Dr. Chapa’s Clinical Pearls.

Explore the fascinating history of C-Sections, as even Shakespeare referenced them! Discover new research indicating that a labored primary C-Section increases the risk of placenta accreta in future pregnancies. Delve into surprising statistics about intraoperative pain during C-Sections, revealing rates from 1.4% to a shocking 36%. This crucial discussion emphasizes the importance of understanding patient experiences and managing pain effectively to improve outcomes.

Just today in clinic, we had a patient, who was well into her third trimester, come to her regular scheduled appointment with new onset left-sided facial droop. Yeah, that’s concerning! A complete history and physical was performed and the diagnosis was made of Bell’s palsy. This is not a rare event and it can be extremely stressful for the affected mother to be because everybody knows facial droop is not normal! And we have recent data regarding this. In July 2025 in the Journal of Plastic, Reconstructive, and Aesthetic Surgery, authors confirmed that Bell’s palsy can have real negative functional and psychosocial implications for those affected. So, in this episode, we are going to discuss Bell’s palsy in pregnancy. How do we differentiate this from the more serious differential, which is a stroke? What about treatment? Listen in for details. 1. Wesley, Shaun R. MD; Vates, G. Edward MD, PhD; Thornburg, Loralei L. MD. Neurologic Emergencies in Pregnancy. Obstetrics & Gynecology 144(1):p 25-39, July 2024. | DOI: 10.1097/AOG.00000000000055752. Vrabec JT, Isaacson B, Van Hook JW. Bell's Palsy and Pregnancy.Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery. 2007;137(6):858-61. doi:10.1016/j.otohns.2007.09.009.3. Evangelista V, Gooding MS, Pereira L.Bell's Palsy in Pregnancy.Obstetrical & Gynecological Survey. 2019;74(11):674-678. doi:10.1097/OGX.00000000000007324. JPRAS (July 2025): https://www.jprasurg.com/article/S1748-6815(25)00328-6/fulltextSTRONG COFFEE PROMO: 20% Off Strong Coffee Company https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

Maternal concerns about decreased fetal movement can be alarming, affecting up to 15% of pregnancies. The podcast delves into why routine labor induction isn't recommended solely for this issue. The discussion highlights the cerebroplacental ratio (CPR) as a potential ultrasound tool for assessing fetal well-being and early placental insufficiency. The results of the CEPRA trial suggest the CPR could influence clinical practice, though caution is advised since routine induction may not improve outcomes. Practical guidance is emphasized throughout.

Explore the evolution of electronic fetal monitoring from the 1960s to today, highlighting its role in intrapartum care despite limitations. Discover three key points from the upcoming ACOG guidelines, including the relevance of intermittent fetal auscultation. Delve into maternal oxygen use for fetal resuscitation and the emerging potential of AI in fetal heart rate assessments. The discussion underscores gaps in evidence while emphasizing best practices for monitoring and resuscitation.

Dive into the impact of insomnia on pregnancy with insights from the latest JAMA study. Explore how sleep disorders like obstructive sleep apnea can lead to serious risks such as ischemic placental disease. Discover the implications of night shift work and altered circadian rhythms on maternal and fetal health. The discussion also covers practical strategies for managing insomnia during pregnancy, including relaxation techniques and the potential benefits of melatonin. Tune in for essential information for expecting moms!

Brain-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) levels originate from the cardiac cells in response to cardiac strain. This may come from a pulmonary embolus, an acute severe infection (sepsis), or cardiomyopathy. But what is the relationship between these 2 cardiac biomarkers and preeclampsia? Can preeclampsia with severe features result in an abnormal rise in these 2 proteins exclusive to heart failure. Listen in to this real case scenario which our on call team cared for. 1. Serum Levels of N-Terminal Pro-Brain Natriuretic Peptide in Gestational Hypertension, Mild Preeclampsia, and Severe Preeclampsia: A Study From a Center in Zhejiang Province, China. Zheng Z, Lin X, Cheng X. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research. 2022;28:e934285. doi:10.12659/MSM.934285.2.Evaluation of B-Type Natriuretic Peptide (BNP) Levels in Normal and Preeclamptic Women. Resnik JL, Hong C, Resnik R, et al. American Journal of Obstetrics and Gynecology. 2005;193(2):450-4. doi:10.1016/j.ajog.2004.12.006.3.Increased B-Type Natriuretic Peptide Levels in Early-Onset Versus Late-Onset Preeclampsia. Szabó G, Molvarec A, Nagy B, Rigó J. Clinical Chemistry and Laboratory Medicine. 2014;52(2):281-8. doi:10.1515/cclm-2013-0307.4. Association of N-Terminal Pro–Brain Natriuretic Peptide Concentration in Early Pregnancy With Development of Hypertensive Disorders of Pregnancy and Future Hypertension.5. Hauspurg A, Marsh DJ, McNeil RB, et al. JAMA logoJAMA Cardiology. 2022;7(3):268-276. doi:10.1001/jamacardio.2021.5617.STRONG COFFEE PROMO: 20% Off Strong Coffee Companyhttps://strongcoffeecompany.com/discount/CHAPANOSPINOBG

Explore the unique risks women face regarding strokes, with insights showing one in five women may experience one between ages 55 and 75. Delve into the safety of low-dose vaginal estradiol after a stroke, with findings suggesting no increased stroke risk. Learn about the nuances of hormone therapy and the importance of caution regarding study limitations. Experts weigh in on the implications for women's health and highlight the need for further research in this critical area.

Mastalgia is a common breast complaint in reproductive aged women. Mastalgia can be separated into three categories: 1) cyclical, 2) noncyclical, and 3) extramammary. Vitamin B6 is often cited as a homeopathic (non-prescription/pharmacological) remedy for simple mastalgia. Does the published data support its use? A newly published meta-analysis sheds light on the subject.1. Sharifipour, F., Siahkal, S.F. & Bagherinia, M. The effectiveness of vitamin B6 in reducing mastalgia: a systematic review and meta-analysis. BMC Women's Health 25, 421 (2025). https://doi.org/10.1186/s12905-025-03991-x2. ACOG PB 164; reaffirmed 2023

We are delaying today's program, as stated in this message. We will resume our program as soon as possible. Remembering Charlie Kirk.

We have a wonderful podacst community! Within 24 hours of our immediate past episode release, one close friend- and fellow OBGYN, Dr. Eric Colton (OB Hospitalist Group) reached out and shared valuable words of wisdom regarding a potentially deadly complication of the CS-scar defect...the CS scar ectopic pregnancy. Listen in for Dr. Colton's cameo and details. 1. Ban, Yanli MD, PhD; Shen, Jia MD; Wang, Xia MD; Zhang, Teng MD, PhD; Lu, Xuxu MD; Qu, Wenjie MD; Hao, Yiping MD; Mao, Zhonghao MD; Li, Shizhen MD; Tao, Guowei MD, PhD; Wang, Fang MD, PhD; Zhao, Ying MD, PhD; Zhang, Xiaolei MD, PhD; Zhang, Yuan MD, PhD; Zhang, Guiyu MD, PhD; Cui, Baoxia MD, PhD. Cesarean Scar Ectopic Pregnancy Clinical Classification System With Recommended Surgical Strategy. Obstetrics & Gynecology 141(5):p 927-936, May 2023. | DOI: 10.1097/AOG.0000000000005113