Dr. Chapa’s OBGYN Clinical Pearls

Actinomyces species are considered part of the normal vaginal and urogenital tract flora. The percentage of Pap smears containing Actinomyces-like organisms varies but is most commonly reported as approximately 7% among women using IUDs. That number is supported by multiple sources, including the Infectious Diseases Society of America guideline and several clinical studies. The incidence can be higher or lower depending on the type of IUD; for example, copper IUDs have been associated with rates up to 20%, while levonorgestrel-releasing IUDs show lower rates around 2.9%. In women with an IUD, who are found to have this finding on their liquid-based Pap smear, what is the appropriate management? In this episode, which comes from one of our podcast family members, we will discuss this topic and it’s management in both symptomatic and symptomatic (pelvic pain) IUD wearing women. 1. McHugh KE, Sturgis CD, Procop GW, Rhoads DD. The Cytopathology of Actinomyces, Nocardia, and Their Mimickers. Diagnostic Cytopathology. 2017;45(12):1105-1115. doi:10.1002/dc.23816.2. Practice Bulletin No. 186: Long-Acting Reversible Contraception: Implants and Intrauterine Devices. Obstetrics and Gynecology. 2017;130(5):e251-e269. doi:10.1097/AOG.0000000000002400.3. Miller JM, Binnicker MJ, Campbell S, et al. Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2024 Update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 2024; ciae104. doi:10.1093/cid/ciae104.5. Carrara J, Hervy B, Dabi Y, et al. Added-Value of Endometrial Biopsy in the Diagnostic and Therapeutic Strategy for Pelvic Actinomycosis. Journal of Clinical Medicine. 2020;9(3):E821. doi:10.3390/jcm9030821.

Recurrent pregnancy loss (RPL) affects approximately 5% of couples and is an emotional burden on those affected. There is some evidence that vaginal progesterone supplementation may be considered in patients with recurrent pregnancy loss who are experiencing vaginal bleeding during the first trimester. But what about prophylactic low dose aspirin in the first trimester, or preconceptionally, for unexplained RPL? Is that evidence-based? A new publication from the SMFM’s journal Pregnancy has examined this. Listen in for details. 1. 22 November 2025: Low-dose aspirin in unexplained recurrent pregnancy loss: A systematic review and meta-analysis (Pregnancy): https://obgyn.onlinelibrary.wiley.com/doi/10.1002/pmf2.700992. American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice, T. Flint Porter, Cynthia Gyanff-Bannerman, Tracy Manuck. Low-Dose Aspirin Use During Pregnancy. American College of Obstetricians and Gynecologists (2018)3. Naimi AI, Perkins NJ, Sjaarda LA, et al. The Effect of Preconception-Initiated Low-Dose Aspirin on Human Chorionic Gonadotropin-Detected Pregnancy, Pregnancy Loss, and Live Birth : Per Protocol Analysis of a Randomized Trial. Annals of Internal Medicine. 2021;174(5):595-601. doi:10.7326/M20-0469.4. Lee EE, Jun JK, Lee EB.Management of Women With Antiphospholipid Antibodies or Antiphospholipid Syndrome During Pregnancy. Journal of Korean Medical Science. 2021;36(4):e24. doi:10.3346/jkms.2021.36.e24.5. de Assis V, Giugni CS, Ros ST. Evaluation of Recurrent Pregnancy Loss. Obstet Gynecol. 2024 May 1;143(5):645-659. doi: 10.1097/AOG.0000000000005498. Epub 2024 Jan 4. PMID: 38176012.

Having data is sometimes different than having clinically applicable data. This is exactly the issue with the proposed plan to reduce surgical site infection (SSI) by changing surgical gloves after placental delivery at C-Section. Just 24 hours ago, we received the question from a PGY4 OBGYN resident asking whether the practice of changing surgical gloves at C-Section after placental delivery to reduce SSI was evidence-based. So, in this episode, we will review the data - which is timely since this was recently published on November 13, 2025 in the J Hospital Infection. This study follows a statement on this practice released by FIGO in September 2025. It’s an interesting proposal, and there is clearly data in support of this, yet the ACOG and CDC do not recommend this practice as of Nov 2025. Is there a disconnect? Listen in for details. 1. FIGO: https://www.figo.org/news/new-ijgo-review-provides-comprehensive-framework-preventing-post-caesarean-sepsis (International Journal of Gynecology & Obstetrics)2. Stanberry B, Jordan L, Pullyblank A, Hargreaves J. Glove change during caesarean birth: impact on maternity service budgets and capacity. J Hosp Infect. 2025 Nov 13:S0195-6701(25)00354-8. doi: 10.1016/j.jhin.2025.10.033. Epub ahead of print. PMID: 41241232.3. Narice BF, Almeida JR, Farrell T, Madhuvrata P. Impact of Changing Gloves During Cesarean Section on Postoperative Infective Complications: A Systematic Review and Meta-Analysis. Acta Obstetricia Et Gynecologica Scandinavica. 2021;100(9):1581-1594. doi:10.1111/aogs.14161.4. Routine Sterile Glove and Instrument Change at the Time of Abdominal Wound Closure to Prevent Surgical Site Infection (ChEETAh): A Pragmatic, Cluster-Randomised Trial in Seven Low-Income and Middle-Income Countries.NIHR Global Research Health Unit on Global Surgery. Lancet (London, England). 2022;400(10365):1767-1776. doi:10.1016/S0140-6736(22)01884-0.5. Gialdini C, Chamillard M, Diaz V, Pasquale J, Thangaratinam S, Abalos E, Torloni MR, Betran AP. Evidence-based surgical procedures to optimize caesarean outcomes: an overview of systematic reviews. EClinicalMedicine. 2024 May 19;72:102632. doi: 10.1016/j.eclinm.2024.102632. PMID: 38812964; PMCID: PMC11134562.

Muscular dystrophy (MD) is a group of genetic diseases that affect about 16 to 25 per 100,000 people in the US, with the most common childhood form being Duchenne muscular dystrophy (DMD) and the most common adult form being myotonic dystrophy. The prevalence of DMD is estimated at around 1 in 3,500 live male births. Prenatal carrier screening for this is part of the ACMG Tier 3 expanded carrier panel. This is different from spinal muscular atrophy (SMA). As we recently had a patient who was a MD carrier, with affected male children, who we cared for, we decided to do a quick review of muscular dystrophy: its prevalence, genetics, and evaluation of asymptomatic maternal carriers.1. https://www.mda.org/disease/duchenne-muscular-dystrophy/causes-inheritance2.https://www.nichd.nih.gov/health/topics/musculardys/conditioninfo/causes3. https://www.nhs.uk/conditions/muscular-dystrophy/4. ACMG: https://thednaexchange.com/2022/03/30/acmg-carrier-screening-guideline-the-hypothetical-tier-3-panel/#:~:text=The%20goal%20of%20this%20ACMG,1%20in%2040%2C000%20or%20higher.

Regional anesthesia, typically with a spinal or epidural, haslong been favored for cesarean births due in part to concerns about the effects that general anesthesia (GA) may have on newborns at delivery. However, data has shown that up to 1 in 6 women may experience pain with a “topped-off”labor epidural, during the cesarean. A new publication in the journal Anesthesia is now being interpreted as implying that general anesthesia may be a valid alternative electively. Is that what this new study found? Has GA been linked to postpartum depression? What about later child neurodevelopmental delays? This is a fascinating topic…Listen in for details. 1.     Langer, Sarah M.D.1; Lim, Grace M.D., M.Sc.2;Qiu, Yue M.D.3; Biaesch, Jingyuan D.O.4; Neuman, Mark D. M.D., M.Sc.5. NeonatalOutcomes with Regional versus General Anesthesia for Cesarean Delivery: AMeta-analysis of Randomized Controlled Trials. Anesthesiology():10.1097/ALN.0000000000005785, November 12, 2025. | DOI:10.1097/ALN.00000000000057852.     Guglielminotti J, Monk C, Russell MT, Li G.Association of General Anesthesia for Cesarean Delivery with PostpartumDepression and Suicidality. Anesth Analg. 2025 Sep 1;141(3):618-628. doi:10.1213/ANE.0000000000007314. Epub 2024 Dec 4. PMID: 39630595; PMCID:PMC12134152.3.     Chen, YC., Liang, FW., Tan, PH. et al.Association between general anesthesia for cesarean delivery and subsequentdevelopmental disorders in children: a nationwide retrospective cohort study.BMC Med 23, 119 (2025). https://doi.org/10.1186/s12916-025-03886-64.     https://www.pennmedicine.org/news/new-study-challenges-fears-about-general-anesthesia-during-c-section

The US has no shortage of lidocaine patch television commercials. Topical lidocaine has a role for local, topical, minor aches and pains. What about lidocaine patches for post-op cesarean section pain? Is there data for that? A brand-new meta-analysis in AJOG-MFM (Nov 13, 2025) looks at this option. However, there has been 3 prior reviews on the same topic from 2019, 2022, and 2023. Do they all arrive at the same result? Listen in for details!1.     Smoker J, Cohen A, Rasouli MR, Schwenk ES. TransdermalLidocaine for Perioperative Pain: A Systematic Review of the Literature. Current Pain and Headache Reports.2019;23(12):89. doi:10.1007/s11916-019-0830-9.2.     Koo CH, Kim J, Na HS, Ryu JH, Shin HJ. TheEffect of Lidocaine Patch for Postoperative Pain: A Meta-Analysis of Randomized Controlled Trials. Journal of Clinical Anesthesia. 2022;81:110918.doi:10.1016/j.jclinane.2022.110918.3.     Wu X, Wei X, Jiang L, et al. Is Lidocaine PatchBeneficial for Postoperative Pain?: A Meta-Analysis of Randomized Clinical Trials. The Clinical Journal of Pain. 2023;39(9):484-490. doi:10.1097/AJP.00000000000011354.     Parisi, Nadia et al.Lidocaine patches aftercesarean delivery: a meta-analysis of randomized controlled trials. American Journal of Obstetrics & Gynecology MFM, Volume 0, Issue 0, 101832

Podcast Family, we have covered the subject of Measles previously on this show (links below). Those episodes were a preview of what has now been released ahead of print as a narrative review in the Green Journal! In this episode, we will summarize the KEY points of measles infection in pregnancy and re-state the “rule of 4” and the importance of the number 10 regarding this.1. Feb 24, 2025: Measles 101: https://open.spotify.com/episode/4lXrpqKTJPdDcTXPxpEmcb2. April 27, 2019: Measles!! ACOG Practice Advisory: https://creators.spotify.com/pod/profile/dr-hector-chapa/episodes/MEASLES---ACOG-practice-advisory-e3s1p43. Joseph, Naima T. MD, MPH. Measles in Pregnancy: Clinical Considerations and Challenges. Obstetrics & Gynecology ():10.1097/AOG.0000000000006126, November 14, 2025. | DOI: 10.1097/AOG.0000000000006126

The term "hypnosis" was first described in 1843 byScottish surgeon James Braid, who published the book Neurypnology. He coined the term "hypnosis" from the Greek word for sleep to describe the trance-like state induced by focusing on a bright object. Self-hypnosis has nowbeen shown to aid in menopausal hot flash reduction! In this episode, we will review this brand new publication from JAMA Network which confirmed via a multicenter RCT that a simple daily hypnosis audio session was effective forsymptom relief. The study is the first to compare self-guided hypnosis with an active control condition (i.e. sham white noise control group). Listen in for details. 1.     Elkins G, Arring N, Morgan G, Lorenz T, Muniz V,Lafferty C, Scheffrahn K, Alldredge C, Barton D. Self-Administered Hypnosis vsSham Hypnosis for Hot Flashes: A Randomized Clinical Trial. JAMA Netw Open.2025 Nov 3;8(11):e2542537. doi: 10.1001/jamanetworkopen.2025.42537. PMID:41217756.2.     https://interestingengineering.com/health/hypnosis-lowers-menopause-hot-flashes 

Well, from time to time we cover RANDOM tidbits of information which cover RANDOM questions and/or RANDOM patient care issues that we encounter. In this episode we will cover one OB issue related to recurrent pregnancy loss, one GYN issue related to unilateral breast swelling in a patient with SLE, and one RANDOM life perspective response from a mock interview that I participated in for a residency candidate. Listen in fordetails!1.     Viviana DO; Giugni, Claudio Schenone MD; Ros, Stephanie T. MD, MSCI. Factor V and recurrent pregnancy loss: de Assis, Evaluation of Recurrent Pregnancy Loss. Obstetrics & Gynecology 143(5):p 645-659, May 2024. | DOI: 10.1097/AOG.0000000000005498Unilateral Breast Swelling with SLE: 2.     Voizard B, Lalonde L, Sanchez LM, et al. LupusMastitis as a First Manifestation of Systemic Disease: About Two Cases With a Review of the Literature. European Journal of Radiology. 2017;92:124-131. doi:10.1016/j.ejrad.2017.04.023.3.     Kinonen C, Gattuso P, Reddy VB. Lupus Mastitis:An Uncommon Complication of Systemic or Discoid Lupus. The American Journal of Surgical Pathology. 2010;34(6):901-6. doi:10.1097/PAS.0b013e3181da00fb.4.      Summers TA, Lehman MB, Barner R, Royer MC. Lupus Mastitis: A Clinicopathologic Review and Addition of a Case. Advances in Anatomic Pathology.2009;16(1):56-61. doi:10.1097/PAP.0b013e3181915ff7.5.     Jiménez-Antón A, Jiménez-Gallo D,Millán-Cayetano JF, Navarro-Navarro I, Linares-Barrios M. Unilateral Lupus Mastitis.Lupus. 2023;32(3):438-440. doi:10.1177/09612033221151011.STRONG COFFEE PROMO: 20% Off Strong Coffee Company https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

On August 15, 2025, we reviewed the data from an FDA expert panel calling on the FDA to remove the exiting Black Box warning on commercial HRT options for menopausal care. In a historic decision, this happened today. Listen in for details! 1. https://www.cbsnews.com/video/fda-chief-explains-changes-to-black-box-warnings-on-some-hormone-therapies-for-menopause/2. https://www.hhs.gov/press-room/hhs-advances-womens-health-removes-misleading-fda-warnings-hormone-replacement-therapy.html

The ACOG acknowledges that maternal obesity affects labor curves and recommends allowing more time for cervical dilation before diagnosing labor arrest in obese patients. This approach aims to avoid unnecessary interventions, such as premature cesarean delivery, which may occur if standard labor curves are strictly applied to obese women. In this episode, we will review a new study from the AJOG (08 Nov 2025) which describes labor progression and duration according to maternal body mass index, validating the need (possibly) for a BMI -based labor curve. Has there been advocates of a BMI-based labor curve? Listen in for details.1. Edwards, Sara et al. Characterizing Labor Progression and Duration According to Maternal Body Mass Index. American Journal of Obstetrics & Gynecology, Volume 0, Issue 02. Lundborg L, Liu X, Åberg K, et al. Association of Body Mass Index and Maternal Age With First Stage Duration of Labour. Scientific Reports. 2021;11(1):13843. doi:10.1038/s41598-021-93217-5.3. Kominiarek MA, Zhang J, Vanveldhuisen P, et al. Contemporary Labor Patterns: The Impact of Maternal Body Mass Index. American Journal of Obstetrics and Gynecology. 2011;205(3):244.e1-8. doi:10.1016/j.ajog.2011.06.014.4. Norman SM, Tuuli MG, Odibo AO, et al. The Effects of Obesity on the First Stage of Labor.Obstetrics and Gynecology. 2012;120(1):130-5. doi:10.1097/AOG.0b013e318259589c.

Do you routinely order prophylactic antibiotics at time ofsecond-degree laceration repair? Is there data for that? While the use of prophylacticantibiotics “is reasonable” (per ACOG PB 198) for OASIS lacerations, what doesthe data look like for second degree lacs? Well, the answer is both supportiveAND non-supportive of that practice! In this episode, we will cover a brand newpublication (RCT) from BMJ on this very issue, and also highlight a meta-analysisfrom Plos One (May 2025) that also examined this question. Listen in fordetails!1.     ACOG PB 1982.     Armstrong H, Whitehurst J, Morris RK, HodgettsMorton V, Man R; CHAPTER group. Antibiotic prophylaxis for childbirth-relatedperineal trauma: A systematic review and meta-analysis. PLoS One. 2025 May9;20(5):e0323267. doi: 10.1371/journal.pone.0323267. PMID: 40344566; PMCID:PMC12064200.3.     Risk of infection and wound dehiscence after useof prophylactic antibiotics in episiotomy or second degree tear (REPAIR study):single centre, double blind, placebo controlled randomised trial. BMJ 2025; 391doi: https://doi.org/10.1136/bmj-2025-084312 (Published 29 October 2025): BMJ2025;391:e084312

On March 29, 2023, we released an episode titled, “The 4 PCOS Phenotypes”. That was in 2023! Now, on 29 October 2025, in the journal Nature Medicine, researchers have published, “Data-driven (FOUR) subtypes of polycystic ovary syndrome and their association with clinical outcomes”. PCOS is not ONE condition: is a constellation of metabolic, endocrine, and ovulatory dysregulation. We covered these 4 phenotypes back then. Is this what the “new data” found? Or what it something else? And how does these affect IVF or pregnancy outcomes? Listen in for details!1. Gao, X., Zhao, S., Du, Y. et al. Data-driven subtypes of polycystic ovary syndrome and their association with clinical outcomes. Nat Med (2025). https://doi.org/10.1038/s41591-025-03984-12. Mar 29, 2023; SPOTIFY: https://creators.spotify.com/pod/profile/dr-hector-chapa/episodes/The-4-PCOS-Phenotypes-e217vv0/a-a9ipgjsSTRONG COFFEE PROMO: 20% Off Strong Coffee Company https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

Taking folic acid prior to conception and during pregnancy can help protect the unborn baby from developing abnormalities. Supplements are particularly important for women who have epilepsy, as anti-seizure medication (previously known as anti-convulsants or anti-epileptic drugs) can lead to a deficiency in folic acid. Until 2023, high doses of 4-5 mg per day were recommended. However, this has changed as the data has changed. Did you know the SMFM no longer recommends “high dose” folic acid preconceptionally for patients on seizure medications? This is also highlighted in a recently released epub from Obstetrics and Gynecology (Green Journal) on October 31, 2025. Listen in for details. 1. Mokashi, Mugdha MD, MPH; Cozzi-Glaser, Gabriella MD; Kominiarek, Michelle A. MD, MS. Dietary Supplements in the Perinatal Period. Obstetrics & Gynecology ():10.1097/AOG.0000000000006098, October 31, 2025. | DOI: 10.1097/AOG.00000000000060982. Asadi-Pooya AA. High dose folic acid supplementation in women with epilepsy: are we sure it is safe? Seizure. 2015 Apr;27:51-3. doi: 10.1016/j.seizure.2015.02.030. Epub 2015 Mar 7. PMID: 25891927.3. https://aesnet.org/about/aes-press-room/press-releases/guideline-issued-for-people-with-epilepsy-who-may-become-pregnant4. Turner C, McIntosh T, Gaffney D, Germaine M, Hogan J, O'Higgins A. A 10-year review of periconceptual folic acid supplementation in women with epilepsy taking antiseizure medications. J Matern Fetal Neonatal Med. 2025 Dec;38(1):2524094. doi: 10.1080/14767058.2025.2524094. Epub 2025 Jun 30. PMID: 40588438.5. https://www.aan.com/PressRoom/Home/PressRelease/5170#:~:text=The%20guideline%20recommends%20that%20people,and%20possibly%20improve%20neurodevelopmental%20outcomes.6. https://aesnet.org/about/aes-press-room/press-releases/guideline-issued-for-people-with-epilepsy-who-may-become-pregnant

Back on August 9, 2024, we released an episode (link in the show notes) reviewing the renewed interest in transfusing whole blood for PPH rather than component therapy. Now, in O&G open, authors from my Alma Mater (UT Southwestern) have published new data bolstering the use of whole blood for PPH. Listen in for details.1. Clinical Pearls Episode 2024: https://open.spotify.com/episode/0ZhqoIE9wMcAboDlevq9OW?si=rM32uK8ER8uuWmq4mf5dzA2. Ambia, Anne M. MD; Burns, R. Nicholas MD; White, Alesha MD; Warncke, Kristen MD; Gorman, April MS; Duryea, Elaine MD; Nelson, David B. MD. Whole Blood in the Management of Postpartum Hemorrhage. O&G Open 2(5):e130, October 2025. | DOI: 10.1097/og9.00000000000001303. ACPG PB 183STRONG COFFEE PROMO: 20% Off Strong Coffee Company https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

Elinzanetant, sold under the brand name Lynkuet, receivedapproval from the U.S. Food and Drug Administration (FDA) on October 24, 2025, for the treatment of moderate to severe hot flashes due to menopause.  How is this different than Fezolinetant, which was approved in 2023? Listen in for details. 1.   Menegaz de Almeida, Artur MS; Oliveira, Paloma MS; Lopes, Lucca MD; Leite, Marianna MS; Morbach, Victória MS; Alves Kelly, Francinny MD; Barros, Ítalo MS; Aquino de Moraes, Francisco Cezar MS; Prevedello, Alexandra MD. Fezolinetant and Elinzanetant Therapy for Menopausal Women Experiencing Vasomotor Symptoms: A Systematic Review and Meta-analysis. Obstetrics & Gynecology 145(3):p 253-261, March 2025. | DOI: 10.1097/AOG.00000000000058122.     Pinkerton JV, Simon JA, Joffe H, Maki PM, NappiRE, Panay N, Soares CN, Thurston RC, Caetano C, Haberland C, Haseli Mashhadi N, Krahn U, Mellinger U, Parke S, Seitz C, Zuurman L. Elinzanetant for the Treatment of Vasomotor Symptoms Associated With Menopause: OASIS 1 and 2 Randomized Clinical Trials. JAMA. 2024 Aug 22;332(16):1343–54. doi: 10.1001/jama.2024.14618. Epub ahead of print. PMID: 39172446; PMCID: PMC11342219.3.     Cardoso F, Parke S, Brennan DJ, Briggs P,Donders G, Panay N, Haseli-Mashhadi N, Block M, Caetano C, Francuski M, Haberland C, Laapas K, Seitz C, Zuurman L. Elinzanetant for Vasomotor Symptomsfrom Endocrine Therapy for Breast Cancer. N Engl J Med. 2025 Aug 21;393(8):753-763. doi: 10.1056/NEJMoa2415566. Epub 2025 Jun 2. PMID: 40454634.STRONG COFFEE PROMO: 20% Off Strong CoffeeCompany https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

On January 18, 2020, we released an episode called “Vaginal Vit C for BV? Yep, it’s DATA”. That was 5 years ago! Now, in the Green Journal, a new systematic review and meta-analysis is examining this subject….AGAIN. Plus, this is not the only systematic review to investigate this; a similar review was published in Acta Obstétrica e Ginecológica Portuguesa earlier this year (2025) in March. So, did we get it right 5 years ago? Can vaginal Vit C help in eliminating BV? Listen in for details!1. Khaikin, Yannay MD; Elangainesan, Praniya MD, MSc; Winkler, Eliot MD, MSc; Liu, Kuan PhD, MMath; Selk, Amanda MD, MSc; Yudin, Mark H. MD, MSc. Intravaginal Vitamin C for the Treatment and Prevention of Bacterial Vaginosis: A Systematic Review and Meta-analysis. Obstetrics & Gynecology ():10.1097/AOG.0000000000006092, October 23, 2025. | DOI: 10.1097/AOG.0000000000006092; https://journals.lww.com/greenjournal/pages/articleviewer.aspx?year=9900&issue=00000&article=01389&type=Fulltext2. Acta Obstétrica e Ginecológica Portuguesa (March 2025): chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://scielo.pt/pdf/aogp/v19n1/1646-5830-aogp-19-01-40.pdf3. Chapa Clinical pearls 2020: https://podcasts.apple.com/gh/podcast/vaginal-vit-c-for-bv-yep-its-data/id1412385746?i=1000463002444

Here is a real-world clinical case with a tricky differential: Our team recently readmitted a patient 6 days postpartum/post C-section (which was done for ICP and fetal macrosomia at close to 4500 grams, with A2GDM). She had elevated blood pressures, a frontal headache, some midepigastric pain/RUQ discomfort. Pretty clear picture right: sounds like preeclampsia (PreE) with severe features based on BP elevation and symptoms. So, we started her on mag-sulfate per protocol. Well, her transaminases were in the 400-600s, which was significantly higher than they were at delivery. They then peaked the next day at 900! OK, it still meets criteria for PreE with severe features. But could this also be postpartum Acute fatty Liver of Pregnancy (AFLP)? The clinical picture of these 2 conditions may overlap but there are distinct differences here. AFLP is potentially fatal, so we have to get that diagnosis correct. How can we distinguish AFLP from PreE with severe features or HELLP? Listen in for details.1. https://www.preeclampsia.org/the-news/health-information/acute-fatty-liver-of-pregnancy-can-be-confused-with-preeclampsia-and-hellp-syndrome2. Yemde A Jr, Kawathalkar A, Bhalerao A. Acute Fatty Liver of Pregnancy: A Diagnostic Challenge. Cureus. 2023 Mar 26;15(3):e36708. doi: 10.7759/cureus.36708. PMID: 37113350; PMCID: PMC10129069.3. Maalbi O, Elachhab N, Elkabbaj A, Arfaoui M, Hindi S, Lahbabi S, Oudghiri N, Tachinante R. Management of Acute Fatty Liver of Pregnancy: A Retrospective Study of 12 Cases Compared With Data in the Literature. Cureus. 2025 Jun 11;17(6):e85753. doi: 10.7759/cureus.85753. PMID: 40656400; PMCID: PMC12247011.4. Siwatch S, De A, Kaur B, et al. Safety and Efficacy of Plasmapheresis in Treatment of Acute Fatty Liver of Pregnancy-a Systematic Review and Meta-Analysis.Frontiers in Medicine. 2024;11:1433324. doi:10.3389/fmed.2024.1433324.5. Sarkar M, Brady CW, Fleckenstein J, et al.6. Reproductive Health and Liver Disease: Practice Guidance by the American Association for the Study of Liver Diseases.Hepatology (Baltimore, Md.). 2021;73(1):318-365. doi:10.1002/hep.31559.STRONG COFFEE PROMO: 20% Off Strong Coffee Company https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

I was recently asked to OPINE on the labor management for a patient who was receiving IV Pitocin for augmentation, who experienced a placental abruption. One physician stated that in "his opinion", Pitocin increased the risk of placental abruption intrapartum, a point which the original treating physician refuted. So, I was asked to be the "referee" on the play. IV Pitocin can result in some maternal-fetal complications but is abruption one of them as a stand-alone complication. Was the first reviewer's opinion correct? Listen in for details.1. Ben-Aroya Z, Yochai D, Silberstein T, Friger M, Hallak M, Katz M, Mazor M. Oxytocin use in grand-multiparous patients: safety and complications. J Matern Fetal Med. 2001 Oct;10(5):328-31. doi: 10.1080/714904358. PMID: 11730496.2. Morikawa M, Cho K, Yamada T, et al. Do Uterotonic Drugs Increase Risk of Abruptio Placentae and Eclampsia? Archives of Gynecology and Obstetrics. 2014;289(5):987-91. doi:10.1007/s00404-013-3101-8.3. ACOG: First and Second Stage Labor Management: ACOG Clinical Practice Guideline No. 8. Obstetrics and Gynecology. 2024;143(1):144-162. doi:10.1097/AOG.0000000000005447.4. Pitocin. FDA Drug Label. Food and Drug Administration Updated date: 2024-08-125. Litorp H, Sunny AK, Kc A. Augmentation of Labor With Oxytocin and Its Association With Delivery Outcomes: A Large-Scale Cohort Study in 12 Public Hospitals in Nepal.Acta Obstetricia Et Gynecologica Scandinavica. 2021;100(4):684-693. doi:10.1111/aogs.13919.

Current guidelines recommend universal collection of a vaginal-rectal swab for GBS colonization at 36-37 weeks and 6 days for the identification of patients who require intrapartum IV antibiotic coverage to prevent early onset neonatal GBS infection/sepsis. Recently, we had a patient in clinic whose GBS culture at 36 weeks was negative. Good right? Well, the patient was on amoxicillin at the time for pharyngitis. Did that course of oral PCN based therapy affect the GBS culture result? Should we believe that culture or could it be a false negative, demanding rescreen after therapy completion? There is currently a GAP here in the guidance. In this episode we will cover this controversial scenario, look at the data, and provide a real-world implementable approach to this case.1. Kim DD, Page SM, McKenna DS, Kim CM. Neonatal Group B Streptococcus Sepsis After Negative Screen in a Patient Taking Oral Antibiotics. Obstetrics and Gynecology. 2005;105(5 Pt 2):1259-61. doi:10.1097/01.AOG.0000159040.51773.bf.2. ACOG CO Number 797 (Replaces Committee Opinion No. 782, June 2019.); 20203. Mackay G, House MD, Bloch E, Wolfberg AJ. A GBS culture collected shortly after GBS prophylaxis may be inaccurate. J Matern Fetal Neonatal Med. 2012 Jun;25(6):736-8. doi: 10.3109/14767058.2011.596961. Epub 2011 Aug 1. PMID: 21801141.STRONG COFFEE PROMO: 20% Off Strong Coffee Company https://strongcoffeecompany.com/discount/CHAPANOSPINOBG