Dr. Chapa’s OBGYN Clinical Pearls

As I have said many times before, some podcast ideas come from REAL clinic encounters. In this episode, Dr Hanna V, our dedicated PGY1 on our call team, and I will answer TWO real questions which arose just today on morning rounds, on our service: 1. Does NORMOTENSIVE HELLP still need Mag Sulfate? And 2. Does an indwelling foley s/p iatrogenic bladder injury at CS require prophylactic antibiotic coverage for urinary infection? Yep: It’s a BOGO sale on today’s podcast- Buy ONE GET ONE! Listen in for details.
1. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222.
Obstetrics and Gynecology. 2020. Committee on Practice Bulletins—ObstetricsGuideline
2. Woudstra DM, Chandra S, Hofmeyr GJ, Dowswell T.SR. Corticosteroids for HELLP (Hemolysis, Elevated Liver Enzymes, Low Platelets) Syndrome in Pregnancy.
The Cochrane Database of Systematic Reviews. 2010.
3. Joshi D, James A, Quaglia A, Westbrook RH, Heneghan MA.Liver Disease in Pregnancy. Lancet. 2010. Review
4. Rimaitis K, Grauslyte L, Zavackiene A, et al.Observational. Diagnosis of HELLP Syndrome: A 10-Year Survey in a Perinatology Centre. International Journal of Environmental Research and Public Health. 2019
5. Reau N, Munoz SJ, Schiano T.Guideline Liver Disease During Pregnancy.
The American Journal of Gastroenterology. 2022.
6. ACG Clinical Guideline: Liver Disease and Pregnancy.
The American Journal of Gastroenterology. 2016. Tran TT, Ahn J, Reau NS.
7. ACOG Practice Bulletin No. 195: Prevention of Infection After Gynecologic Procedures. Obstetrics and Gynecology. 2018. Committee on Practice Bulletins—Gynecology Guideline
8. Niels Johnsen, Hunter Wessells, Krystal Archer-Arroyo, et al. Best Practices Guidelines Management of Gentiunrinary Injuries.American College of Surgeons (2025). 2025
9. Fletke KJ, Jeong DH, Herrera AV . Urinary Catheter Management. American Family Physician. 2024..

Hantavirus was first discovered in the early 1950s near the Hantaan River in South Korea. The US has seen this before: the 1993 Four Corners outbreak was the first recognition of the virus in the United States, causing a deadly respiratory syndrome. Now, Hantavirus is in the news again with 17 Americans currently (5.10.26) enroute back to the US for specialized observation. In this episode, we will briefly review what this virus does and cover the SPARSE data we have regarding hantavirus infection in pregnancy.
1. Gilson GJ, Maciulla JA, Nevils BG, et al. Hantavirus Pulmonary Syndrome Complicating Pregnancy. American Journal of Obstetrics and Gynecology. 1994.
2. 5.10.26: https://www.nbcnews.com/health/health-news/hantavirus-stricken-cruise-ship-arrives-tenerife-rcna344318
3. Janwadkar RS, Ritchie HM, Johnson CA. Unexpected Challenges: A Case Report of Hantavirus Infection in a Pregnant Patient in a Rural Emergency Department. The Journal of Emergency Medicine. 2025.

Uterine hysterotomy unintended extensions happen. For sure. This has been analyzed over many years, and it is still making news. Look at this mini-timeline: Back in 2018, authors published “Unintended hysterotomy extension during caesarean delivery: risk factors and maternal morbidity”. Moving up the timeline to 2020, others published in J Maternal-Fetal Neonatal Medicine, “Risk factors for uterine incision extension during cesarean delivery”. Then in 2024, in the PINK journal, authors published a related study, “The association between unintended hysterotomy extensions with cesarean delivery and subsequent preterm birth”. In this episode, we will review a new narrative review (in the Green Journal, May 3, 2026) of unintended hysterotomy extension at C-section. We will summarize known risk factors and focus on subsequent uterine rupture risk. Does unintended hysterotomy extension at CS increase TOLAC uterine rupture? It’s complicated. Listen in for details.
1. Giugale LE, Sakamoto S, Yabes J, Dunn SL, Krans EE. Unintended hysterotomy extension during caesarean delivery: risk factors and maternal morbidity. J Obstet Gynaecol. 2018 Nov;38(8):1048-1053.
2. Epub: Unintentional Extensions of the Cesarean Hysterotomy Incision. A Review and Proposed Classification System (May 3, 2026)

Genome-wide noninvasive prenatal testing (GW-NIPT) was introduced in 2015 and became widely available in 2019. Nonetheless, we are still learning more about this important prenatal screening test. In January 2026, the ACOG released a new PA on this, which we will also review in this episode. Our main publication ti review, however, will be the AJOG May 2026’s systematic review and meta-analysis on the finding of “genome-wide” cfDNA discordant results and what this may mean for the pregnancy. Although rare, this may lead (over a third of cases) to some adverse perinatal issues. Listen in for details.

1. ACOG PA Jan 2026: Screening for Fetal Chromosomal Abnormalities
2. AJOG May 2026: https://click.notification.elsevier.com/CL0/https:%2F%2Fwww.ajog.org%2Farticle%2FS0002-9378(25)00865-8%2Ffulltext%3Fdgcid=raven_jbs_etoc_email/1/0100019d9ec37d7b-c586438d-021a-4097-8db3-c158e6f97c9b-000000/Vq6ksekOuvTxcv8OEZZ2uBesCg_hG6qlhqU_BlCnAK4=452

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.