Dr. Chapa’s OBGYN Clinical Pearls

ACOG first recommended antiviral suppressive therapy at 36 weeks of gestation for women with a history of genital herpes in 2007, with the publication of Practice Bulletin No. 82 ("Management of Herpes in Pregnancy," June 2007). This was the first ACOG practice bulletin specifically dedicated to genital herpes management in pregnancy, and it established the 36-week suppressive therapy recommendation based on the RCTs available at that time (including the Watts 2003, Sheffield 2006, and Andrews 2006 trials). The recommendation was subsequently reaffirmed and updated in Practice Bulletin No. 220, published in May 2020, which is the current version. However, these trials had patients who ultimately delivered at/after 38 weeks. In a patient with a history of genital HSV for whom suppression is recommended but who will have a medically indicated delivery at 37 weeks, say for a hypertension disorder of pregnancy, is 36 week initiation of HSV antiviral medication enough time for suppression? There is a gap in high quality data on this. In this episode, we will review the published data and reach a clinical decision as to whether one week suppression is enough, or if initiation earlier is reasonable.
1. ACOG PB 82
2. ACOG PB 220

Today, we’re diving straight into a topic that hits close to home for millions of patients and providers alike: IUD insertion pain, and more importantly, how we can actually make it better. Now, if you’ve been practicing or following clinical guidelines for a while, you know the frustrating backstory here. For years, the standard advice was simple: "Just take 800 milligrams of ibuprofen an hour before your appointment." But a 2015 double-blinded, randomized placebo-controlled clinical trial showed that taking a single dose of 800 mg within an hour before insertion did not relieve procedural pain. That was published in the journal Contraception in 2015. This left clinicians wishing for better options. Fast forward to 2024, when the CDC updated its guidelines to formally recommend local analgesia, like lidocaine blocks or topical use, to help manage insertion pain. That was a huge, long-overdue win for patient-centered care. But local numbing isn't the only tool we should be looking at. What if the issue with oral NSAIDs wasn't the medication itself, but how and when we dosed it? That brings us to a brand-new study published in the American Journal of Obstetrics and Gynecology (AJOG), August 2026. Researchers looked at a preemptive, multidose ibuprofen regimen- starting the day before insertion to reach sustained, therapeutic blood levels ahead of time. And the results? They offer some new insights into how we can stack our pain control strategies. So, let's break down what this study found, how it builds on our CDC guidance, and what it means for our clinical practice starting at our next IUD placement. Let’s jump in.
1. Bednarek PH, Creinin MD, Reeves MF, et al. Contraception. 2015;91(3):193–197.
2. Ouyang C, Lamvu G, Quach H, et al. Multidose Ibuprofen Prior to Intrauterine device insertion (MIPI): a triple blinded randomized controlled trial. American Journal of Obstetrics & Gynecology, August 2026; 235, 330-337
3. Management of Premenstrual Disorders: ACOG Clinical Practice Guideline No.7 Obstetrics and Gynecology. 2023. Committee on Clinical Practice Guidelines–Gynecology
4. McKenna KA, Fogleman CD. Dysmenorrhea.American Family Physician. 2021.

Podcast family, we pride ourselves on this show on being avant-garde and forward thinking on the topics we choose. For example, on February the 20th, 2026, we released an episode called “New Data: Screen Maternal Ferritin with Prenatal Care?” In that episode we reviewed a publication from the previous month (January 2026) that was released in Lancet Hematology. This study made the case for screening for early iron deficiency, even without anemia, with serum ferritin at the initiation of prenatal care. This was a multicenter, 2-arm, randomized controlled trial. Earlier identification of low serum ferritin prevented iron deficiency anemia in the third trimester. That's a win! Back then, we also stated how Australia has been leading the charge on this with the Australian HOW. That stands for Hematology in Obstetrics and Women's Health. This Australian consensus committee now recommends screening for iron deficiency, not just iron deficiency anemia, at the initiation of prenatal care, at 24 to 28 weeks, and then again at the third trimester when necessary. And now, as of August 2026, we have additional supportive data that including serum ferritin at the initial OB visit is evidence-based and best for the patient! In this episode we will review this brand-new, prospective cohort study published as a Research Letter in the AJOG August 2026.
1. Australian HOW: Iron optimisation in pregnancy: a Haematology in Obstetric and Women's Health Collaborative consensus statement; https://onlinelibrary.wiley.com/doi/10.1111/imj.16602
2. Konecke N, Jackson T, Angeles I. et al. The association between first trimester iron deficiency without anemia and the development of iron-deficiency anemia prior to childbirth. American Journal of Obstetrics & Gynecology, 2026; 235, e36-e38
3. ACOG Clinical Practice Update: An Update to Clinical Guidance for Delayed Umbilical Cord Clamping After Birth in Preterm Neonates. Obstet Gynecol. 2025 Jul 24;146(3):442-444.

If you’ve scrolled through your feeds recently, you’ve probably seen the video that’s causing a stir: a prominent infertility doctor sharing her “Hot Take” personal observations on social media, claiming that IUDs are a hidden cause of intrauterine adhesions- or severe uterine scar tissue. Now, Listen. It is completely natural to see a specialist standing in a white coat making a passionate claim and think, "Wow, should I be worried about my birth control?" But here is the reality we need to establish right out of the gate: a handful of individual cases shared online is the very definition of anecdotal evidence. It does not fulfill the criteria of rigorous scientific observation. When we pull back from the algorithm and look at the actual clinical data involving millions of IUD users worldwide, the science shows us something completely different. In fact, large-scale studies demonstrate that IUDs do not cause this scarring—and historically, certain models have actually been used to prevent the uterine walls from sticking together during post-surgical healing. So today, we are separating the scrolling panic from the actual science. We have REA data from the recent FACT (Fertility After Contraceptive Termination) study from 2021 (AJOG). We’re breaking down what the data really says, why the internet loves a medical scare, and the true, proven causes of intrauterine adhesions.
1. Abel MK, Wald K, Cedars MI, Noel M. Uterine Synechiae After Intrauterine Device Use: A Case Series. Journal of Assisted Reproduction and Genetics. 2021.
2. Chung E, Wang F, Zhang J, Strug M, Aghajanova L, Lathi R. The impact of prior hormonal intrauterine device (IUD) use on endometrial lining thickness in the fertility clinic setting: a retrospective cohort study. J Assist Reprod Genet. 2026 Jun 25. doi: 10.1007/s10815-026-03950-x. Epub ahead of print. PMID: 42347902.
3. Peipert JF, Zhao Q, Schreiber CA, Teal S, Turok DK, Natavio M, Cordon S, Daggy J. Intrauterine device use, sexually transmitted infections, and fertility: a prospective cohort study. Am J Obstet Gynecol. 2021 Aug;225(2):157.e1-157.e9. doi: 10.1016/j.ajog.2021.03.011. Epub 2021 Mar 11. PMID: 33716075.

Antenatal corticosteroids are a MAJOR win in the management of preterm labor. An initial course of antenatal corticosteroids has been shown to reduce morbidity and mortality in patients with preterm prelabor rupture of membranes. For patients who remain undelivered after the initial course of antenatal corticosteroids, it is uncertain whether a booster course of antenatal corticosteroids reduces neonatal morbidity or increases the infection risk. The ACOG, in its current guidance, has concluded that the current evidence is insufficient to make a recommendation. Corticosteroids, especially at the doses given, are also powerful immunosuppressants. When you administer that first course, you accept a minor, calculated risk for a massive, proven benefit. But when you introduce a second course of steroids into a uterine environment that has already been ruptured and exposed to vaginal flora for weeks, you are pouring fuel on the fire. PLUS, the environment for the fetus with prolonged preterm prelabor rupture of membranes is unique. PPPROM, the chronic exposure to ruptured membranes and the resultant oligohydramnios is theorized to trigger a kind of stress response in the fetus- so the baby may make their own endogenous corticosteroid flare. So, rescue steroids after an initial course of steroids in PPROM cases has remained controversial but we have updated data that has provided new insights. In this episode, we will highlight an RCT from 2023 and a more recent systematic review and meta-analysis from May 2026 on this very subject. Listen in for details.
1. Garite TJ, Kurtzman J, Maurel K, Clark R; Obstetrix Collaborative Research Network. Impact of a 'rescue course' of antenatal corticosteroids: a multicenter randomized placebo-controlled trial. Am J Obstet Gynecol. 2009 Mar;200(3):248.e1-9. doi: 10.1016/j.ajog.2009.01.021. Erratum in: Am J Obstet Gynecol. 2009 Oct;201(4):428. PMID: 19254583.
2. Tenbrink E, Quain A, Rone V, Harris K, Hadley E, Haas D, Shanks A. Risk of Neonatal Sepsis With Rescue Steroids in Preterm Premature Rupture of Membranes. Cureus. 2023 Apr 6;15(4):e37207. doi: 10.7759/cureus.37207. PMID: 37159785; PMCID: PMC10163895.
3. Melamed N, Murphy KE, Pylypjuk C, et al. Timingof Antenatal Corticosteroid Administration and Neonatal Outcomes. JAMA Netw Open. 2025;8(5):e2511315.
4. Porreco R, Garite TJ, Combs CA, Maurel K, Huls CK, Baker S, Fortner KB, Longo SA, Nageotte M, Lewis D, Tran L; Obstetrix Collaborative Research Network. Booster course of antenatal corticosteroids after preterm prelabor rupture of membranes: a double-blind randomized trial. Am J Obstet Gynecol MFM. 2023 May;5(5):100896. doi: 10.1016/j.ajogmf.2023.100896. Epub 2023 Feb 14. PMID: 36796641.
5. Da Costa Y, Ramanathan V, Oliveira JA, Brito J, Yousif A. Repeat versus Single Course of Antenatal Corticosteroid in Management of Preterm Premature Rupture of Membranes: A Systematic Review and Meta-analysis. Am J Perinatol. 2026 May;43(7):925-932. doi: 10.1055/a-2708-5314. Epub 2025 Oct 9. PMID: 41067234