Dr. Chapa’s OBGYN Clinical Pearls

Outside of pregnancy, guidelines emphasize diabetes self-management education and support to facilitate informed decision making, self-care behaviors, problem solving, and active collaboration with health care professionals. This includes, in those with good health literacy, the concept of patient-led self-titration of basal insulin results which has data that it improves glycemic management compared with clinician-led titration for type 2 diabetes among nonpregnant adults. But what about for GDM? Can patient’s self manage their BASAL insulin? In this episode, we will review a new RCT published in April 2026 in the Green Journal on this very subject. As novel as this is, it is not the first to report on this as it was also published (retrospective study in the UK) in 2022. This is a novel approach to insulin in GDM but there are some questions that remain. Listen in for details.
1. Boonpattharatthiti K, Wechkunanukul K, Mayang N, et al . Comparison of Insulin Titration Strategies for Glycemic Control in Type 2 Diabetes: A Systematic Review and Network Meta-Analysis.Diabetes Care. 2025.
2. Valent, Amy M. DO, MCR; Barbour, Linda A. MD, MSPH. Insulin Management for Gestational and Type 2 Diabetes in Pregnancy. Obstetrics & Gynecology 144(5):p 633-647, November 2024. | DOI: 10.1097/AOG.0000000000005640
3. Wang, Xiao-Yu MD; Gabbe, Steven MD; Landon, Mark B. MD; Venkatesh, Kartik K. MD, PhD et al. Patient-Led Insulin Titration for Glycemic Management With Gestational Diabetes Mellitus: A Randomized Controlled Trial. Obstetrics & Gynecology 147(4):p 501-509, April 2026.
4. McGovern AP, Hirwa KD, Wong AK, et al. Patient-led rapid titration of basal insulin in gestational diabetes is associated with improved glycaemic control and lower birthweight. Diabet Med. 2022;39:e14926. doi: 10.1111/dme.14926

Hyperemesis gravidarum (HG) represents the most severe end of the nausea and vomiting of pregnancy spectrum. It has a reported incidence of approximately 0.3–3% of pregnancies and is the most common cause of hospitalization in early pregnancy and the second most common cause of hospitalization in pregnancy overall. In June 2024, the ACOG published a Clinical Expert series summarizing the inpatient management of HG. In that guidance, it describes mirtazapine as an “alternative pharmacologic” option. How effective is this medication compared to ondansetron? A new study (published ahead of print on 12/30/25 and officially out June 2026), out of Denmark, sheds some new light on this medication. This trial is the first double-blind RCT comparing mirtazapine to ondansetron AND placebo. Although a BIG limitation of this study exists (which we will discuss), it does provide some interesting insights. Listen in for details.

1. (ACOG CES) Clark, Shannon M. MD; Zhang, Xue MD; Goncharov, Daphne Arena MD. Inpatient Management of Hyperemesis Gravidarum. Obstetrics & Gynecology 143(6):p 745-758, June 2024. | DOI: 10.1097/AOG.0000000000005518
2. Ostenfeld, AnneDroogh, Marjoes et al.Mirtazapine or ondansetron for hyperemesis gravidarum. A randomized placebo-controlled trial. American Journal of Obstetrics & Gynecology, June 2026

Cervical exams can be tricky for the novice practitioner. Think about this: it’s a blind exam, we measure that distance using only two fingers, through a layer of tissue, sometimes with a patient moving up on the bed as we examine. That is the reality of a cervical exam. Intrapartum, some nursing staff and clinicians use qualitative descriptors like "a tight 4" or "a generous 5" to convey nuance. In line with this, some report cervical examinations in “half- centimeters”. This sounds like this: “well, her last cervical exam was 5cm but now she is 5 and a half”. Is that a thing? What does the data say? Listen in for details.
1. Hamilton EF, Zhoroev T, Warrick PA, et al. New Labor Curves of Dilation and Station to Improve the Accuracy of Predicting Labor Progress. American Journal of Obstetrics and Gynecology. 2024.
2. Hanidu A, Kovalenko M, Usman S, et al. Intrapartum Ultrasound for Cervical Dilatation: Inter- And Intra-Observer Agreement. Acta Obstetricia Et Gynecologica Scandinavica. 2024.
3. Abedi, P. (n.d.). Accuracy of ultrasound methods versus other methods for detecting of cervical dilatation during labor, a protocol for systematic review. ECronicon.

Oh, What’s in a Name? Irving F. Stein and Michael L. Leventhal first described the syndrome, originally known as Stein-Leventhal syndrome, in 1935, in the AJOG. They published a case series of seven women displaying a triad of symptoms, including hirsutism, amenorrhea (absent menstruation), and bilaterally enlarged polycystic ovaries. We now know that PCOS affects 1 in 8 women globally (170 million women of reproductive age worldwide), and that there are 4 main manifestations of the condition- reflecting its diverse phenotype. Now, as of 05/12/25, a collaboration across 56 leading academic, clinical, and patient organizations, as well as iterative global surveys that garnered responses from over 14,300 people with PCOS and multidisciplinary health professionals have endorsed a NEW term (Lancet) for this: polyendocrine metabolic ovarian syndrome. This is actually STAGE 7 of an 8 stage process Yep, 1-6 are already done). But hold on…this is not taking over tomorrow! There is a THREE-YEAR implementation strategy that has already gotten started and culminating in 2028. Listen in for details.
1. Teede HJ, Khomami MB, Morman R, et al. Polyendocrine metabolic ovarian syndrome, the new name for polycystic ovary syndrome: a multistep global consensus process. The Lancet. Published online May 12, 2026. Accessed May 12, 2026. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00717-8/fulltext
2. International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome; 2023
3. https://www.contemporaryobgyn.net/view/global-consensus-renames-pcos-to-polyendocrine-metabolic-ovarian-syndrome-pmos-?utm_campaign=42986360-COG%20-%20Breaking%20News&utm_medium=email&_hsenc=p2ANqtz--5Of8-OwjOeKLtknr8YdFbh9G8_c7iQqliHnMz2pYOpi2x4Pp8dRH6bSHjrQIqnth_fLPywQM2ByNp7via22VJ8yyLbg&_hsmi=418414457&utm_content=418414457&utm_source=hs_email
4. Polyendocrine Metabolic Ovarian Syndrome: New name to improve diagnosis and care of condition affecting 170 million women worldwide. Monash University. News release. May 12, 2026. Accessed May 12, 2026. https://www.eurekalert.org/news-releases/1127647

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..