Dr. Chapa’s OBGYN Clinical Pearls

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

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.

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

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

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

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.