Dr. Chapa’s OBGYN Clinical Pearls

There is no denying it, you know of one or MORE individuals or patients currently on a GLP1 agent. Although not FDA approved for PCOS as a stand-alone diagnosis, there is growing evidence supporting their offlabel use in PCOS, and international guidelines now include them as a conditional recommendation. In women, the weight loss associated with these medications may trigger the return of spontaneous ovulation, making mistimed pregnancy a possibility. A key study by Sanz and Blázquez (back in 2011) demonstrated that both GLP-1 and the GLP-1 receptor are present in mouse embryos as early as embryonic day 6 (E6) and continue through the first trimester, as well as in pluripotent mouse embryonic stem cells. In these undifferentiated cells, GLP-1 modified the expression of endodermal, ectodermal, and mesodermal gene markers, as well as critical developmental signaling molecules. So, there is a concern about embryogenesis if inadvertent exposure to these meds occurs in early pregnancy. In this episode, we will summarize 2 recent and separate systematic reviews (March 2026; April 2026) on fetal/OB outcomes after periconceptional exposure. This builds on the Parker data set from 2025. One of these reviews, from April 2026, is also a meta-analysis. Listen in for details.

1. Ozbek L, Shah E, Al-Shiab R, Inal A, Guldan M, Afsar B, Covic A, Kanbay M. Safety of GLP-1 and Dual GLP-1/GIP Receptor Agonists in Preconception, Pregnancy, and Lactation: A Systematic Review of Maternal, Fetal, and Neonatal Outcomes. Diabetes Obes Metab. 2026 Mar 26. https://pubmed.ncbi.nlm.nih.gov/41885132/
2. Hakim J, Rajesh D, Tello J. Neonatal and Obstetric Outcomes Following Periconceptional Exposure to Glucagon-Like Peptide-1 Receptor Agonists: A Systematic Review and Meta-analysis. AJOG; April 28, 2026; https://www.ajog.org/article/S0002-9378(26)00222-X/fulltext
3. Parker CH, et al. Glucagon-Like Peptide 1 (GLP-1) Receptor Agonists' Use During Pregnancy: Safety Data From Regulatory Clinical Trials. Diabetes, Obesity & Metabolism. 2025.

The belief that IV dextrose is necessary to clear ketones in hyperemesis gravidarum originated from a logical, and now known to be outdated, extrapolation of basic starvation ketosis physiology and the treatment paradigm for diabetic ketoacidosis (DKA). The original experiments that led to this conclusion go back to the 1960s (Foster data). Not only is this outdated, but it is also physiologically incorrect. We’ve learned a lot about IV fluid replacement about hyperemesis gravidarum in the last several years- in the last data review was in January 2026 in Lancet. Even the correction of hyponatremia has evolved. Should we be following urine ketones for patients being treated for HG? Is Dextrose needed? Listen in for details.
1. Nana M, Painter R, Williamson C et al. Hyperemesis gravidarum. The Lancet, Jan 2026; 407, 78-89
2. Clark SM, Zhang X, Goncharov DA. Inpatient Management of Hyperemesis Gravidarum. Obstet Gynecol. 2024 Jun 1;143(6):745-758. doi: 10.1097/AOG.0000000000005518. Epub 2024 Feb 1. PMID: 38301258.
3. Ayus JC, et al.Correction rates and clinical outcomes in hospitalized adults with severe hyponatremia: a systematic review and meta-analysis. JAMA Intern Med. 2025;185(1):38-51.
4. ACOG Clinical Epert Series: Inpatient Management of Hyperemesis Gravidarium. Obstet Gynecol; 2024

AUDIO EXCERPT from our recent Instragm post on this Social Media trend. Silly or Science? Listen in for details.

Uterine compression sutures are effective, uterus-sparing techniques for managing severe postpartum hemorrhage (PPH) due to atony, avoiding hysterectomy. Keytypes include the B-Lynch suture (vertical, brace-like), Hayman suture (simplified vertical), and Pereira sutures (multiple, comprehensive sutures), and Cho Compression (quadrant square anterior to posterior closures), are applied when pharmacological methods fail. But these, while helpful with atony, do not address the LUS bleeding from previa which are below these applications. Even the O’Leary lateral sutures are often higher tha the bleeding and thin, anterior LUS affected by previa. Previa is a significant risk factor for PPH. In this episode, we will highlight 3 novel suture techniques which have been in print (TWO as recent as January 2026) which can be effective in stopping the LUS bleeding and avoiding hysterectomy. We will highlight the transverse circumferential purse string, the simple transverse Nausicaa suture, and theLUS WaveForm suture. These are easy to use and may be lifesaving.
1.   Shih J, Li J, Kang J .The Nausicaä suture in the management of the placenta accreta spectrum. AJOG. Jan 2026: 233, S671-S688 S
2.   Transverse Purse String Suture for Placenta Previa in the Presence of Previous Cesarean Section, Experience in Northern Borders Saudi Arabia. 2022
3.    Zhou L et alWave compression suture: A modifieduterus-preserving treatment for placenta previa by reconstruction of the lower uterine segment. Medicine (Baltimore). 2026 Jan 30;105(5):e47468.

(From our Instagram Video Post): A very quick recap of the brand new ACOG Cervcial Caner Screening Update from April 24, 2026.