Dr. Chapa’s OBGYN Clinical Pearls

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.

Delayed cord clamp is standard of care. On today’s episode, we are stepping into a high-pressure dilemma in the labor and delivery room. Imagine this (which doesn’t need a lot of imagination, because it is a real event which occurred to one of our podcast family members): A mother has carefully drafted a birth plan. One of her non-negotiable requests is delayed cord clamping for two full minutes. But the moment the baby is delivered, it becomes clear that the infant is non-vigorous: floppy, pale, and not breathing. The baby urgently needs immediate resuscitation.

The physician reaches for the cord shears, but the mother demands: "No! Wait the two minutes! It's my decision!" What happens next? Whose rights win out? Today, we’re exploring clinical guidelines, the core ethical principles, the legal mandates, and state FOUR established norms that govern the delivering professional’s actions.

1. American College of Obstetricians and Gynecologists Committee on Clinical Consensus–Obstetrics. 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. doi: 10.1097/AOG.0000000000006020. PMID: 40706055.

2. Jabeen S, Salam SS, Gillespie S, Hasan M, Islam S, Chowdhury AT, Ameen S, Balen J, Rahman AE, Arifeen SE, Nahar Q, Anumba DO. Delayed cord clamping: Perceptions, practices and influencers among the healthcare providers of selected healthcare facilities in Bangladesh. PLoS One. 2024 Dec 5;19(12):e0313938.

Here is a sobering fact: Iron deficiency is one of the most common health conditions in the world. Iron deficiency affects an estimated one in three people, yet many go undiagnosed and untreated despite widespread treatment options. Iron deficiency can progress to iron deficiency anemia. If you’ve been listening for a while, you know we have banged the drum on this podcast time and time again about why serum ferritin matters. We’ve talked about how so many people suffer from low iron stores even when their basic blood work comes back looking "normal," and why we have to look way beyond just standard iron deficiency anemia. Well, guess what? The medical establishment is officially catching up! In September 2026, the American Society of Hematology (ASH) released brand new, evidence-based recommendations that are set to completely change how we diagnose iron deficiency. Published in ASH’s prestigious, peer-reviewed journal Blood Advances, these new guidelines were brought together by a multidisciplinary team of experts across multiple medical specialties to redefine critical thresholds- especially for women and during pregnancy. Today, we are diving deep into what these new guidelines actually mean for us. Listen in for details

1. https://www.hematology.org/newsroom/press-releases/2026/ash-sets-new-standards-for-diagnosing-iron-deficiency

2. https://ashpublications.org/bloodadvances/article/doi/10.1182/bloodadvances.2025015950/570502/American-Society-of-Hematology-2026-guidelines-for

Innie vs Outies: no, we are not referring to bellybuttons. In this episode, we’re talking about the labia of the Volva! Does it actually matter? Which one is more common? Now, this episode was actually sparked by a brilliant listener who sent us her question to our IG inbox (as a non-clinician): “Can having an innie labia actually cause me to have recurrent bacterial vaginosis?” Such a good question, right? So today, we’re going to break down what the medical literature actually says about anatomy and BV. Plus, well answer the question: What is ACOG’s stance on elective labioplasty? Grab a cup of coffee, get comfortable, and let’s normalize the normal.

1. Lykkebo AW, Drue HC, Lam JUH, Guldberg R. The Size of Labia Minora and Perception of Genital Appearance: A Cross-Sectional Study. J Low Genit Tract Dis. 2017 Jul;21(3):198-203. doi: 10.1097/LGT.0000000000000308. PMID: 28369012.

2. Aydın A, Atılgan AE, Sönmez MG, Sönmez L, Boğa MS, Balasar M. Do variations in labial anatomy have an effect on recurrent urinary tract infection? Int Urogynecol J. 2020 Oct;31(10):2129-2136. doi: 10.1007/s00192-020-04310-8. Epub 2020 May 9. PMID: 32388633.

3. Elective Female Genital Cosmetic Surgery. American College of Obstetricians and Gynecologists. 2020. Committee on Gynecologic PracticeGuideline

4. ACOG Committee Opinion 795: Elective Female Genital Cosmetic Surgery; 2020 (reaffirmed 2026)

Marfan syndrome is an autosomal dominant, connective tissue disorder. Because it’s autosomal dominant, an affected parent has a 50% chance of passing the genetic mutation to their offspring in every pregnancy. Approximately 25% of cases actually stem from spontaneous, de novo mutations with no prior family history. In the United States, the prevalence of Marfan syndrome is estimated at roughly 1 in 5,000 individuals. It affects males and females equally across all ethnic backgrounds. Although this topic and condition might sound rare at first glance- Marfan syndrome in pregnancy- it is in our communities, and we need to be ready for the potential complications that come with it. When is vaginal delivery allowable here? Do these patients need any maintenance meds during pregnancy? What about postpartum surveillance? Grab your coffee, get comfortable, and let's jump right in!

1. Elkayam U et al. High-Risk Cardiac Disease in Pregnancy: Part II. J Am Coll Cardiol. 2016 Aug 2;68(5):502-516. doi: 10.1016/j.jacc.2016.05.050.

2. Milleron O, Arnoult F, Delorme G, et al. Pathogenic FBN1 Genetic Variation and Aortic Dissection in Patients With Marfan Syndrome. J Am Coll Cardiol. 2020 Mar 3;75(8):843-853.

3. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022 Dec 13;80(24):e223-e393.

4. Narula N. et al. Pregnancy-Related Aortic Complications in Women With Marfan Syndrome. J Am Coll Cardiol. 2021 Aug 31;78(9):870-879.

If you’ve ever managed postpartum preeclampsia, you know the clinical gray zone: after an initial intrapartum course of magnesium sulfate, when do you actually restart it for a postpartum, readmission exacerbation? Always? There’s no standard national guidance on this. Every unit seems to do something a little different. In this episode, we’re summarizing a new study looking at practice patterns across the country. This study is actually a survey of US MFM fellowship directors across the ACOG Districts. This publication will be officiallyreleased/published in the Journal of Maternal-Fetal and Neonatal Medicine in December 2026. We’ll break down what these fellowship directors would do, why the variation exists, and what this means for your clinical practice. Let’sget into it.

1. Dellapiana G, Thompson K, Gregory KD. Repeatadministration of magnesium for an exacerbation of postpartum preeclampsia: anational survey. J Matern Fetal Neonatal Med. 2026 Dec;39(1):2738315. doi:10.1080/14767058.2026.2738315. Epub 2026 Sep 28. PMID: 42805980.

If you’ve been listening for a while, you might remember an episode we ran about two years ago where we dove deep into the use of low-titer O-positive whole blood in emergency resuscitation. At the time, the consensus in trauma care was leaning heavily "pro"—advocating for getting O-positive blood into bleeding patients fast, especially given the persistent and severe shortages of O-negative inventory. Fast forward to today, and the conversation around balancing immediate survival against downstream risks has taken center stage. In just the last two months, two major publications have come out with seemingly conflicting perspectives on this exact issue. First, in July 2026, the American College of Surgeons released their consensus guidance, which attempts to strike a delicate balance between saving lives in acute trauma and mitigating future reproductive risks associated with Rh sensitization in patients of childbearing potential. But then, in September 2026, Obstetrics & Gynecology—the Green Journal—published an editorial by Jacobs et al. offering a very different lens on the practice. In today's episode, we’re unpacking both papers, comparing where they align, where they clash, and what this evolving debate means for trauma protocols, blood bank management, and patient care on the front lines. Let’s dive in.

• ​Post-Transfusion Management of RhD-Negative Females of Childbearing Potential Who Receive RhD-Positive Low-Titer Group O Whole Blood and Red Blood Cells During Trauma Resuscitation: A Joint Position Statement and Resource Document of the American College of Surgeons Committee on Trauma (ACS-COT), Prehospital Blood Transfusion Coalition (PBTC), National Association of Emergency Medical Services Physicians (NAEMSP), Trauma Hemostasis and Oxygenation Research (THOR) Network, and Allo Hope Foundation (AHF). J Am Coll Surg. July 2026.2. Jacobs, J. W., Callum, J., Adkins, B. D., Abels, E. A., Raza, S., Sharma, D., Wheeler, A. P., Osmundson, S. S., Chooljian, D. M., & Booth, G. S. (2026). RhD-Positive Whole Blood for Patients With Reproductive Potential After Two Randomized Trials of Prehospital Trauma Resuscitation; Obstetrics & Gynecology.

In June 2026, the ASRM released its updated guidance on recurrent pregnancy loss. This is the most updated guidance in over a decade and includes a decision tree algorithm that starts with a pivotal test. In this episode we will review this “first pass” triage test and provide clinical implications.

1. ASRM CO: https://www.asrm.org/practice-guidance/practice-committee-documents/recurrent-pregnancy-loss-a-committee-opinion-2026/

2. de Assis V, Giugni CS, Ros ST. Evaluation of Recurrent Pregnancy Loss. Obstet Gynecol. 2024 May 1;143(5):645-659. doi: 10.1097/AOG.0000000000005498. Epub 2024 Jan 4. PMID: 38176012.

Currently, the CDC U.S. Medical Eligibility Criteria (USMEC) rate CHCs as category 4 (unacceptable health risk) for migraine with aura, versus category 2 for migraine without aura; ACOG similarly recommends avoiding estrogen-containing contraception in migraine with aura. But, recent data published in August 2026 from the UK seems to show no increased risk with “modern”/low-dose combination birth control pills when compared to progesterone only options. Is the CDC contraindication out outdated? Not quite. Listen in for details.

1. https://www.podcastrepublic.net/podcast/1412385746Ihara K, et al. Estrogen exposure from modern contraceptives and vascular risk in women with migraine: A nationwide electronic medical record database study. Cephalalgia. 2025 Dec;45(12):3331024251404924. doi: 10.1177/03331024251404924. Epub 2025 Dec 17.

2. Gibbs LR, Fox MP, Aparicio HJ, Jick S. Combined Oral Contraceptives and Stroke Risk in Individuals With Migraine With Aura. Obstet Gynecol. 2026 Aug 1;148(2):160-170. doi: 10.1097/AOG.0000000000006306. Epub 2026 May 7.

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

If you’ve been following health and medical headlines over the past few weeks, you’ve likely seen a renewed and urgent conversation around postpartum depression—a condition that affects millions of new mothers worldwide, often with devastating consequences. While we’ve long understood that postpartum depression is deeply multifactorial—shaped by a complex web of hormonal shifts, psychological stressors, and socio-economic factors—a compelling wave of new data points to a key physical variable that might be playing a far bigger role than we previously realized: how we manage pain during cesarean deliveries. Specifically, emerging studies are highlighting a striking potential association between the use of general anesthesia during C-sections and a higher risk of subsequent postpartum depression compared to neuraxial options like epidurals or spinal blocks. Why would the choice of anesthetic in the operating room ripple into neurochemical changes weeks or months later? In today’s episode, we’re going to dive deep into this latest data. We’ll break down what the numbers actually tell us, examine the clinical nuances, and explore the potential biological and neuroendocrine mechanisms of action—from acute inflammatory cascades to neurotransmitter disruption—that could explain this link.

1. Oh TK, Song IA. Neuraxial versus General Anesthesia for Cesarean Delivery and the Risk of Postpartum Depression: A Nationwide Population-Based Study. Anaesth Crit Care Pain Med. 2026 Jun 3:101871. doi: 10.1016/j.accpm.2026.101871. Epub ahead of print. PMID: 42242358.

2. Fagan JJ, Dufour SI, Duet SJ, Downs EM, Siddaiah H, Viswanath O, Shekoohi S, Kaye AD. Influence of Neuraxial Anesthesia Technique During Vaginal and Cesarean Delivery and Association with Postpartum Depression: A Narrative Review of Literature. Neuropsychiatr Dis Treat. 2026 Apr 14;22:579920.

3. Guglielminotti J, Monk C, Russell MT, Li G. Association of General Anesthesia for Cesarean Delivery with Postpartum Depression and Suicidality. Anesth Analg. 2025 Sep 1;141(3):618-628.

4. Xie SC, Liu CH, Hung YT. Association between postpartum depression and anaesthesia methods in women undergoing caesarean section: A systematic review and meta-analysis. Eur J Anaesthesiol. 2026 Jan 1;43(1):66-73. doi: 10.1097/EJA.0000000000002252. Epub 2025 Aug 6. PMID: 40771157.

MS is a complex polygenic disease with over 200 associated genetic variants. The risk of an offspring developing MS if one parent is affected is relatively low at 2% to 3% (though maternal transmission shows slightly higher heritability), with some possible epigenetic influences. The National Multiple Sclerosis Society reports that up to 4 times as many women have MS as men. The average age at MS diagnosis is around 30 years. Studies show this ratio has grown over the past several decades; in the mid-20th century, the ratio was roughly 2:1, but the proportion of affected females has steadily increased due to a combination of environmental, hormonal, and diagnostic factors. MS does not impair natural fertility, so OB providers should be aware of the effect of pregnancy on MS and vice verse. In this episode, we will review a brand new (as of Aug 8, 2026) expert review on the subject which was published in the AJOG. Over the last decade, clinical guidance has shifted from advising women with MS to avoid pregnancy to a more active and permissive stance, largely due to the advent of new pharmacological and biologic therapies. Listen in for details.

1. Balshi A, et al. Management of Multiple Sclerosis During Pregnancy and the Reproductive Years in 2026: An Expert Clinical Review, American Journal of Obstetrics and Gynecology (2026), doi: https://doi.org/10.1016/j.ajog.2026.08.043.

The ACOG PB 222 states, “In women with preeclampsia with severe features at less than 34 0/7 weeks of gestation, with stable maternal and fetal condition, expectant management may be considered”. The expectant management of preeclampsia with severe features before 34 0/7 weeks of gestation is based on strict selection criteria of those appropriate candidates and is best accomplished in a setting with resources appropriate for maternal and neonatal care. BOX 4 in that ACOG guidance lists “Conditions Precluding Expectant management”, with one of the conditions being “Uncontrolled severe-range blood pressures (persistent systolic blood pressure 160 mm Hg or more or diastolic blood pressure 110 mm Hg or more not responsive to antihypertensive medication” (i.,e. persistent and refractory to appropriate medication). But what defines “uncontrolled hypertension”? When is preterm delivery indicated based on that feature? In this episode, we will answer this real-world clinical question. So, for a patient who is otherwise stable, asymptomatic, without HELLP syndrome, whose fetus is stable but is under 34 weeks, when can “uncontrolled hypertension” be diagnosed to prompt delivery? Listen in for details as we highlight the 2022 SMFM Special Report on that matter.

1. ACOG PB 222

2. SMFM Special report: Preeclampsia: a report and recommendations of the workshop of the Society for Maternal-Fetal Medicine and the Preeclampsia Foundation, Nov 2022

3. De Backer J, Haugaa KH, Hasselberg NE, et al. 2025 ESC Guidelines for the Management of Cardiovascular Disease and Pregnancy. European Heart Journal. 2025

4. SOGC Clinical Practice Guideline: Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy: Executive Summary; No. 307, May 2014

5. ISSHP (2018): The hypertensive disorders of pregnancy: ISSHP classification, diagnosis & management recommendations for international practice. Preg Hypertension. chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/http://www.isshp.org/wp-content/uploads/2018/06/1-s2.0-S2210778918301260-main.pdf

So, here is a not uncommon situation: A new OB patient presents for initial prenatal care at 28 weeks by “sure LMP” but her ultrasound EGA is just over 3 weeks behind. Simple redating, right? How can we be assured that we are not missing FGR? That is where the “ancillary” use of transcerebellar diameter (TCD) plays a role. In this episode, we will highlight the recent JUNE 2026 data on this and review the 4 scenarios when this supplemental ultrasound finding can play a vital role.

1. Fetal Transcerebellar Diameter Measurement With Particular Emphasis in the Third Trimester: A Reliable Predictor of Gestational Age. AJOG. 2004.

2. Elgadi A, Wagealla M, Idris E, Eissa AYH, Altraifi S, Altraifi H, Abdallah E, Noorallah T, AbdAlla E. Accuracy of Ultrasonographic Transcerebellar Diameter for Gestational Age Estimation: A Systematic Review and Meta-Analysis. J Clin Ultrasound. 2026 Jun 17.

3. ACOG Committee on Obstetric Practice. Committee Opinion No 700: Methods for Estimating the Due Date.Obstetrics and Gynecology. 2017.

4. Arzik IG, Golbasi H, Can ST, Aktas HA, Cakir ZE, Purut CS, Torun R, Toka I, Oztataroglu C, Ekin A. Role of Transcerebellar Diameter in Estimating Gestational Age in the Third Trimester: A Comparative Analysis in Fetuses With Different Growth Patterns. J Ultrasound Med. 2026 Apr;45(4):895-903.