Dr. Chapa’s OBGYN Clinical Pearls

The ACOG recommends a multimodal approach to postoperative pain that includes nonsteroidal NSAIDs, acetaminophen, and opioids. Ketorolac is a favored NSAID for postop pain control. However, the optimal dose of ketorolac after cesarean delivery has not been determined. In this episode, we will summarize a brand new randomized, controlled, single-blind trial of pregnant women undergoing cesarean delivery under regional anesthesia at a large academic medical center between June 2022 and October 2023. Enrolled participants were randomized to receive an initial loading dose of 60 mg (intervention) or 30 mg (control) of intravenous ketorolac in the operating room at the end of surgery.

1. Pharmacologic Stepwise Multimodal Approach for Postpartum Pain Management: ACOG Clinical Consensus No. 1. Obstetrics and Gynecology. 2021.
2. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstetrics and Gynecology. 2020.
3. Eid, Joe MD; Caplan, Madeleine MD; Goel, Nidhi MD; Poirier, Marie-Veronique MD; Montaine-O'Brien, Skyler MS; Rood, Kara M. MD; Costantine, Maged M. MD. Two Perioperative Ketorolac Dosing Regimens After Cesarean Delivery and Opioid Use: A Randomized Controlled Trial. O&G Open 3(2):e159, April 2026. | DOI: 10.1097/og9.0000000000000159

Uterine hemorrhage remains a significant complication following abortion loss and in the postpartum period and contributes to substantial morbidity and mortality among pregnant patients. Although some FDA approved devices are on the market (Bakri balloon and Jada vacuum), they may be cost prohibited in some settings and/or some uterine cavities may be very small for either option, like after a mid-second trimester or early third trimester PPH. But every delivery unit has some form of suction tool and wall suction ability. This is where FOCUS*, STUT, and/or U-CaVIT come into play. And now there is new data on this from the AJOG (epub, April 2026). Listen in for details. (*Shout Out to Dr. Frank Jackson for his work on this as well).

1. Singata-Madliki et al. Suction Tube Uterine Tamponade Versus Uterine Balloon Tamponade for Treatment of Refractory Postpartum Hemorrhage: A Randomized Clinical Feasibility Trial. International Journal of Gynaecology and Obstetrics: The Official Organ of FIGO. July 2025. (South Africa)
2. Hofmeyr GJ, Singata-Madliki M. Novel Suction Tube Uterine Tamponade for Treating Intractable Postpartum Haemorrhage: Description of Technique and Report of Three Cases. BJOG : An International Journal of Obstetrics and Gynaecology. 2020
3. Jackson FI, Dilena NJ, Abelman SH, Blitz MJ, Gerber S. Hemorrhage management using a Foley catheter for uterine suction. Am J Obstet Gynecol. 2025 Nov;233(5):503-504.
4. ACOG Practice Bulletin No. 183: Postpartum Hemorrhage. Obstetrics and Gynecology. 2017.
5. Ranieri E, Kalimeris S, Ochsenbein N, Haslinger C, Vacuum-Induced Tamponade Using Urological Catheters for Postpartum Hemorrhage, American Journal of Obstetrics and Gynecology (2026), doi: https://doi.org/10.1016/j.ajog.2026.04.026

“GOOD VIBRATIONS”: Its not just a Marky Mark song, but it is also part of GYNECOLOGIC SEXUAL HEALTH! In this episode, we will highlight an April 2026 new qualitative study on women’s vibrator use, as well as a separate publication (on a similar topic) also released in April 2026 in the journal Menopause.
1. Leong KA, Carlton CE, Deverdis EC, Grimes CL, Jacobs BE, Rogers RG, Roberts BL. Intimacy and empowerment in urogynecology: a qualitative exploration of vibrator use. Am J Obstet Gynecol. 2026 Apr;234(4):1103-1111. doi: 10.1016/j.ajog.2025.11.037. Epub 2025 Dec 2. PMID: 41344528.
2. Lehmiller JJ, Graham CA, Ferrall L, Mendelson EA, Prine MS. The role of masturbation in relieving symptoms associated with menopause. Menopause. 2026 Apr 1;33(4):384-394. doi: 10.1097/GME.0000000000002675. PMID: 41217890; PMCID: PMC13011940.

In the ACOG CO 734 from 2018, it states, “Transvaginal ultrasonography usually is sufficient for an initial evaluation of postmenopausal bleeding if the ultrasound images reveal a thin endometrial echo (less than or equal to 4 mm), given that an endometrial thickness of 4 mm or less has a greater than 99% negative predictive value for endometrial cancer”. But medicine moves fast. This is NO LONGER the guideline. In this episode, we will summarize the new ACOG CPU on the primary evaluation of a patient with postmenopausal vaginal bleeding. Is ultrasound still the single first line test used for evaluation? Listen in for details.
1. Updated Guidance Regarding The Role of Transvaginal Ultrasonography in Evaluating the Endometrium of Individuals With Postmenopausal Bleeding
2. The Role of Transvaginal Ultrasonography in Evaluating the Endometrium of Women With Postmenopausal Bleeding

Yes we have covered antenatal corticosteroids in the late preterm interval on several episodes in the past- it's DEJA VU! However, there is new data in the American Journal of Perinatology (April 2026 ) that is helpful for us as clinicians as we do “shared decision making” with patients in offering betamethasone in the late preterm interval. Listen in for details.
1. Zigron R, Rotem R, Erlichman I, Rottenstreich M, Rosenbloom JI, Porat S, Rottenstreich A. Factors associated with the development of neonatal hypoglycemia after antenatal corticosteroid administration: It's all about timing. Int J Gynaecol Obstet. 2022 Aug;158(2):385-389. doi: 10.1002/ijgo.13975. Epub 2021 Oct 30. PMID: 34625970.
2. Asirwatham A, Loke R, Rose S, Ho J, Leung K, Leftwich HK. Neonatal Hypoglycemia after Antenatal Late Preterm Steroids. Am J Perinatol. 2026 Apr;43(5):616-620. doi: 10.1055/a-2663-5798. Epub 2025 Aug 4. PMID: 40759170.
3. ALPS Trial. NEJM. Published April 7, 2016;374:1311-1320