Dr. Chapa’s Clinical Pearls.

Explore the fascinating evolution of anesthesia, highlighting pioneers like William Morton and Horace Wells. Discover how labor epidurals are linked to fever and the complexities of diagnosing causes. Get insights on the evidence debunking the myths surrounding epidurals and autism risk. Learn about the use of phenylephrine during spinal anesthesia for C-sections and the importance of managing fevers in labor. Dr. Chapa covers key management strategies in obstetric anesthesiology in a lively and informative discussion.

EMDR (Eye Movement Desensitization and Reprocessing) therapy is a recognized and effective treatment for postpartum PTSD, particularly when related to a traumatic birth experience. EMDR helps individuals process traumatic memories and reduce the associated distress, allowing for a more adaptive way of remembering the event. On Aug 4, 2025, a new publication was released in AJOG pertaining to this therapy. What’s this latest randomized controlled trial data saying? Listen in for details.     1. Hendrix YMGA, van Dongen KSM, de Jongh A, vanPampus MG. Postpartum Early EMDR therapy Intervention (PERCEIVE) study forwomen after a traumatic birth experience: study protocol for a randomizedcontrolled trial. Trials. 2021 Sep 6;22(1):599. doi: 10.1186/s13063-021-05545-6.PMID: 344888472.     Sajedi, S.S., Navvabi-Rigi, SD. & Navidian,A. Midwifery-led brief counseling on the severity of posttraumatic stresssymptoms of postpartum hemorrhage: quasi-experimental study. BMC PregnancyChildbirth 24, 729 (2024).3.     8/4/25: Treatment of Traumatic Birth Experiencewith Postpartum Early Eye Movement Desensitization and Reprocessing Therapy:Hendrix, Yvette M.G. A. et al.4.     A Randomized Clinical Trial. American Journal ofObstetrics & Gynecology, Volume 0, Issue 0

Edwards syndrome (trisomy 18) affects approximately 1 in 5,000 to 6,000 live births. Patau syndrome (also known as Trisomy 13) is even less common, occurring in about 1 in 8,000 to 12,000 live births. About 20% of cases of Patau syndrome are caused by translocation. On the other hand, approximately 10% of Edwards syndrome cases are caused by a genetic translocation. Both conditions result in a wide range of birth anomalies including the heart, kidneys, and brain as well as cognitive limitations. Both of these conditions are part of maternal cell free fetal DNA testing (NIPTs). Prenatal counseling for expectant parents whose fetus was found to have T13 or T18 once focused exclusively on options for pregnancy termination or postnatal comfort care, on the presumptive basis that all affected infants died. However, examination of contemporary outcomes for these infants suggests that death in the neonatal period is not universal, particularly for infants who receive intensive medical and surgical care after birth. Although severe cognitive and motor impairment and shortened lifespan are anticipated for all survivors, some infants with these disorders live for 1 year or more, and some attain social and interactive milestones, with positive quality of life noted by their caregivers. This has led to newly updated guidance released by the AAP on July 21, 2025. This is a marked shift in counseling for parents of an affected child. Here, we will review what this new guidance is, and what it isn’t. Listen in for details.1.https://publications.aap.org/pediatrics/article/doi/10.1542/peds.2025-072719/202649/Guidance-for-Caring-for-Infants-and-Children-With Guidance for Caring for Infants and Children With Trisomy 13 and Trisomy 18: Clinical Report | Pediatrics | American Academy of Pediatrics

Delayed (AKA deferred) Cord Clamping (DCC) is extremely beneficial for both the preterm and term neonate. In September 2025, a new Clinical Practice Update (CPU) will be released by the ACOG regarding the amount of time DCC should be done for preterm newborns. This updates data from a Clinical Expert Series which was released in 2022, called “Management of Placental Transfusion to the Neonate”. Is the recommended amount of DCC 30 sec, 45 sec, or at least 60 seconds for preterm newborns? We will highlight this data in this episode. PLUS, we will very quickly summarize a separate yet related publication from JAMA Pediatrics regarding the use of supplemental O2 (100% PP face mask) during DCC for babies born at 22- 28 weeks. Listen in for details.1. ACOG CPU, Sept 2025: “An Update to Clinical Guidance for Delayed UmbilicalCord Clamping After Birth in Preterm Neonates”2. ACOG Clinical Expert Series, Management of Placental Transfusion to the Neonate”; 2022. 3. JAMA PEDIATRICS (July 21, 2025): https://jamanetwork.com/journals/jamapediatrics/article-abstract/2836681

Podcast family, in this episode we will reply to 2 questions raised by our 2 of our podcast family members. The first pertains to a real world, HORRIBLE tragedy of hepatic rupture in pregnancy (no identifiable information released). We will review how and why this happens and what is the single, 5-letter, clinical diagnosis that makes this a possibility. Secondly, we will answer this question: Can MagSo4 ALONE lead to pulmonary edema. The answer is YES. Listen in for details.1. ACOG PB 222;20202. COMMONLY USED MAGNESIUM SULFATE UNCOMMONLY CAUSING PULMONARY EDEMAVYATA, VISHRUTH et al.CHEST, Volume 162, Issue 4, A10293. Singh Y, Kochar S, Biswas M, Singh KJ. Hepatic Rupture Complicating HELLP Syndrome in Pregnancy. Med J Armed Forces India. 2009 Jan;65(1):89-90. doi: 10.1016/S0377-1237(09)80072-5. Epub 2011 Jul 21. PMID: 27408207; PMCID: PMC4921511.4. Escobar Vidarte MF, Montes D, Pérez A, Loaiza-Osorio S, José Nieto Calvache A. Hepatic rupture associated with preeclampsia, report of three cases and literature review. J Matern Fetal Neonatal Med. 2019 Aug;32(16):2767-2773. doi: 10.1080/14767058.2018.1446209. 

Polyhydramnios may be due to excess urine production or impaired fetal swallowing. The ACOG CO 831 states that mild, idiopathic polyhydramnios may be delivered at 39 weeks and 0 days and thereafter, but there is no specific mention regarding moderate to severe poly. In this episode we will cover delivery of moderate to severe poly. Is that data in SMFM consult series 46 (Evaluation and management of polyhydramnios)? The answer is both YES and NO. Listen in for details.1. ACOG CO 8312. SMFM CS 463. https://med.uc.edu/docs/default-source/obstetrics-and-gynecology-docs/ob-mfm-protocols/a-d/isolatd-amniotic-fluid-disorders.pdf?sfvrsn=75dc58e4_4

What’s best for skin closure at C-Section? Staples or suture? This debate has raged for over 20 years. Past data has shown greater odds of wound complications with metal staples compared to suture. But new a meta-analysis from June 2025 is challenging the prior results. In this episode, we will explore the data from 2010 to present day. PLUS, we will summarize a separate meta-analysis examining if wound dressing removal is tied to any wound complication. This was just published July 15, 2025 in the “Pink” journal. Listen in for details. 1. 2010: Basha SL, Rochon ML, Quiñones JN, Coassolo KM, Rust OA, Smulian JC. Randomized controlled trial of wound complication rates of subcuticular suture vs staples for skin closure at cesarean delivery. Am J Obstet Gynecol. 2010 Sep;203(3):285.e1-8. doi: 10.1016/j.ajog.2010.07.011. PMID: 20816153.2. 2015: Mackeen AD, Schuster M, Berghella V. Suture versus staples for skin closure after cesarean: a metaanalysis. Am J Obstet Gynecol. 2015 May;212(5):621.e1-10. doi: 10.1016/j.ajog.2014.12.020. Epub 2014 Dec 19. PMID: 25530592.3. Jan 2025: Gabbai D, Jacoby C, Gilboa I, Maslovitz S, Yogev Y, Attali E. Comparison of complications and surgery outcomes in skin closure methods following cesarean sections. Arch Gynecol Obstet. 2025 Jul;312(1):125-129. doi: 10.1007/s00404-024-07911-6. Epub 2025 Jan 25. PMID: 39862268; PMCID: PMC12176926.4. June 2025: Post-cesarean skin closure with metal staples versus subcuticular suture in obese patients: A systematic review and meta-analysis of randomized controlled trials. Luis Sanchez-Ramos et al (Univ Florida). https://onlinelibrary.wiley.com/doi/pdf/10.1002/pmf2.700615. DRESSING REMOVAL: July 15, 2025: Leshae A Cenac, Serena Guerra, Alicia Huckaby, Gabriele Saccone, Vincenzo Berghella. Early Wound Dressing (soft gauze/tape dressing) Removal after Cesarean Delivery: A Meta-Analysis of Randomized Trials: Short title: early wound dressing removal after cesarean, American Journal of Obstetrics & Gynecology MFM, 2025; https://doi.org/10.1016/j.ajogmf.2025.101739.6. https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf

Is it beneficial to continue low-dose aspirin postpartum for preeclampsia prevention? New research sheds light on this clinical question. The podcast delves into a randomized clinical trial linking postpartum aspirin use to maternal cardiac health, specifically NT-proBNP levels. While findings suggest that continuing aspirin may not show immediate benefits, it raises important discussions about its effects during pregnancy. Listeners will gain insights into recent publications enhancing their understanding of aspiring treatment strategies.

Amniotic Fluid Sludge (AFS) has been theorized to be sonographic evidence of an underlying infection/inflammation. Others have proposed it may represent an organized clot from the placental surface. At the same time, the finding of AFS may be more common as a benign finding especially at/after 40 weeks as the amniotic fluid accumulates shed skin cells, vernix, and possibly meconium past 41 weeks. What can be tell the patient when we identify AFS in the early second trimester? What do we do with this? In this episode, we will summarize the data on second trimester AFS and review the evidence-based “next steps” in care. Does this require empiric antibiotic therapy in the asymptomatic patient? Listen in for details. 1.     Zimmer EZ, Bronshtein M. Ultrasonic features ofintra-amniotic "unidentified debris' at 14-16 weeks' gestation. UltrasoundObstet Gynecol. 1996 Mar;7(3):178-81. doi: 10.1046/j.1469-0705.1996.07030178.x.PMID: 8705409.2.     Luca S-T, Săsăran V, Muntean M, Mărginean C. AReview of the Literature: Amniotic Fluid “Sludge”—Clinical Significance andPerinatal Outcomes. Journal of Clinical Medicine. 2024; 13(17):5306. https://doi.org/10.3390/jcm131753063.     Sapantzoglou I, Pergialiotis V, Prokopakis I,Douligeris A, Stavros S, Panagopoulos P, Theodora M, Antsaklis P, Daskalakis G.Antibiotic therapy in patients with amniotic fluid sludge and risk of pretermbirth: a meta-analysis. Arch Gynecol Obstet. 2024 Feb;309(2):347-361. doi:10.1007/s00404-023-07045-1. Epub 2023 Apr 25. PMID: 37097312;

Podcast family, we are in process of an exciting rebrand! Dr. Chapa's Clinical Pearls will soon become our legacy show as we change names and channels to, "Dr. Chapa's OBGYN No Spin Podcast". This will allow us to better align with our mission. Listen in for details and FIND US, as Dr. Chapa's OBGYN No Spin Podcast!!