux-Tharaux C, Rozenberg P, Berveiller P. Duration of Intrauterine Balloon Tamponade in Post-Partum Haemorrhage Management After Vaginal Delivery: A Secondary Cohort Analysis From the French TUB Trial. BJOG. 2026 Jan;133(1):123-131. doi: 10.1111/1471-0528.18345. Epub 2025 Sep 1. PMID: 40888007; PMCID: PMC12676195.3. Einerson BD, Son M, Schneider P, Fields I, Miller ES. The association between intrauterine balloon tamponade duration and postpartum hemorrhage outcomes. Am J Obstet Gynecol 2017;216:300.e1–5.

Gonadal hormones have a complicated influence on appetite. Estradiol generally suppresses appetite, whereas progesterone opposes estradiol's action such that their combined presence represents a high-risk hormonal milieu for Binge Eating (BE). Testosterone is thought to be associated with increased BE in females but appears protective in males. In some reports, combination oral contraceptive (COC) use has been linked to greater BE-related appetitive processes (e.g., food intake). Now, we have 2 recent, back-to-back publications (June 2026 in JAMA Network Open, and July 2026 in Appetite) that have examined the relationship of hormonal contraception on binge eating behavior. These found seemingly opposing conclusions. Listen in for details. 1. Klump KL, Di Dio AM, Anaya C, et al. Combined Oral Contraceptive Use and Binge Eating. JAMA Netw Open. 2026;9(6):e2619047. doi:10.1001/jamanetworkopen.2026.190472. Katz JM, Yan R, Beltz AM, Gearhardt AN. Associations between reproductive hormonal milieus and binge eating: The roles of sex and hormonal contraceptive use. Appetite. 2026 Jul 1;222:108547. doi: 10.1016/j.appet.2026.108547. Epub 2026 Mar 20. PMID: 41866083.3. Bass L, Prostináková T, Silang KG, Griffiths-Gray A, McQuilliam S, Mahon E, Whitehead A, Johnson KO. Does it hold weight? The perceived effects of contraceptive use on weight status in females: A mixed-methods study. PLoS One. 2025 Dec 29;20(12):e0339323. doi: 10.1371/journal.pone.0339323. PMID: 41460817; PMCID: PMC12747328.

The DIY at-home gynecology health market has EXPLODED. There is at-home vaginal/cervical HPV testing, screening for STIs, and even a blood test for multi-cancer screening (Cancer Guard). These provide a potential solution for access to care and social determinants of health. Now, a new study is seeking to add DIY at-home transvaginal ultrasounds to that mix. Yep…at home. This was published in Jama Network on July 6, 2026. Premenopausal women aged 22 to 50 years participated from 12 different locations in the US, including my home state of Texas. In this episode, we will highlight this new prospective, interventional, single group nonrandomized clinical trial. Listen in for details. 1. At-Home Transvaginal Pelvic Ultrasonography and Image Quality in Premenopausal Women A Nonrandomized Clinical Trial; Published Online: July 6, 20262026;9;(7):e2621476. doi:10.1001/jamanetworkopen.2026.21476

As healthcare professionals, we should all seek and encourage scientific and medical discovery and new therapies. That's one big goal of the scientific process: to bring new therapies to otherwise lethal condition. For example, back in the 80s and 90s, HIV uniformly led to AIDS, which was a death sentence. But now, HIV is 100% manageable with appropriate medical care and medical therapy. That's a win! On the Prenatal side, lack of amniotic fluid (anhydramnios) under 22 weeks has uniformly been regarded as a fatal/lethal condition. This is because of the direct association with previable lack of amniotic fluid and lung hypoplasia. But now, serial amniocentesis for this condition is making headlines. While the headlines are catchy and serve as appropriate “click bait”, there's more to this story. This may be a perfect example of “Robbing Peter, to Pay Paul”. Listen in for details.1. Neonatal Survival After Serial Amnioinfusions for Anhydramnios Due to Fetal Kidney Failure: The RAFT Clinical Trial. JAMA Netwoek, July 1, 20262. Medpage July 7, 2026: Amnioinfusions Mitigate Lethal Lung Hypoplasia From Fetal Kidney Failure

Placenta previa has an incidence of about 0.4% to 0.5% (or 1 in 200 to 1 in 250 deliveries). Anterior placenta previa poses a unique obstacle in fetal extraction at CS: Is it best to transect (enter) the placenta or to cause a marginal abruption at the placental edge for fetal extraction? In this episode we will review an upcoming “Surgeon's Corner” in the AJOG (July 2026) which provides some tips and tricks for this very issue.1. Verspyck E, Douysset X, Roman H, Marret S, Marpeau L. Transecting versus avoiding incision of the anterior placenta previa during cesarean delivery. Int J Gynaecol Obstet. 2015 Jan;128(1):44-7. doi: 10.1016/j.ijgo.2014.07.020. Epub 2014 Aug 27. PMID: 25218131.2. Nieto-Calvache AJ, Palacios-Jaraquemada JM, Basanta N, Suarez-Revelo MA, Benavides-Calvache JP, Meade P, Lopez-Franco MJ, Burgos-Luna JM. How to avoid placental transection during low transverse cesarean delivery for anterior placenta previa. Am J Obstet Gynecol. 2026 Jul;235(1):225-228. doi: 10.1016/j.ajog.2026.02.032. Epub 2026 Feb 25. PMID: 41759607.

In 2018, the ARIVE trial was published in the NEJM revealingthat induction of labor at 39 weeks reduced cesarean deliveries and gestational hypertension/preeclampsia in low-risk nulliparous women who had labor induced,compared to expectant management. Then, in 2025, and partly in response to L&D units across the country becoming saturated with low- risk, nulliparous patients awaiting their induction of labors at 39 weeks and 0 days, the ACOGreleased its clinical practice update in Jan 2025 stating, “The optimal timing of delivery for full-term pregnancies (39 0/7 to 40 6/7 weeks of gestation has not been determined”. Now there is new data, released as an article in press(June 26, 2026), out of the AJOG that raises some interesting questions about potential benefits of induction of labor LATER in the “full term” interval (40- 40 and 6 days) compared to earlier full term (39 weeks to 39 weeks 6 days). Thesefindings are “hypothesis- generating”.  Listen in for details. Strong Coffee Company - Protein Coffee PLUS MORE; Get 20%OFF | Promo Code: CHAPANOSPINOBG https://promocode.to/strong-coffee-company/chapanospinobg-hbv​     Grobman WA, Rice MM, Reddy UM, Tita ATN, et al;Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentMaternal–Fetal Medicine Units Network. Labor Induction versus ExpectantManagement in Low-Risk Nulliparous Women. N Engl J Med. 2018 Aug9;379(6):513-523. ​     Damri NT, Sheiner E, Wainstock T, GestationalAge at Full-Term Delivery and Long-Term Offspring Morbidity in Low-RiskPregnancies: A Population-Based Cohort Study, American Journal of Obstetricsand Gynecology (2026), ​     Management of Full-Term Nulliparous IndividualsWithout a Medical Indication for Delivery: ACOG Clinical Practice Update.Obstet Gynecol. 2025 Jan 1;145(1):e45-e50. doi: 10.1097/AOG.0000000000005783.Epub 2024 Nov 7. PMID: 39513607.

If you practice obstetrics, you already know that our entire world is ruled by a stopwatch. Think about it: we are obsessed with time. We wait exactly 60 or 120 minutes for a gestational diabetes challenge. We stare at a monitor for a strict 30 minutes timing a biophysical profile. The entire pregnancy is dictated by an Estimated Date of Delivery that has us counting down the literal days. But what happens when we step into the OR? Once that scalpel hits the skin for a cesarean section, does the clock matter just as much? There are two separate intervals which have generated data: the skin incision to delivery interval, and the uterine incision to delivery interval. In today's episode, we are CUTTING INTO the data. First, we are summarizing a hot-off-the-press study from AJOG-MFM (Pink) that takes a hard look at the macro clock—the skin incision-to-delivery interval. Then, we are going to contrast those findings with the recent Bart 2026 study published in the AJOG (Grey) Journal, which tracked over 5,800 routine deliveries to see exactly what happens to a baby's pH and clinical outcome when that uterine extraction takes longer than 120 seconds. These two are somewhat at odds. Listen in for details. Strong Coffee Company - Protein Coffee PLUS MORE; Get 20% OFF | Promo Code: CHAPANOSPINOBG https://promocode.to/strong-coffee-company/chapanospinobg-hbv​ Zayat N, Bertozzi-Villa C, Cavallino A, et al. Skin incision-to-delivery interval and neonatal outcomes: A retrospective cohort study. Am J Obstet Gynecol MFM2026;00:101980.​ Bart Y, Sibai BM, Fishel Bartal M, Mazaki-Tovi S, Yoeli R. Uterine incision-to-delivery interval and neonatal outcomes among nonurgent, term, cesarean deliveries. Am J Obstet Gynecol. 2026 May;234(5):1459-1469. doi: 10.1016/j.ajog.2025.12.059. Epub 2025 Dec 30. PMID: 41478544.

Think about the last time you had to time something perfectly. Maybe it taking that perfect swing at the baseball, or catching a flight after a commute, or making a high-stakes decision. In the world of high-risk pregnancy, clinicians play a constant game of high-stakes timing with a usual medication called antenatal corticosteroids. Given to moms at risk of giving birth early, these steroids are a gamechanger for a preterm neonate. But there's a catch. If you give them too early, the benefits fade. If you give them too late and she delivers very quickly, they don't have time to work. A brand-new study published in the journal Obstetrics & Gynecology by Mark Clapp et al reveals just how incredibly difficult this balancing act is. This data shows that nearly 26% of pregnant individuals who received these steroids actually went on to deliver completely full-term, exposing babies to medications they might not have needed. So how do we as clinicians solve this OB Goldilocks problem where the stakes are a newborn baby's health? On today's episode, we break down the data behind 'maximizing benefit while avoiding overuse' and what it means for real world practice.Strong Coffee Company - Protein Coffee PLUS MORE; Get 20% OFF | Promo Code: CHAPANOSPINOBG https://promocode.to/strong-coffee-company/chapanospinobg-hbv1. Clapp, Mark A. MD, MPH; Li, Siguo MS; Melamed, Alexander MD, MPH; Reiff, Emily MD; Gyamfi-Bannerman, Cynthia MD, MS; Kaimal, Anjali J. MD, MAS. Maximizing Benefit From Antenatal Steroid Use While Avoiding Overuse. Obstetrics & Gynecology 148(1):p e33-e42, July 20262. FIGO good practice recommendations on the use of prenatal corticosteroids to improve outcomes and minimize harm in babies born preterm. Int J Gynaecol Obstet. 2021 Oct;155(1):26-303. Society for Maternal-Fetal Medicine Special Statement: Quality metrics for optimal timing of antenatal corticosteroid administration; 2022

More than 60% of maternal deaths occur during the postpartum period, and hypertensive disorders of pregnancy are a major, preventable driver of that statistic. For too long, the transition from labor and delivery to home has been a vulnerable blind spot—leading to high rates of avoidablereadmissions. But the landscape has shifting. In this episode, we are diving deep into why OB providers must optimize blood pressure control before and after postpartum discharge. We'll be breaking down the landmark 2025 MOPP study, which shook up our traditional targets by examining tight versus standard blood pressure control, alongside the recently released May 2026 ACC Expert ConsensusDecision Pathway.What is the actual "goal BP" for a safe postpartum discharge? When should we initiate outpatient tight control, and how do we prevent these patients from bouncing back to the ED? Grab your coffee and pull up a chair. Let's look at the evidence.20% DISCOUNT: https://strongcoffeecompany.com/discount/CHAPANOSPINOBG1.          Gibson K, Hameed A. Society for Maternal-Fetal Medicine Special Statement: Checklist forpostpartum discharge of women with hypertensive disorders. AJOG, 2020. 2.          Farahi N, Oluyadi F, Dotson AB. Hypertensive Disorders of Pregnancy. American Family Physician. 2024. 4.          Lindley KJ, Bello NA, Berlacher KL, et al. Optimization of Postpartum Care for Patients With and at Risk for Premature and Long-Term Cardiovascular Disease: 2026 ACC Expert Consensus. Journal of the American College of Cardiology. May 2026. 5.          ACOG Task Force on Hypertension in Pregnancy, 20136.          Rosenfeld EB, Sagaram D, Lee R, et al. Management of Postpartum Preeclampsia and Hypertensive Disorders (MOPP): Postpartum Tight vs Standard Blood PressureControl. JACC. Advances. 2025.

Welcome back to the show, everybody! Today, we are diving deep into the intersection of maternal-fetal medicine and cardiology. We're tackling a condition that keeps every OB/GYN, MFM, and cardiologist up at night: Peripartum Cardiomyopathy, or PPCM. And to keep our clinical gears turning, we are framing this discussion squarely through the lens of Society for Maternal-Fetal Medicine (SMFM) Consult Series #73, which focuses on right and left heart failure in pregnancy, alongside the foundational data from ACOG Practice Bulletin #212. PPCM presents fundamentally as acute left heart failure with reduced ejection fraction. Think of the left ventricle as the primary engine pump of the systemic circulation. When it stalls, everything upstream gets backed up. While this was traditionally called IDIOPATHIC, newer data says otherwise. We are going to cover presentation, eval, care and prognosis. So, get your palpitations in check- here we go. 16% OFF TONA ACTIVE WEAR PROMO: https://tonaactive.com/discount/CHAPANOSPINOBG1. SMFM CS 73; 20252. ACOG PB 212; 20193. Arany Z. Peripartum Cardiomyopathy. The NEJM. 2024. 4. Sliwa K, Hilfiker-Kleiner D, Damasceno A, Al Farhan H, Goland S, Johnson MR, Bauersachs J. Peripartum cardiomyopathy. Lancet. 2025 Nov 22;406(10518):2483-2493. doi: 10.1016/S0140-6736(25)01451-5. Epub 2025 Oct 28. PMID: 41173010.

Podcast Family, in this episode we will focus on the “20-minute rule” for vacuum assisted vaginal delivery. This is an important aspect of neonatal safety and is a vital part of procedure documentation. Documentation for vacuum assisted vaginal delivery should include station at application, number of tractions, number of pop-offs and the total traction time and the vacuum trackable time (time from first application to delivery). This has historical roots as well as new data to validate it (March 2026). Listen in for details. 1. ACOG PB 219; 20202. Preuss E, Porto A, Sheiman V, Bitton M, Tovbin J, Kedem HI, Barzilay E. When to stop? A single center experience on vacuum-assisted deliveries. Eur J Obstet Gynecol Reprod Biol. 2026 Mar 25;320:114983. 3. Teng FY, Sayre JW. Vacuum Extraction: Does Duration Predict Scalp Injury?.Obstetrics and Gynecology. 1997. 4. Tsakiridis I, Giouleka S, Mamopoulos A, et al.Operative Vaginal Delivery: A Review of Four National Guidelines. Journal of Perinatal Medicine. 2020. 16% OFF TONA ACTIVE WEAR PROMO: https://tonaactive.com/discount/CHAPANOSPINOBG

The March 2026 ACC/AHA Guideline on the Management of Dyslipidemia made a major pivot regarding Lipoprotein(a) by establishing a formal recommendation for universal screening in adults. This 2026 guideline, published in the Journal of the American College of Cardiology, issued a Class 1 recommendation stating that every adult should have their Lp(a) measured at least once in their lifetime. Because Lp(a) levels are genetically determined and remain highly stable throughout a person's life, a single lifetime check is sufficient for the vast majority of the population to establish their baseline risk. Well, that's great for Family medicine or internal medicine, but how does that affect us in women's health? Well, it's complicated: lipoprotein(a) has been associated with an increased risk of VTE and has also been associated, in some studies, with FGR, preeclampsia, and preterm birth! So, can these patients receive oral contraceptives? What about Perioperative and postop care? Do these patients require anticoagulation? What about pregnancy- is LDA recommended here? And lastly, what about TXA use in patients with HMB? This podcast topic comes from one of our podcast family members who is an OBGYN military personnel caring for our wonderful troops overseas. Listen in for details!16% OFF TONA ACTIVE WEAR PROMO: https://tonaactive.com/discount/CHAPANOSPINOBG1. Ezzat, D., Lopez, D. M., Claggett, B. L., Li, L., Mohammadnia, N., Schuermans, A., Hemeryck, J., Chang, A., Murillo, S., O'Donoghue, M. L., Bikdeli, B., Yu, Z., Natarajan, P., Patel, A. P., Pabon, M. A., & Honigberg, M. C. (2026). Lipoprotein(a) and incident venous thromboembolism in pre- and postmenopausal women, and in men. European Heart Journal, ehag252. https://doi.org/10.1093/eurheartj/ehag2522.ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Dyslipidemia Writing Committee. (2026). 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia. Circulation, 153, e1155–e1300. https://doi.org/10.1161/CIR.00000000000014233. CDC MEC 4. Prevention of Venous Thromboembolism in Gynecologic Surgery: ACOG Practice Bulletin, Number 232. Obstetrics and Gynecology. 2021. Committee on Practice Bulletins—Gynecology5. Sofi F, Marcucci R, Abbate R, Gensini GF, Prisco D.Lipoprotein(a) as a Risk Factor for Venous Thromboembolism: A Systematic Review and Meta-Analysis of the Literature.Seminars in Thrombosis and Hemostasis. 2017. Dentali F, Gessi V, Marcucci R, et al. Lipoprotein (A) and Venous Thromboembolism in Adults: The American Journal of Medicine. 2007.

Hey everyone, thanks for tuning in. If you've spent any time in the OR during a cesarean delivery, you know that the choice between uterine exteriorization and in situ repair usually comes down to how you were trained or personal surgeon preference. It's a debate as old as modern obstetrics. But a major piece of clarity is coming down the pipeline. This episode, we are getting a sneak peek at a brand-new systematic review and meta-analysis dropping this July 2026 in the European Journal of OBGYN. We're asking the big question: is this the study that finally settles the debate once and for all? Grab your coffee, stick around, and let's find out.16% OFF TONA ACTIVE WEAR PROMO: https://tonaactive.com/discount/CHAPANOSPINOBG​ Coutinho, I. C., Ramos de Amorim, M. M., Katz, L., & Bandeira de Ferraz, Á. A. (2008). Uterine exteriorization compared with in situ repair at cesarean delivery: A randomized controlled trial. Obstetrics & Gynecology, 111(3), 639–647. https://doi.org/10.1097/aog.0b013e31816521e2 . (One of the most heavily cited clinical trials on the subject. It established that women in the exteriorized group experienced a 41% greater risk of moderate-to-severe pain at 6 hours postoperatively compared to the non-exteriorized cohort).​ Tan, H. S., Taylor, R. C., Sharawi, N., Sultana, R., Barton, K. D., & Habib, A. S. (2021). Uterine exteriorization versus in situ repair in Cesarean delivery: A systematic review and meta-analysis. Canadian Journal of Anaesthesia, 69(2), 216–233. https://doi.org/10.1007/s12630-021-02142-8​ Fonseca Queiroz L, Lemos M, Pereira da Silva D . Uterine exteriorization versus in-situ uterine repair during cesarean delivery: a systematic review and meta-analysis of randomized controlled trial. European Journal of Obstetrics and Gynecology and Reproductive Biology, 2026; 323

In the ACOG PB 231, Multifetal Gestations Twin Triplet and Higher-Order Multifetal Pregnancies, it states, “based on the improved outcomes reported in singleton gestations, the National Institutes of Health recommends that, unless a contraindication exists, a course of antenatal corticosteroids should be administered to all patients who are at risk of delivery within 7 days and who are between 24 weeks and 34 weeks of gestation, irrespective of the fetal number”. But a BRAND NEW meta-analysis is saying the exact opposite- with a catch. Listen in for details.1. ACOG PB 2312. Felippe, Carolina Alves MS; Ruiz, Sinrraim dos Santos Chaves MD; de Souza, Rebeca Ferreira MS; de Lima, Aliny Silva MS; dos Santos, Priscila Luiza MS; Fonseca, Pandora Eloa Oliveira MS; de Almeida Silva, Ingryd MS; Montes-de-Oca-Saucedo, Carlos Roberto MD; Santana, Ana Cecília Oliveira MS; Veta Darkovski, Jasmina MD; Matlaw, Hadas Rachel MD; Fonseca Queiroz, Laura MD. Antenatal Corticosteroid Use in Twin Pregnancies: A Systematic Review and Meta-analysis. Obstetrics & Gynecology ():10.1097/AOG.0000000000006344, June 4, 2026. | DOI: 10.1097/AOG.000000000000634416% OFF TONA ACTIVE WEAR PROMO: https://tonaactive.com/discount/CHAPANOSPINOBG

Historically we were taught as surgeons that 1-centimeter bites that between suture throws on a Pfannenstiel (low transverse) fascial closure was enough to prevent hernia formation and optimize facial healing. But is this still evidence based? We can extrapolate data from a May 2026 systematicreview/meta-anlysis as well as a separate study from the Dutch published in 2021. Both of these studies were in the journal Hernia. The evidence does favor one technique over the other! Listen in for details.1.     Golling M, Baumann P, Kuger F, Fortelny RH.Impact of the SUture BIte TEchnique on clinical outcomes after midlinelaparotomy closure: SUBITE-a systematic review and meta-analysis. Hernia. 2026May 19;30(1):221. doi: 10.1007/s10029-026-03700-z. PMID: 42154339; PMCID:PMC13186860.2.     Paulsen CB, Zetner D, Rosenberg J. Variation inabdominal wall closure techniques in lower transverse incisions: a nationwidesurvey across specialties. Hernia. 2021 Apr;25(2):345-352. doi:10.1007/s10029-020-02280-w. Epub 2020 Aug 8. PMID: 32770366.

Today, we are talking about a true paradigm shift in prenatal genetics. For decades, we've relied on cell-free DNA for screening, but when it came to definitive confirmation of fetal aneuploidy, we've had to counsel our patients through the anxiety and physical risks of invasive procedures like amniocentesis and CVS. But what if the line between screening and confirmation just blurred? In this episode, we are diving into an avant-garde, first-of-its-kind maternal blood test that is now actively in clinical use and may prove to rival traditional invasive testing for fetal aneuploidy confirmation: the Unity CONFIRM test. To break down the cutting-edge science, the clinical validity, and exactly what this means for your daily practice, I am thrilled to welcome Jen Hoskovec, the Vice President of Medical Affairs for BillionToOne. You might have recently seen her insights featured alongside Dr. Haywood Brown in Contemporary OB/GYN, and today, she's here with us. We're going to discuss the availability of this test, the technology that makes it possible, and what the next concrete steps are for integrating this into modern obstetrical care. Grab your coffee. Let's get into the science.1. https://www.contemporaryobgyn.net/view/haywood-brown-md-jennifer-hoskovec-explain-new-non-invasive-confirmatory-test2. Screening for Fetal Chromosomal Abnormalities PA; January 2026

Back in June 2024, we highlighted surprising data from JAMA Network Open regarding adolescent care in the ED. Because many adolescents use the ED as their primary care provider, it's a good opportunity for them to have contraception addressed regardless of why they presented. But that's not what was happening. That publication from two years ago showed significant gaps in addressing contraception in the ED to pregnancy vulnerable young women, mainly teens. We covered those results back then and said that that would be a wonderful QI project for any resident or medical students to work with their hospital ED to improve that. Well, now a similar publication, looking at a different target- STI empiric treatment among pregnant women in the ED, has been published with that same vibe. Yep, there are BIG discrepancies in what pregnant women are given- or in this case, NOT GIVEN, in the ED compared to their nonpregnant peers. This was published in mid-April 2026. Two big questions remain unanswered in this data. Listen in for details. 1. Gottlieb M, Moyer E, Slocum GW, et al. Sexually Transmitted Infection Treatment Rates Among Pregnant vs Nonpregnant Patients in Emergency Departments. JAMA Network Open. 2026. 2. Canter H, Reed J, Palmer C, et al. Contraception Use and Pregnancy Risk Among Adolescents in Pediatric Emergency Departments. JAMA Netw Open. 2024;7(6):e2418213. doi:10.1001/jamanetworkopen.2024.18213

It's a QUICKY: IMPROMPTU episode in clinic today..

Welcome back, everyone. Today we're diving into one of the most hotly debated topics in obstetrics- should we be treating preeclampsia without severe features with antihypertensive medications during expectant management? Now, if you've been following the literature- and our show, you know that the landmark CHAP trial changed the game for chronic hypertension in pregnancy. It showed us that targeting a blood pressure below 140 over 90 reduces serious maternal complications, without harming the baby. That was a big deal. But here's the thing, CHAP studied chronic hypertension. Then there was the CHIP trial- that also found that tight control of gestational hypertension and nonproteinuric chronic hypertension was also beneficial. These did not address preeclampsia without severe features, and yet, the ripple effects of that trial have sparked a global conversation about whether we should be extending those same treatment principles to women with preeclampsia who don't yet have severe features. And this is where it gets really interesting, because the guidelines don't agree. In the United States, ACOG and the Society for Maternal-Fetal Medicine still say: hold off on antihypertensives unless blood pressures hit the severe range at 160/110. But step outside the US, and you'll find the World Health Organization, the International Society for the Study of Hypertension in Pregnancy, FIGO, NICE, and Hypertension Canada all recommending treatment at 140 over 90, regardless of whether the diagnosis is chronic hypertension, gestational hypertension, or preeclampsia. So who's right? And more importantly what does this mean for the patient sitting in front of you right now, at 34 weeks, with a blood pressure of 150 over 95, some proteinuria, but no severe features? Today, we're going to break this down. We'll review the controversy, walk through the divergent guidelines, and most importantly talk about the real, practical implications that favor treating these patients during expectant management. Because when you're watching someone with preeclampsia, waiting for the right time to deliver, there's a strong argument that controlling their blood pressure isn't just reasonable…may be protective. So grab your coffee, settle in, and let's get into it.1. Society for Maternal-Fetal Medicine Statement: Antihypertensive Therapy For mild chronic Hypertension in Pregnancy-The Chronic Hypertension And Pregnancy Trial. American Journal of Obstetrics and Gynecology. 2022. Society for Maternal-Fetal Medicine; Publications Committee. 2. Preeclampsia. The New England Journal of Medicine. 2022. Magee LA, Nicolaides KH, von Dadelszen P.3. Antihypertensive Drug Therapy for Mild to Moderate Hypertension During Pregnancy.The Cochrane Database of Systematic Reviews. 2018. Abalos E, Duley L, Steyn DW, C.4. Prevention and Treatment of Maternal Stroke in Pregnancy and Postpartum: A Scientific Statement From the American Heart Association. Stroke. 2026. Miller EC, Bello NA, Chen PR, et al.5.Hypertension in Pregnancy: Diagnosis, Blood Pressure Goals, and Pharmacotherapy: A Scientific Statement From the American Heart Association. Hypertension. 2022. Garovic VD, Dechend R, Easterling T, et al.

The American College of Obstetricians and Gynecologists (ACOG) does not recommend routine ultrasound measurement of the lower uterine segment (LUS) thickness as part of the evaluation for trial of labor after cesarean delivery (TOLAC). ACOG Practice Bulletin No. 205 (2019) on Vaginal Birth After Cesarean Delivery does not include LUS measurement among its recommendations for TOLAC candidacy assessment. The guideline focuses on clinical factors such as type of prior uterine incision, number of prior cesarean deliveries, and other obstetric history to determine TOLAC candidacy, and emphasizes that most women with one previous low-transverse cesarean delivery should be counseled about and offered TOLAC. But what if you find a likely uterine window at the LUS? Does that mandate a repeat C-section? This topic comes from Serena, one of our podcast family members. Listen in for details. 1. Dr. Chapa's Clinical Pearls, Dec 31., 2023: LUST FOR TOLAC; and follow up episode Jan 15, 20242. ACOG Practice Bulletin No. 205: Vaginal Birth After Cesarean Delivery. Committee on Practice Bulletins—Obstetrics Obstetrics and Gynecology. 2019;133(2):e110-e127. doi:10.1097/AOG.0000000000003078.3. Rozenberg P, Sénat MV, Deruelle P, et al. Evaluation of the Usefulness of Ultrasound Measurement of the Lower Uterine Segment Before Delivery of Women With a Prior Cesarean Delivery: A Randomized Trial. American Journal of Obstetrics and Gynecology. 2022. 4. Swift BE, Shah PS, Farine D. Sonographic Lower Uterine Segment Thickness After Prior Cesarean Section to Predict Uterine Rupture: A Systematic Review and Meta-Analysis. Acta Obstetricia Et Gynecologica Scandinavica. 2019. 5. McLeish SF, Murchison AB, Smith DM, et al. Predicting Uterine Rupture Risk Using Lower Uterine Segment Measurement During Pregnancy With Cesarean History: How Reliable Is It? A Review. Obstetrical & Gynecological Survey. 2023. 6. Jastrow N, Demers S, Chaillet N, et al. Lower Uterine Segment Thickness to Prevent Uterine Rupture and Adverse Perinatal Outcomes: A Multicenter Prospective study.7. American Journal of Obstetrics and Gynecology. 2016. 8. Guerby P, Bujold E, Chaillet N. Impact of Third-Trimester Measurement of Low Uterine Segment Thickness and Estimated Fetal Weight on Perinatal Morbidity in Women With Prior Cesarean Delivery. Journal of Obstetrics and Gynaecology Canada. JOGC. 2022.

Should patients check their own urine protein at home when they have a gestational hypertension? After all, home-based BP monitoring is an established part of HDP care. Is there data on home urine protein dipstick tests in gestational hypertension? What do professional guidelines say? And what are the pros and cons of home self-monitoring of urine protein? Thank you, SJ, for the podcast topic suggestion. FListen in for details.1. ACOG PB 2222. Jayawardena L, Mcnamara E. Diagnosis and Management of Pregnancies Complicated by Haemolysis, Elevated Liver Enzymes and Low Platelets Syndrome in the Tertiary Setting.Internal Medicine Journal. 2020. 3. Tucker KL, et al. (2022). "Effect of self-monitoring of blood pressure on diagnosis of hypertension during higher-risk pregnancy: the BUMP 1 randomized clinical trial. JAMA4. Chappell LC, et al. (2022). "Effect of self-monitoring of blood pressure on blood pressure control in pregnant individuals with chronic or gestational hypertension: The BUMP 2 Randomized Clinical Trial. JAMA5. UDIP (Urinary Dipstick In Pregnancy) trial. 2022 May 12;129(13):2142–2148. doi: 10.1111/1471-0528.17180

The vast majority of the time, “community standard of care” reflects evidence-based recommendations. This means that both the predominance of clinical data and what is clinically practice align one with another period but at times, clinical standard practice doesn't always align with what the data shows. How is this possible? This is exactly the case for home blood pressure monitoring in pregnancy (HBPM). This episode idea comes from an OB PGY-3, soon PGY-4, who asked his attending this brilliant question: “If the BUMP1 and BUMP2 clinical trials did not show a benefit with HBPM, why are we still doing it?” That is a complicated question that has a solid answer! Unsatisfied with his response, he asked for our opinion. Listen in for details.1. Tucker KL, et al. (2022). "Effect of self-monitoring of blood pressure on diagnosis of hypertension during higher-risk pregnancy: the BUMP 1 randomized clinical trial. JAMA2. Chappell LC, et al. (2022). "Effect of self-monitoring of blood pressure on blood pressure control in pregnant individuals with chronic or gestational hypertension: The BUMP 2 Randomized Clinical Trial. JAMA3. SMFM Special Statement (2023): Society for Maternal-Fetal Medicine Special Statement: Telemedicine in obstetrics—quality and safety considerations; AJOG

Outside of pregnancy, guidelines emphasize diabetes self-management education and support to facilitate informed decision making, self-care behaviors, problem solving, and active collaboration with health care professionals. This includes, in those with good health literacy, the concept of patient-led self-titration of basal insulin results which has data that it improves glycemic management compared with clinician-led titration for type 2 diabetes among nonpregnant adults. But what about for GDM? Can patient's self manage their BASAL insulin? In this episode, we will review a new RCT published in April 2026 in the Green Journal on this very subject. As novel as this is, it is not the first to report on this as it was also published (retrospective study in the UK) in 2022. This is a novel approach to insulin in GDM but there are some questions that remain. Listen in for details.1. Boonpattharatthiti K, Wechkunanukul K, Mayang N, et al . Comparison of Insulin Titration Strategies for Glycemic Control in Type 2 Diabetes: A Systematic Review and Network Meta-Analysis.Diabetes Care. 2025. 2. Valent, Amy M. DO, MCR; Barbour, Linda A. MD, MSPH. Insulin Management for Gestational and Type 2 Diabetes in Pregnancy. Obstetrics & Gynecology 144(5):p 633-647, November 2024. | DOI: 10.1097/AOG.00000000000056403. Wang, Xiao-Yu MD; Gabbe, Steven MD; Landon, Mark B. MD; Venkatesh, Kartik K. MD, PhD et al. Patient-Led Insulin Titration for Glycemic Management With Gestational Diabetes Mellitus: A Randomized Controlled Trial. Obstetrics & Gynecology 147(4):p 501-509, April 2026. 4. McGovern AP, Hirwa KD, Wong AK, et al. Patient-led rapid titration of basal insulin in gestational diabetes is associated with improved glycaemic control and lower birthweight. Diabet Med. 2022;39:e14926. doi: 10.1111/dme.14926

Hyperemesis gravidarum (HG) represents the most severe end of the nausea and vomiting of pregnancy spectrum. It has a reported incidence of approximately 0.3–3% of pregnancies and is the most common cause of hospitalization in early pregnancy and the second most common cause of hospitalization in pregnancy overall. In June 2024, the ACOG published a Clinical Expert series summarizing the inpatient management of HG. In that guidance, it describes mirtazapine as an “alternative pharmacologic” option. How effective is this medication compared to ondansetron? A new study (published ahead of print on 12/30/25 and officially out June 2026), out of Denmark, sheds some new light on this medication. This trial is the first double-blind RCT comparing mirtazapine to ondansetron AND placebo. Although a BIG limitation of this study exists (which we will discuss), it does provide some interesting insights. Listen in for details.1. (ACOG CES) Clark, Shannon M. MD; Zhang, Xue MD; Goncharov, Daphne Arena MD. Inpatient Management of Hyperemesis Gravidarum. Obstetrics & Gynecology 143(6):p 745-758, June 2024. | DOI: 10.1097/AOG.00000000000055182. Ostenfeld, AnneDroogh, Marjoes et al.Mirtazapine or ondansetron for hyperemesis gravidarum. A randomized placebo-controlled trial. American Journal of Obstetrics & Gynecology, June 2026

Cervical exams can be tricky for the novice practitioner. Think about this: it's a blind exam, we measure that distance using only two fingers, through a layer of tissue, sometimes with a patient moving up on the bed as we examine. That is the reality of a cervical exam. Intrapartum, some nursing staff and clinicians use qualitative descriptors like "a tight 4" or "a generous 5" to convey nuance. In line with this, some report cervical examinations in “half- centimeters”. This sounds like this: “well, her last cervical exam was 5cm but now she is 5 and a half”. Is that a thing? What does the data say? Listen in for details. 1. Hamilton EF, Zhoroev T, Warrick PA, et al. New Labor Curves of Dilation and Station to Improve the Accuracy of Predicting Labor Progress. American Journal of Obstetrics and Gynecology. 2024. 2. Hanidu A, Kovalenko M, Usman S, et al. Intrapartum Ultrasound for Cervical Dilatation: Inter- And Intra-Observer Agreement. Acta Obstetricia Et Gynecologica Scandinavica. 2024. 3. Abedi, P. (n.d.). Accuracy of ultrasound methods versus other methods for detecting of cervical dilatation during labor, a protocol for systematic review. ECronicon.

Oh, What's in a Name? Irving F. Stein and Michael L. Leventhal first described the syndrome, originally known as Stein-Leventhal syndrome, in 1935, in the AJOG. They published a case series of seven women displaying a triad of symptoms, including hirsutism, amenorrhea (absent menstruation), and bilaterally enlarged polycystic ovaries. We now know that PCOS affects 1 in 8 women globally (170 million women of reproductive age worldwide), and that there are 4 main manifestations of the condition- reflecting its diverse phenotype. Now, as of 05/12/25, a collaboration across 56 leading academic, clinical, and patient organizations, as well as iterative global surveys that garnered responses from over 14,300 people with PCOS and multidisciplinary health professionals have endorsed a NEW term (Lancet) for this: polyendocrine metabolic ovarian syndrome. This is actually STAGE 7 of an 8 stage process Yep, 1-6 are already done). But hold on…this is not taking over tomorrow! There is a THREE-YEAR implementation strategy that has already gotten started and culminating in 2028. Listen in for details.1. Teede HJ, Khomami MB, Morman R, et al. Polyendocrine metabolic ovarian syndrome, the new name for polycystic ovary syndrome: a multistep global consensus process. The Lancet. Published online May 12, 2026. Accessed May 12, 2026. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00717-8/fulltext2. International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome; 20233. https://www.contemporaryobgyn.net/view/global-consensus-renames-pcos-to-polyendocrine-metabolic-ovarian-syndrome-pmos-?utm_campaign=42986360-COG%20-%20Breaking%20News&utm_medium=email&_hsenc=p2ANqtz--5Of8-OwjOeKLtknr8YdFbh9G8_c7iQqliHnMz2pYOpi2x4Pp8dRH6bSHjrQIqnth_fLPywQM2ByNp7via22VJ8yyLbg&_hsmi=418414457&utm_content=418414457&utm_source=hs_email4. Polyendocrine Metabolic Ovarian Syndrome: New name to improve diagnosis and care of condition affecting 170 million women worldwide. Monash University. News release. May 12, 2026. Accessed May 12, 2026. https://www.eurekalert.org/news-releases/1127647

As I have said many times before, some podcast ideas come from REAL clinic encounters. In this episode, Dr Hanna V, our dedicated PGY1 on our call team, and I will answer TWO real questions which arose just today on morning rounds, on our service: 1. Does NORMOTENSIVE HELLP still need Mag Sulfate? And 2. Does an indwelling foley s/p iatrogenic bladder injury at CS require prophylactic antibiotic coverage for urinary infection? Yep: It's a BOGO sale on today's podcast- Buy ONE GET ONE! Listen in for details.1. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222.Obstetrics and Gynecology. 2020. Committee on Practice Bulletins—ObstetricsGuideline2. Woudstra DM, Chandra S, Hofmeyr GJ, Dowswell T.SR. Corticosteroids for HELLP (Hemolysis, Elevated Liver Enzymes, Low Platelets) Syndrome in Pregnancy.The Cochrane Database of Systematic Reviews. 2010. 3. Joshi D, James A, Quaglia A, Westbrook RH, Heneghan MA.Liver Disease in Pregnancy. Lancet. 2010. Review4. Rimaitis K, Grauslyte L, Zavackiene A, et al.Observational. Diagnosis of HELLP Syndrome: A 10-Year Survey in a Perinatology Centre. International Journal of Environmental Research and Public Health. 20195. Reau N, Munoz SJ, Schiano T.Guideline Liver Disease During Pregnancy.The American Journal of Gastroenterology. 2022. 6. ACG Clinical Guideline: Liver Disease and Pregnancy.The American Journal of Gastroenterology. 2016. Tran TT, Ahn J, Reau NS.7. ACOG Practice Bulletin No. 195: Prevention of Infection After Gynecologic Procedures. Obstetrics and Gynecology. 2018. Committee on Practice Bulletins—Gynecology Guideline8. Niels Johnsen, Hunter Wessells, Krystal Archer-Arroyo, et al. Best Practices Guidelines Management of Gentiunrinary Injuries.American College of Surgeons (2025). 20259. Fletke KJ, Jeong DH, Herrera AV . Urinary Catheter Management. American Family Physician. 2024..

Hantavirus was first discovered in the early 1950s near the Hantaan River in South Korea. The US has seen this before: the 1993 Four Corners outbreak was the first recognition of the virus in the United States, causing a deadly respiratory syndrome. Now, Hantavirus is in the news again with 17 Americans currently (5.10.26) enroute back to the US for specialized observation. In this episode, we will briefly review what this virus does and cover the SPARSE data we have regarding hantavirus infection in pregnancy. 1. Gilson GJ, Maciulla JA, Nevils BG, et al. Hantavirus Pulmonary Syndrome Complicating Pregnancy. American Journal of Obstetrics and Gynecology. 1994. 2. 5.10.26: https://www.nbcnews.com/health/health-news/hantavirus-stricken-cruise-ship-arrives-tenerife-rcna3443183. Janwadkar RS, Ritchie HM, Johnson CA. Unexpected Challenges: A Case Report of Hantavirus Infection in a Pregnant Patient in a Rural Emergency Department. The Journal of Emergency Medicine. 2025.

Uterine hysterotomy unintended extensions happen. For sure. This has been analyzed over many years, and it is still making news. Look at this mini-timeline: Back in 2018, authors published “Unintended hysterotomy extension during caesarean delivery: risk factors and maternal morbidity”. Moving up the timeline to 2020, others published in J Maternal-Fetal Neonatal Medicine, “Risk factors for uterine incision extension during cesarean delivery”. Then in 2024, in the PINK journal, authors published a related study, “The association between unintended hysterotomy extensions with cesarean delivery and subsequent preterm birth”. In this episode, we will review a new narrative review (in the Green Journal, May 3, 2026) of unintended hysterotomy extension at C-section. We will summarize known risk factors and focus on subsequent uterine rupture risk. Does unintended hysterotomy extension at CS increase TOLAC uterine rupture? It's complicated. Listen in for details.1. Giugale LE, Sakamoto S, Yabes J, Dunn SL, Krans EE. Unintended hysterotomy extension during caesarean delivery: risk factors and maternal morbidity. J Obstet Gynaecol. 2018 Nov;38(8):1048-1053.2. Epub: Unintentional Extensions of the Cesarean Hysterotomy Incision. A Review and Proposed Classification System (May 3, 2026)

Genome-wide noninvasive prenatal testing (GW-NIPT) was introduced in 2015 and became widely available in 2019. Nonetheless, we are still learning more about this important prenatal screening test. In January 2026, the ACOG released a new PA on this, which we will also review in this episode. Our main publication ti review, however, will be the AJOG May 2026's systematic review and meta-analysis on the finding of “genome-wide” cfDNA discordant results and what this may mean for the pregnancy. Although rare, this may lead (over a third of cases) to some adverse perinatal issues. Listen in for details. 1. ACOG PA Jan 2026: Screening for Fetal Chromosomal Abnormalities2. AJOG May 2026: https://click.notification.elsevier.com/CL0/https:%2F%2Fwww.ajog.org%2Farticle%2FS0002-9378(25)00865-8%2Ffulltext%3Fdgcid=raven_jbs_etoc_email/1/0100019d9ec37d7b-c586438d-021a-4097-8db3-c158e6f97c9b-000000/Vq6ksekOuvTxcv8OEZZ2uBesCg_hG6qlhqU_BlCnAK4=452

There is no denying it, you know of one or MORE individuals or patients currently on a GLP1 agent. Although not FDA approved for PCOS as a stand-alone diagnosis, there is growing evidence supporting their offlabel use in PCOS, and international guidelines now include them as a conditional recommendation. In women, the weight loss associated with these medications may trigger the return of spontaneous ovulation, making mistimed pregnancy a possibility. A key study by Sanz and Blázquez (back in 2011) demonstrated that both GLP-1 and the GLP-1 receptor are present in mouse embryos as early as embryonic day 6 (E6) and continue through the first trimester, as well as in pluripotent mouse embryonic stem cells. In these undifferentiated cells, GLP-1 modified the expression of endodermal, ectodermal, and mesodermal gene markers, as well as critical developmental signaling molecules. So, there is a concern about embryogenesis if inadvertent exposure to these meds occurs in early pregnancy. In this episode, we will summarize 2 recent and separate systematic reviews (March 2026; April 2026) on fetal/OB outcomes after periconceptional exposure. This builds on the Parker data set from 2025. One of these reviews, from April 2026, is also a meta-analysis. Listen in for details.1. Ozbek L, Shah E, Al-Shiab R, Inal A, Guldan M, Afsar B, Covic A, Kanbay M. Safety of GLP-1 and Dual GLP-1/GIP Receptor Agonists in Preconception, Pregnancy, and Lactation: A Systematic Review of Maternal, Fetal, and Neonatal Outcomes. Diabetes Obes Metab. 2026 Mar 26. https://pubmed.ncbi.nlm.nih.gov/41885132/2. Hakim J, Rajesh D, Tello J. Neonatal and Obstetric Outcomes Following Periconceptional Exposure to Glucagon-Like Peptide-1 Receptor Agonists: A Systematic Review and Meta-analysis. AJOG; April 28, 2026; https://www.ajog.org/article/S0002-9378(26)00222-X/fulltext3. Parker CH, et al. Glucagon-Like Peptide 1 (GLP-1) Receptor Agonists' Use During Pregnancy: Safety Data From Regulatory Clinical Trials. Diabetes, Obesity & Metabolism. 2025.

The belief that IV dextrose is necessary to clear ketones in hyperemesis gravidarum originated from a logical, and now known to be outdated, extrapolation of basic starvation ketosis physiology and the treatment paradigm for diabetic ketoacidosis (DKA). The original experiments that led to this conclusion go back to the 1960s (Foster data). Not only is this outdated, but it is also physiologically incorrect. We've learned a lot about IV fluid replacement about hyperemesis gravidarum in the last several years- in the last data review was in January 2026 in Lancet. Even the correction of hyponatremia has evolved. Should we be following urine ketones for patients being treated for HG? Is Dextrose needed? Listen in for details.1. Nana M, Painter R, Williamson C et al. Hyperemesis gravidarum. The Lancet, Jan 2026; 407, 78-892. Clark SM, Zhang X, Goncharov DA. Inpatient Management of Hyperemesis Gravidarum. Obstet Gynecol. 2024 Jun 1;143(6):745-758. doi: 10.1097/AOG.0000000000005518. Epub 2024 Feb 1. PMID: 38301258.3. Ayus JC, et al.Correction rates and clinical outcomes in hospitalized adults with severe hyponatremia: a systematic review and meta-analysis. JAMA Intern Med. 2025;185(1):38-51. 4. ACOG Clinical Epert Series: Inpatient Management of Hyperemesis Gravidarium. Obstet Gynecol; 2024

AUDIO EXCERPT from our recent Instragm post on this Social Media trend. Silly or Science? Listen in for details.

Uterine compression sutures are effective, uterus-sparing techniques for managing severe postpartum hemorrhage (PPH) due to atony, avoiding hysterectomy. Keytypes include the B-Lynch suture (vertical, brace-like), Hayman suture (simplified vertical), and Pereira sutures (multiple, comprehensive sutures), and Cho Compression (quadrant square anterior to posterior closures), are applied when pharmacological methods fail. But these, while helpful with atony, do not address the LUS bleeding from previa which are below these applications. Even the O'Leary lateral sutures are often higher tha the bleeding and thin, anterior LUS affected by previa. Previa is a significant risk factor for PPH. In this episode, we will highlight 3 novel suture techniques which have been in print (TWO as recent as January 2026) which can be effective in stopping the LUS bleeding and avoiding hysterectomy. We will highlight the transverse circumferential purse string, the simple transverse Nausicaa suture, and theLUS WaveForm suture. These are easy to use and may be lifesaving. 1.   Shih J, Li J, Kang J .The Nausicaä suture in the management of the placenta accreta spectrum. AJOG. Jan 2026: 233, S671-S688 S2.   Transverse Purse String Suture for Placenta Previa in the Presence of Previous Cesarean Section, Experience in Northern Borders Saudi Arabia. 20223.    Zhou L et alWave compression suture: A modifieduterus-preserving treatment for placenta previa by reconstruction of the lower uterine segment. Medicine (Baltimore). 2026 Jan 30;105(5):e47468.

(From our Instagram Video Post): A very quick recap of the brand new ACOG Cervcial Caner Screening Update from April 24, 2026.

Just a VERY QUICK episode in rsponse to my sweet friend's question. Kerri is an MFM in another part of the country and she had KEEN insights on our recent episode on "Best Perioperative ose for Ketorolac at CS". Listen in for more good stuff!

The ACOG recommends a multimodal approach to postoperative pain that includes nonsteroidal NSAIDs, acetaminophen, and opioids. Ketorolac is a favored NSAID for postop pain control. However, the optimal dose of ketorolac after cesarean delivery has not been determined. In this episode, we will summarize a brand new randomized, controlled, single-blind trial of pregnant women undergoing cesarean delivery under regional anesthesia at a large academic medical center between June 2022 and October 2023. Enrolled participants were randomized to receive an initial loading dose of 60 mg (intervention) or 30 mg (control) of intravenous ketorolac in the operating room at the end of surgery.1. Pharmacologic Stepwise Multimodal Approach for Postpartum Pain Management: ACOG Clinical Consensus No. 1. Obstetrics and Gynecology. 2021.2. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstetrics and Gynecology. 2020.3. Eid, Joe MD; Caplan, Madeleine MD; Goel, Nidhi MD; Poirier, Marie-Veronique MD; Montaine-O'Brien, Skyler MS; Rood, Kara M. MD; Costantine, Maged M. MD. Two Perioperative Ketorolac Dosing Regimens After Cesarean Delivery and Opioid Use: A Randomized Controlled Trial. O&G Open 3(2):e159, April 2026. | DOI: 10.1097/og9.0000000000000159

Uterine hemorrhage remains a significant complication following abortion loss and in the postpartum period and contributes to substantial morbidity and mortality among pregnant patients. Although some FDA approved devices are on the market (Bakri balloon and Jada vacuum), they may be cost prohibited in some settings and/or some uterine cavities may be very small for either option, like after a mid-second trimester or early third trimester PPH. But every delivery unit has some form of suction tool and wall suction ability. This is where FOCUS*, STUT, and/or U-CaVIT come into play. And now there is new data on this from the AJOG (epub, April 2026). Listen in for details. (*Shout Out to Dr. Frank Jackson for his work on this as well).1. Singata-Madliki et al. Suction Tube Uterine Tamponade Versus Uterine Balloon Tamponade for Treatment of Refractory Postpartum Hemorrhage: A Randomized Clinical Feasibility Trial. International Journal of Gynaecology and Obstetrics: The Official Organ of FIGO. July 2025. (South Africa)2. Hofmeyr GJ, Singata-Madliki M. Novel Suction Tube Uterine Tamponade for Treating Intractable Postpartum Haemorrhage: Description of Technique and Report of Three Cases. BJOG : An International Journal of Obstetrics and Gynaecology. 20203. Jackson FI, Dilena NJ, Abelman SH, Blitz MJ, Gerber S. Hemorrhage management using a Foley catheter for uterine suction. Am J Obstet Gynecol. 2025 Nov;233(5):503-504. 4. ACOG Practice Bulletin No. 183: Postpartum Hemorrhage. Obstetrics and Gynecology. 2017. 5. Ranieri E, Kalimeris S, Ochsenbein N, Haslinger C, Vacuum-Induced Tamponade Using Urological Catheters for Postpartum Hemorrhage, American Journal of Obstetrics and Gynecology (2026), doi: https://doi.org/10.1016/j.ajog.2026.04.026

“GOOD VIBRATIONS”: Its not just a Marky Mark song, but it is also part of GYNECOLOGIC SEXUAL HEALTH! In this episode, we will highlight an April 2026 new qualitative study on women's vibrator use, as well as a separate publication (on a similar topic) also released in April 2026 in the journal Menopause.1. Leong KA, Carlton CE, Deverdis EC, Grimes CL, Jacobs BE, Rogers RG, Roberts BL. Intimacy and empowerment in urogynecology: a qualitative exploration of vibrator use. Am J Obstet Gynecol. 2026 Apr;234(4):1103-1111. doi: 10.1016/j.ajog.2025.11.037. Epub 2025 Dec 2. PMID: 41344528.2. Lehmiller JJ, Graham CA, Ferrall L, Mendelson EA, Prine MS. The role of masturbation in relieving symptoms associated with menopause. Menopause. 2026 Apr 1;33(4):384-394. doi: 10.1097/GME.0000000000002675. PMID: 41217890; PMCID: PMC13011940.

In the ACOG CO 734 from 2018, it states, “Transvaginal ultrasonography usually is sufficient for an initial evaluation of postmenopausal bleeding if the ultrasound images reveal a thin endometrial echo (less than or equal to 4 mm), given that an endometrial thickness of 4 mm or less has a greater than 99% negative predictive value for endometrial cancer”. But medicine moves fast. This is NO LONGER the guideline. In this episode, we will summarize the new ACOG CPU on the primary evaluation of a patient with postmenopausal vaginal bleeding. Is ultrasound still the single first line test used for evaluation? Listen in for details. 1. Updated Guidance Regarding The Role of Transvaginal Ultrasonography in Evaluating the Endometrium of Individuals With Postmenopausal Bleeding2. The Role of Transvaginal Ultrasonography in Evaluating the Endometrium of Women With Postmenopausal Bleeding

Yes we have covered antenatal corticosteroids in the late preterm interval on several episodes in the past- it's DEJA VU! However, there is new data in the American Journal of Perinatology (April 2026 ) that is helpful for us as clinicians as we do “shared decision making” with patients in offering betamethasone in the late preterm interval. Listen in for details.1. Zigron R, Rotem R, Erlichman I, Rottenstreich M, Rosenbloom JI, Porat S, Rottenstreich A. Factors associated with the development of neonatal hypoglycemia after antenatal corticosteroid administration: It's all about timing. Int J Gynaecol Obstet. 2022 Aug;158(2):385-389. doi: 10.1002/ijgo.13975. Epub 2021 Oct 30. PMID: 34625970.2. Asirwatham A, Loke R, Rose S, Ho J, Leung K, Leftwich HK. Neonatal Hypoglycemia after Antenatal Late Preterm Steroids. Am J Perinatol. 2026 Apr;43(5):616-620. doi: 10.1055/a-2663-5798. Epub 2025 Aug 4. PMID: 40759170.3. ALPS Trial. NEJM. Published April 7, 2016;374:1311-1320

Iron-deficiency anemia during pregnancy is associated withseveral adverse pregnancy outcomes, including severe maternal morbidity, preeclampsia, placenta previa, and placental abruption. It makes sense that diagnosing and treating anemia and its underlying causes in earlypregnancy may reduce the risk of adverse outcomes, but evidence has been scarce…until now. In this episode, we will review a new retrospective study based on nationwide data that examines this very issue (Green journal, April 2026).Listen for details. 1.  Booman A, Bateman BT, Siadat S, Berube C, Igbinosa I, Leggett C, Lyell DJ, Main EK, Leonard SA. Pregnancy Outcomes Associated With Anemia in the First Trimesterand Anemia Resolution by Late Pregnancy. Obstet Gynecol. 2026 Apr 1;147(4):518-527. doi: 10.1097/AOG.0000000000006183. Epub 2026 Feb 6. PMID:41643193; PMCID: PMC12880618.2.  ACOG OCC 5: Severe Maternal Morbidity: Screening and Review; 2016 and reaffirmed 20253.  ACOG PB 233

The diagnosis of fetal growth restriction can be made with an isolated abdominal circumference less than the 90th percentile. So is the opposite true? Does a fetal abdominal circumference (isolated) of greater than 90% qualify for “LGA” fetus? In this episode we're going to explain why, although it is logically correct, it is diagnostically incorrect. An isolated abdominal circumference on ultrasound of greater than 90% is however a strong predictive risk factor for one delivery finding. Listen in for details.1. Macrosomia: ACOG Practice Bulletin, Number 216. Obstetrics and Gynecology. 20202. Canavan TP, Hill LM.. Sonographic Biometry in the Early Third Trimester: A Comparison of Parameters to Predict Macrosomia at Birth. Journal of Clinical Ultrasound : JCU. 2015. 3. Culliney KA, Parry GK, Brown J, Crowther CA. Regimens of Fetal Surveillance of Suspected Large-for-Gestational-Age Fetuses for Improving Health Outcomes.The Cochrane Database of Systematic Reviews. 2016.

Livi by LiviWell is an FDA-cleared, single-use, soft polyurethane foam device designed to immediately absorb post-intercourse fluids (semen) to support vaginal health. Inserted like a tampon within 15 minutes post-coitus, it works in roughly 60 seconds to restore natural pH, helping to manage odor, dripping, and discomfort. Is this evidence-based? Listen in for details.1. https://www.biospace.com/press-releases/liviwell-secures-fda-clearance-for-livi-introducing-a-new-category-in-post-intercourse-vaginal-care#:~:text=Advertise-,LiviWell%20Secures%20FDA%20Clearance%20for%20Livi%2C%20Introducing%20a%20New%20Category,and%20other%20post%2Dintercourse%20fluids.2. Mngomezulu K, Mzobe GF, Mtshali A, et al. Recent Semen Exposure Impacts the Cytokine Response and Bacterial Vaginosis in Women. Frontiers in Immunology. 2021. 3. Abstract: ISSWSH/ISSM Joint Meeting 2025. Abstract citation ID: qdaf068.138 (155) SEMEN IS NOTTHEVAGINA'SFRIEND:ANOVEL POST-SEX TAMPON IMPROVES VAGINAL HEALTH PARAMETERS

Modern medicine has come a long way in its fight against diabetes. We now have continuous glucose monitors (CGM) and automated insulin delivery (AIDs) systems. These have revolutionized patient care. The FDA has approved devices for use in pregnancy as “nonadjunctive use” (meaning they may be used alone), although capillary finger stick assessments are currently still considered the Gold Standard. While the most robust data in support of CGMs is for preexisting Type 1 DM (Class B or beyond) and Type 2, there is recent growing support for CGM use in GDM patients, although some limitations still apply. Listen in for details.1. Feig DS, et al; CONCEPTT Collaborative Group. Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomised controlled trial. Lancet. 2017 Nov 25;390(10110):2347-2359. doi: 10.1016/S0140-6736(17)32400-5. Epub 2017 Sep 15. Erratum in: Lancet. 2017 Nov 25;390(10110):2346. 2. Benhalima K, Durnwald C, Sweeting A et al.Application of continuous glucose monitoring and automated insulin delivery technologies for pregnant women with type 1, type 2, or gestational diabetes: an international consensus statementThe Lancet Diabetes & Endocrinology, 2025; 14, 157-1773. Salmen BM, Reurean-Pintilei D, Salmen T, Bohîlțea RE. Exploring Continuous Glucose Monitoring in Gestational Diabetes: A Systematic Review. Life (Basel). 2025 Aug 28;15(9):1369. doi: 10.3390/life15091369. PMID: 41010309; PMCID: PMC12470761.4. Wyckoff JA, Lapolla A, Asias-Dinh BD, et al.Preexisting Diabetes and Pregnancy: An Endocrine Society and European Society of Endocrinology Joint Clinical Practice Guideline. The Journal of Clinical Endocrinology and Metabolism. 20255. American Diabetes Association Professional Practice Committee for Diabetes*; 15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes—2026. Diabetes Care 1 January 2026; 49 (Supplement_1): S321–S338. https://doi.org/10.2337/dc26-S0156. Burk J, Ross GP, Hernandez TL, Colagiuri S, Sweeting A. Evidence for improved glucose metrics and perinatal outcomes with continuous glucose monitoring compared to self-monitoring in diabetes during pregnancy. Am J Obstet Gynecol. 2025 Sep;233(3):162-175. doi: 10.1016/j.ajog.2025.04.010. Epub 2025 Apr 10. PMID: 40216177.7. Linder T, et al; GRACE study collaborative group. Glycaemic control and pregnancy outcomes with real-time continuous glucose monitoring in gestational diabetes (GRACE): an open-label, multicentre, multinational, randomised controlled trial. Lancet Diabetes Endocrinol. 2026 Jan;14(1):50-61. doi: 10.1016/S2213-8587(25)00288-8. Epub 2025 Nov 24. PMID: 41308662.8. Valent AM, et al. Real-Time Continuous Glucose Monitoring in Pregnancies With Gestational Diabetes Mellitus: A Randomized Controlled Trial. Diabetes Care. 2025 Sep 1;48(9):1581-1588. doi: 10.2337/dc25-0115. PMID: 40730104; PMCID: PMC12368369.9. Kusinski LC, et al. Continuous Glucose Monitoring Metrics and Pregnancy Outcomes in Women With Gestational Diabetes Mellitus: A Secondary Analysis of the DiGest Trial. Diabetes Care. 2025 Aug 19:dc250452. doi: 10.2337/dc25-0452. Epub ahead of print. PMID: 40828742; PMCID: PMC7618813.10. García-Moreno RM, et al. Efficacy of continuous glucose monitoring on maternal and neonatal outcomes in gestational diabetes mellitus: a systematic review and meta-analysis of randomized clinical trials. Diabet Med. 2022 Jan;39(1):e14703. doi: 10.1111/dme.14703. Epub 2021 Oct 13. PMID: 34564868.11. Amylidi-Mohr Set,.et al (DipGluMo): an open-label, single-centre, randomised, controlled trial. Lancet Diabetes Endocrinol. 2025 Jul;13(7):591-599. doi: 10.1016/S2213-8587(25)00063-4. Epub 2025 May 26. Erratum in: Lancet Diabetes Endocrinol. 2026 Mar;14(3):e6. doi: 10.1016/S2213-8587(25)00403-6. PMID: 40441173.

Podcast family, we have to be careful what we ask for…Because we might just get it! We have been asking for new ways to predict preeclampsia for close to two decades. Well now we have new biomarker serum tests that are even offered direct- to-consumer. The problem is, what do we dowith a positive test?! In a past episode we covered an FDA cleared serum test by Thermo Fisher for use in patients already diagnosed with preeclampsia. Now there is a new blood test which uses cell free RNA, drawn between 18 and 22 weeks of gestation, which can also predict preterm preeclampsia. Does this work? And what do we do when the result shows “high risk” It's a complicated issue. Wehave to be careful what we ask for. Listen in for details!1.     https://publications.smfm.org/publications/554-acog-clinical-practice-update-biomarker-prediction-of-preeclampsia/2.     ACOG Clinical Practice Update: BiomarkerPrediction of Preeclampsia With Severe Features June 20243.    https://www.healthywomen.org/tech-talk-hp/tools-to-predict-preeclampsia4.     Elovitz, M.A., Gee, E.P.S., Delaney-Busch, N. etal. Molecular subtyping of hypertensive disorders of pregnancy. Nat Commun 16,2948 (2025). https://doi.org/10.1038/s41467-025-58157-y5.     https://www.businesswire.com/news/home/20250717476669/en/New-Study-in-JAMA-Network-Open-Shows-Current-Approaches-to-Assessing-Preeclampsia-Risk-Are-Failing-the-Majority-of-Pregnant-Moms

Words matter, and equally as important, our actions matter. Sometimes the words opportunistic salpingectomy (OPS or OS) are used interchangeably with risk-reducing salpingectomy (RRS). However, these are two completely different items. In fact, there are 4 very important differences between the two. In the April 2026 AJOG, there's a new Clinical Opinion on this very topic. Listen in for details.1. Kindelberger DW, Lee Y, Miron A, Hirsch MS, Feltmate C, Medeiros F, Callahan MJ, Garner EO, Gordon RW, Birch C, Berkowitz RS, Muto MG, Crum CP. Intraepithelial carcinoma of the fimbria and pelvic serous carcinoma: Evidence for a causal relationship. Am J Surg Pathol. 2007 Feb;31(2):161-9. 2. ACOG CO 774; 20193. NCCN, Ovarian Cancer Including Fallopian Tube Cancer and Primary Peritoneal Cancer. Updated 2026-03-12.4. ACOG Practice Bulletin No. 147: Lynch Syndrome.Obstetrics and Gynecology. 20145. Falconer H, Yin L, Grönberg H, Altman D. Ovarian cancer risk after salpingectomy: a nationwide population-based study. J Natl Cancer Inst. 2015 Jan 27;107(2):dju410. doi: 10.1093/jnci/dju410. PMID: 25628372.6. Rice MS, Hankinson SE, Tworoger SS. Tubal ligation, hysterectomy, unilateral oophorectomy, and risk of ovarian cancer in the Nurses' Health Studies. Fertil Steril. 2014 Jul;102(1):192-198.e3. doi: 10.1016/j.fertnstert.2014.03.041. Epub 2014 May 10. PMID: 24825424; PMCID: PMC4074555.7. Wilke RN, Pennington KP, Gootzen TA, Steenbeek MP, de Hullu JA, Long KC, Blank SV, Swisher EM, Lu KH, Norquist B. Salpingectomy in individuals at high risk for tubo-ovarian cancer: consensus and precaution. Am J Obstet Gynecol. 2025 Nov 1:S0002-9378(25)00820-8. doi: 10.1016/j.ajog.2025.10.044. Epub ahead of print. PMID: 41183726.

Platelet-rich plasma (PRP) injections do not have formal FDA approval for specific clinical indications. PRP is regulated as an autologous blood product and is used "off-label" in clinical practice. However, there is substantial clinical evidence supporting its use for certain dental surgeries and musculoskeletal conditions, particularly lateral epicondylitis, knee osteoarthritis, and plantar fasciitis. The American Medical Society for Sports Medicine notes that PRP is primarily used to treat tendinopathies and osteoarthritis, though clinical efficacy results remain mixed due to variability in PRP formulations and preparation methods. As of now, there are no FDA approved uses for PRP for gynecologic use, although there has been some evidence of possible benefit in vulvar dermatoses and possiblt ovarian function enhancement. But what about its use in the vagina for sexual pleasure? Injecting into the anterior vaginal wall (around the famed G-Spot location) is nothing new. Over a decade ago, a TV show introduced the masses to the “G-Spot amplication” shot which injected collagen to that area. But there was no data for this. Well, we are back to this idea in a new RCT in the Green Journal. Can PRP light up the vaginal fires of pleasure? Listen in for details. 1. Clarke, Bayley MD; Gaddam, Neha MD; Garcia, Bobby MD; Iglesia, Cheryl B. MD; Podolsky, Robert PhD; Dieter, Alexis A. MD. Vaginal Injection of Platelet-Rich Plasma for Sexual Function: A Randomized Controlled Trial. Obstetrics & Gynecology ():10.1097/AOG.0000000000006256, March 19, 2026. | DOI: 10.1097/AOG.00000000000062562. Finnoff JT, Awan TM, Borg-Stein J, et a American Medical Society for Sports Medicine Position Statement: Principles for the Responsible Use of Regenerative Medicine in Sports Medicine. Clinical Journal of Sport Medicine : Official Journal of the Canadian Academy of Sport Medicine. 2021. 3. Alsousou J, Ali A, Willett K, Harrison P. The Role of Platelet-Rich Plasma in Tissue Regeneration.Platelets. 2012.