Dr. Chapa’s OBGYN Clinical Pearls

Yes, we have covered cervical cancer screening many, many times on this show. It is truly a testament to science and research just how far we have come from using slide-based cytology for cervical cancer screening. Primary high-risk HPV, as a screening modality, has been favored for many years and is now officially part of the age-based, ACOG cervical cancer screening guideline (July 2026). We will summarize that update in this episode. Plus, we will also review about what to do when the hrHPV expanded genotype panel returns positive for 56/59/66. Modern cervical screening reports frequently refer to HPV 56, 59, and 66, typically grouping them together into a single pooled result (often labeled as a trio "HPV 56/59/66"). This is due to the widespread adoption of extended HPV genotyping technology. WE, what do we do with that? Listen in for details.
1. ACOG Committee Statement No. 28: Screening for Cervical Cancer; July 2026
2. Massad LS, Clarke MA, Perkins RB, Garcia F, Chelmow D, Cheung LC, Darragh TM, Egemen D, Lorey TS, Nayar R, Newman M, Risley C, Smith RA, Wentzensen N; Enduring Consensus Cervical Cancer Screening and Management Guidelines Committee. Applying Results of Extended Genotyping to Management of Positive Cervicovaginal Human Papillomavirus Test Results: Enduring Guidelines. J Low Genit Tract Dis. 2025 Apr 1;29(2):134-143. PMC11939109.

If you work in women’s health, you already know the golden rule: just when you think you’ve got a guideline memorized, the ink dries, and the updates drop. Medicine moves fast, and this month is no exception. Today, we are diving straight into the fresh-off-the-press October 2026 ACOG Practice Advisory on Premature Ovarian Insufficiency. Now, if you’re thinking, 'Wait, didn’t ACOG just reaffirm their POI guidance last year in 2025?'- you aren't crazy! They did. But clinical evidence doesn't wait around. ACOG has officially updated its stance to align directly with international consensus from ESHRE-the European Society of Human Reproduction and Embryology. So, what actually changed? How are we shifting our diagnostic thresholds, workups, and long-term hormone replacement strategies for these patients? We're covering all of it-the new shifts, the clinical pearls, and what you need to change in your practice starting today. Let’s get into it.
1. ACOG PA POI October 2026
2. ACOG Committee Opinion No. 605, Primary Ovarian Insufficiency in Adolescents and Young Women; July 2014.

Back in 2021, we discussed the FDA approval of a combination GNRH antagonist (relagolix) with estradiol and norethindrone. This was originally approved to treat uterine fibroid related heavy menstrual bleeding. It is also now approved for endometriosis care. In theory, this should also be an effective contraceptive agent. However, the FDA label strictly cautions against its use for birth control. In this episode, we will discuss data from the recent ASRM 2026 annual conference that looked at this medication's ability to possibly function as hormonal contraception. But there is a catch. Listen in for details.
1. https://www.medscape.com/viewarticle/fibroid-drug-relugolix-may-act-contraceptive-2026a10015db
2. Myfembreehcp.com

Today, we’re diving into a topic that has completely transformed prenatal care over the past decade—non-invasive prenatal testing, or NIPT. Thanks to recent technological leaps, cfDNA, cell-free fetal DNA, is giving us unprecedented visibility through just a simple maternal blood draw. Take Fetal Focus by Natera, for example, or the UNITY Reflex Screen from BillionToOne. These options offer single-gene NIPT that can evaluate fetal risk for specific autosomal recessive conditions, like cystic fibrosis, spinal muscular atrophy, or sickle cell disease, to better risk stratify the fetus without going immediately to an invasive diagnostic test. Similarly, The UNITY CONFIRM option also evaluates whether a fetus is at low or high risk for fetal aneuploidies—chromosomal conditions like Trisomy 21, 18, and 13 up to a set gestational age as an alternative to amniocentesis, although that is still considered a screening test. That specialized test uses intact circulating fetal cells to non-invasively help assess aneuploidy risk without an immediate invasive procedure. But what happens when the maternal carrier screen comes back positive for a complex genetic variant, specifically a Fragile X mutation (an FMR1 gene expansion)? Should that automatically trigger a referral for diagnostic testing? In this episode, we’re going to cover exactly how Fragile X inheritance works, why current non-invasive technologies hit a wall with repeat expansion disorders, and what clinical decision steps patients and providers need to take next.
1. Carrier Screening for Genetic Conditions; ACOG CO NUMBER 691. MARCH 2017
(REAFFIRMED 2025)
2. https://utswmed.org/medblog/fragile-x-syndrome-pregnancy/

Choline is not a nutrient that the human body can synthesize in sufficient quantities; it must be obtained from dietary sources (eggs, meat, fish, dairy products, grains, and nuts). Its a water-soluble amine that serves as a precursor for phospholipids, which are vital components of cell membranes. Plus, it’s a vital component of acetylcholine, a neurotransmitter involved in numerous brain functions. Inadequate choline intake during fetal organogenesis is associated with neural tube defects and cognitive deficits in offspring. In the mother, low choline use has been associated with preeclampsia, preterm birth and possible fetal growth restriction. While choline is crucial for fetal development and maternal outcomes, studies suggest that many pregnant women don’t meet the recommended dietary intake, potentially risking maternal and fetal health. ACOG recommends that pregnant women consume 450 mg of choline each day, although there is no universal internationally agreed upon dose for proper maternal supplementation. Of note, the current recommendations for pregnant women were set in 1998 and were based on the amount of choline needed to prevent liver dysfunction in men, not on the more relevant outcome of offspring neurocognitive development. In this episode, we will highlight a new RCT (Article in Press-AJOG; Oct 19, 2026) on Choline supplementation in pregnancy and early childhood behavioral and cognitive outcomes. While the results were promising, there are some limitations to this study. Listen in for details.
1. Jaiswal A, Dewani D, Reddy LS, Patel A. Choline Supplementation in Pregnancy: Current Evidence and Implications. Cureus. 2023 Nov 8;15(11):e48538. doi: 10.7759/cureus.48538. PMID: 38074049; PMCID: PMC10709661.
2. Hunter S, Hoffman M, Law A .Prenatal Maternal Phosphatidylcholine and Children’s Behavior and Cognition through 4 Years of Age: Randomized Clinical Trial. American Journal of Obstetrics & Gynecology, 2026;
3. Bahnfleth CL, Strupp BJ, Caudill MA, Canfield RL. Prenatal choline supplementation improves child sustained attention: A 7-year follow-up of a randomized controlled feeding trial. FASEB J. 2022 Jan;36(1):e22054.
4. Cai F, Young BK, Mccoy JA. Commercially Available Prenatal Vitamins Do Not Meet American College of Obstetricians and Gynecologists Nutritional Guidelines. Am J Perinatol. 2024 May;41(S 01):e2547-e2554.