Dr. Chapa’s OBGYN Clinical Pearls

A growing body of research reveals the link between STIs andthe pathogens that cause most cases of vaginitis. Over 90% of vaginitis cases result from BV, yeast, or trich- alone or in combination. But, a recent 2024 study from Schwebke et al., in the J Clinical Microbiology, found that about 1 in 5 women who presented with symptoms of vaginitis also had at least one STI…a good reminder to not just stop at a VP3 or wet mount. Additionally, women who tested positive for BV had an STI infection rate double the rate found in womenwho tested negative for BV. In fact, T. vaginalis (TV) and Mycoplasma genitalium (M. gen) infections were significantly associated with BV. We generally trust our tests- don’t we? Negative VP3 for trich- all clear right? Not quite. In this episode, we will highlight our real case where the VP3 testconfirmed BV as the only issue in our symptomatic pregnant patient, yet the cervical NAAT collected at the same time returned positive for Trichomoniasis. Why the discrepancy? It actually is very common- and that may be a care gap.Listen in for details.
1.     Schwebke JR, Nyirjesy P, Dsouza M, et al.Vaginitis and risk of sexually transmitted infections: Results from a multi-center U.S. clinical study using STI nucleic acid amplification testing. J Clin Microbiol. 2024;62(9):e0081624.
2.      Peebles, K., Velloza, J., Balkus, J. E.,McClelland, R. S. & Barnabas, R. V. High global burden and costs of bacterial vaginosis: a systematic review and meta-analysis. Sex. Trans. Dis. 46, 304–311 (2019).
3.     Paladine HL and Desai UA. Vaginitis: Diagnosisand treatment. Am Fam Physician. 2018;97(5):321-329.

An important clinical advantage of cfDNA screening for autosomal recessive conditions is its ability to provide meaningful fetal risk assessment in general-risk pregnancies at an early gestational age, even when partner carrier testing is unavailable. But is this reflex cell-free DNA approach reliable. In this episode, we will review NEW DATA (Oct 2026) from a prospective, multi-site study whose goal was to “evaluate the clinical performance of cell- free DNA (cfDNA) screening as a primary screening tool for autosomal recessive conditions in a large, prospective, general-risk population”. We will review the sensitivity, specificity, PPV and NPV of this (UNITY) approach.
1. A Prospective, Multi-Site Study of Performance of Cell-Free DNA Testing for Recessive Conditions in a Large, General-Risk Pregnancy Population. Obstet Gynecol (OCT) 2026;148:509–15
2. SMFM STATEMENT Society for Maternal-Fetal Medicine Statement: Evaluation and management of cell-free DNA screening for fetal red cell antigen genotype in alloimmunized and non-alloimmunized pregnancies. Pregnancy; June 2026

Welcome back to the show, everyone! Today,we are diving deep into one of the most effective, set-it-and-forget-it contraceptive options available: the Nexplanon implant. With a failure rate of about 0.05%, it is apowerhouse of birth control. You pop it just under the skin of the inner upper arm, and for up to five years, you are covered. Standard removal is usually a quick, straightforward, in-office visit. But what happens when you go to feel for the implant... and it’s not palpable? That single scenario can beincredibly anxiety-provoking—both for the patient lying othe table and for the clinician trying to locate it. Did it migrate? Is it sitting deeper in the fascia or muscle? Or was it ever actually inserted in the first place? When an implant isn’t palpable, standard removal techniques won't cut it. What are theexact next steps for clinical localization? Which imaging modalities should you order first—high-resolution ultrasound, X-ray, or MRI? And here is a twist you might not expect: what on earth does a vasectomy procedure have to do withremoving a difficult Nexplanon implant? Believe it or not, specialized removal techniques borrowing instruments from vasectomies are changing the game for deep implant retrievals! In today’s episode, we break down the brand-newclinical guidance from the Society of Family Planning, authored by Dr. Paula Castaño et al. and published in the journal Contraception. We’ll walk through the step-by-step algorithms for localization, safety protocols, and advanced removal techniques so you can handle non-palpable implants with complete confidence. Grab your coffee, hit subscribe, and let’s dive into the details!
1.     Castaño PM, Creinin MD, Eisenberg DL, et al.Society of Family Planning Committee Statement: Management and removal of deep and nonpalpable contraceptive implants. Contraception. Published 2026.doi:10.1016/j.contraception.2026.111567
2.     Society of Family Planning. News release: TheSociety releases clinical guidance addressing contraceptive implant removal, expands pathways to timely care. Published August 31, 2026. Accessed September 10, 2026. https://societyfp.org/about/society-statements/news-release-the-society-releases-clinical-guidance-addressing-contraceptive-implant-removal-expands-pathways-to-timely-care/

Picture this common, late-gestation conundrum: You’re reviewing a 34-week sono. The mid-pregnancy 24-to-28-week glucose screen was completely normal. But now, the sonogram pops up with an estimated fetal weight of over 90%, or maybe a MVP (or AFI) that’s overtly elevated. The classic clinical dilemma hits: Do you order a repeat OGTT this late in the game? Is it actually worth poking the patient again, or are you just chasing shadows? Well, we now have new meta-analytic data. Today, we are reviewing fresh, high-yield data hot off the press from the American Journal of Obstetrics & Gynecology (OCT 2026). We’re breaking down this systematic review evaluating late-onset GDM- looking at precisely who may yield a positive diagnosis on a repeat third-trimester test, why LGA and polyhydramnios are not created equal when deciding to re-screen, and what these late numbers mean for neonatal hypoglycemia and cesarean delivery rates. AND, although these insights are helpful- some questions remain. Let’s jump in!
1. Dominsky O, Berkovitz-Shperling R, Rosenberg-Fridman M .Late-onset diagnosis of gestational diabetes after normal mid-pregnancy screening in women with large for gestational age or polyhydramnios: a systematic review and meta-analysis. American Journal of Obstetrics & Gynecology, 2026; 235, 789-799

Today we’re diving into a lab order that almost every ob-gyn, midwife, and labor-and-delivery nurse were traditionally trained to do: the routine Postpartum Day 1 Hemoglobin and hematocrit. For decades, checking a patient’s H&H after delivery was automatic. Didn’t matter if it was a smooth, uncomplicated vaginal birth with minimal blood loss or a complex emergency C-section- come 6:00 AM the next morning, someone was drawing blood. Historically, the logic felt airtight: First, visual estimation of blood loss (the EBL) during delivery is notoriously inaccurate; clinicians often underestimate heavy bleeding by as much as 30 to 50 percent. Second, severe postpartum anemia can be sneaky. A patient might look fine lying in bed, but an undetected crash in hemoglobin can lead to severe fatigue, impaired bonding, delayed recovery, or even delayed postpartum hemorrhage complications. And third, early detection meant early intervention- giving iron or transfusing blood before the patient got discharged home. It was standard, it was defensive, and it felt safe. But here is the million-dollar question: Is a blanket, universal Postpartum H&H actually evidence-based in modern obstetric care? Or are we just poking healthy, asymptomatic patients, driving up healthcare costs, and treating lab numbers instead of the clinical patient? Today we will be looking at what the major guidelines, including ACOG, actually say, and why target-based screening has long replaced universal testing. Let’s get into it!
1. Ruiz de Viñaspre-Hernández R, Gea-Caballero V, Juárez-Vela R, Iruzubieta-Barragán FJ.The definition, screening, and treatment of postpartum anemia: A systematic review of guidelines. Birth. 2021.
2. Anemia in Pregnancy: ACOG Practice Bulletin, Number 233.Obstetrics and Gynecology. 2021. Committee on Practice Bulletins—Obstetric
3. Muñoz M, et al. Patient blood management in obstetrics: management of anaemia and haematinic deficiencies in pregnancy and in the post-partum period: NATA consensus statement. Transfus Med. 2018 Feb;28(1):22-39