Dr. Chapa’s Clinical Pearls.

• AFS in Second Trimester: Implications?

  Amniotic Fluid Sludge (AFS) has been theorized to be sonographic evidence of an underlying infection/inflammation. Others have proposed it may represent an organized clot from the placental surface. At the same time, the finding of AFS may be more common as a benign finding especially at/after 40 weeks as the amniotic fluid accumulates shed skin cells, vernix, and possibly meconium past 41 weeks. What can be tell the patient when we identify AFS in the early second trimester? What do we do with this? In this episode, we will summarize the data on second trimester AFS and review the evidence-based “next steps” in care. Does this require empiric antibiotic therapy in the asymptomatic patient? Listen in for details.

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• BIG Announcement!

  Podcast family, we are in process of an exciting rebrand! Dr. Chapa's Clinical Pearls will soon become our legacy show as we change names and channels to, "Dr. Chapa's OBGYN No Spin Podcast". This will allow us to better align with our mission. Listen in for details and FIND US, as Dr. Chapa's OBGYN No Spin Podcast!!

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• New ICP Proposed Schema

  Intrahepatic Cholestasis of Pregnancy (ICP) has dichotomous effects: Benign for the mother (although the itching it causes may be a qualify of life issue, yet potentially devasting for the child in-utero. In 2021, SMFM released Consult series 53 on the subject. This, together with the ACOG 's CO 831 (Medically Indicated Late Preterm and early term delivery) also from 2021 provide management options for ICP. However, this month- July 2025- Dr. Cynthia Gyamfi-Bannerman et al published a new proposed ICP classification and management schema that is easy to follow. Listen in for details. ​ SMFM CS #53,2021​ ACOG CO #831, 2021​ Sarker M, Ramos GA, Ferrara L, Gyamfi-Bannerman C. Simplifying Management of Cholestasis: A Proposal for a Classification System. Am J Perinatol. 2025 Jul;42(9):1229-1234. doi: 10.1055/a-2495-3553. Epub 2024 Dec 4. PMID: 39631774

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• New SMFM Stillbirth Checklist Update (July 2025)

  Stillbirth is one of the most devastating adverse pregnancy outcomes, occurring in 1 in 160 deliveries in the United States. In March 2020, the ACOG released OCC #10, "Management of Stillbirth". Now, formally released July 2025, the SMFM has an updated checklist for stillbirth care, published in the journal Pregnancy. In this episode, we will highlight some nuances in this list. Listen in for details.​ SMFM Special Statement (July 2025): Society for Maternal-Fetal Medicine Special Statement: Checklists for management of pregnancies complicated by stillbirth.​ ACOG OCC 10; March 2020

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• FOCUS For PPH: A DIY Approach

  PPH is terrible. PPH must be assessed quickly via the “4Ts” and acted upon in a timely manner. And listen to this: new data from the Journal of Maternal-Fetal & Neonatal Medicine (June 24, 2025 ahead of print) finds an association with PPH and adverse outcomes years later: the odds of cardiovascular disease (CVD) and thromboembolism disease are increased in patients with postpartum hemorrhage (PPH), to a magnitude of 1.76 fold. That’s why these authors recommended "proactive postpartum care". That’s what we’re gonna talk about in this episode. Control of PPH includes bladder drainage, uterine massage, medications as appropriate, and mechanical methods of bleeding control. So… Vacuum uterine contraction works, and a balloon works. Even a simply 24 Fr foley has efficacy data in this setting as a uterine tamponade tool. But, in an attempt to have a LOW-COST, HIGHLY EFFECTIVE, and easy to use alternative to the Jada and Bakri- could we just use an intrauterine foley catheter and connect that to vacuum suction? JADA is effective but it limited based on uterine (EGA) size, or in cases of uterine anomaly. But most importantly…JADA and Bakri are expensive! Well, we now have data that this approach, using a low-cost, easy to use alternative, may be a consideration. It is FOCUS. This idea comes from one of our podcast family members, Dr. Frank Jackson- an MFM fellow- who has published his experience with this and already has a new publication on this technique (FOCUS), which was released as we were recording this very episode! Listen in for details.

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