Dr. Chapa’s OBGYN Clinical Pearls

Podcast family, we have to be careful what we ask for…Because we might just get it! We have been asking for new ways to predict preeclampsia for close to two decades. Well now we have new biomarker serum tests that are even offered direct- to-consumer. The problem is, what do we dowith a positive test?! In a past episode we covered an FDA cleared serum test by Thermo Fisher for use in patients already diagnosed with preeclampsia. Now there is a new blood test which uses cell free RNA, drawn between 18 and 22 weeks of gestation, which can also predict preterm preeclampsia. Does this work? And what do we do when the result shows “high risk” It's a complicated issue. Wehave to be careful what we ask for. Listen in for details!1.     https://publications.smfm.org/publications/554-acog-clinical-practice-update-biomarker-prediction-of-preeclampsia/2.     ACOG Clinical Practice Update: BiomarkerPrediction of Preeclampsia With Severe Features June 20243.    https://www.healthywomen.org/tech-talk-hp/tools-to-predict-preeclampsia4.     Elovitz, M.A., Gee, E.P.S., Delaney-Busch, N. etal. Molecular subtyping of hypertensive disorders of pregnancy. Nat Commun 16,2948 (2025). https://doi.org/10.1038/s41467-025-58157-y5.     https://www.businesswire.com/news/home/20250717476669/en/New-Study-in-JAMA-Network-Open-Shows-Current-Approaches-to-Assessing-Preeclampsia-Risk-Are-Failing-the-Majority-of-Pregnant-Moms

Words matter, and equally as important, our actions matter. Sometimes the words opportunistic salpingectomy (OPS or OS) are used interchangeably with risk-reducing salpingectomy (RRS). However, these are two completely different items. In fact, there are 4 very important differences between the two. In the April 2026 AJOG, there's a new Clinical Opinion on this very topic. Listen in for details.1. Kindelberger DW, Lee Y, Miron A, Hirsch MS, Feltmate C, Medeiros F, Callahan MJ, Garner EO, Gordon RW, Birch C, Berkowitz RS, Muto MG, Crum CP. Intraepithelial carcinoma of the fimbria and pelvic serous carcinoma: Evidence for a causal relationship. Am J Surg Pathol. 2007 Feb;31(2):161-9. 2. ACOG CO 774; 20193. NCCN, Ovarian Cancer Including Fallopian Tube Cancer and Primary Peritoneal Cancer. Updated 2026-03-12.4. ACOG Practice Bulletin No. 147: Lynch Syndrome.Obstetrics and Gynecology. 20145. Falconer H, Yin L, Grönberg H, Altman D. Ovarian cancer risk after salpingectomy: a nationwide population-based study. J Natl Cancer Inst. 2015 Jan 27;107(2):dju410. doi: 10.1093/jnci/dju410. PMID: 25628372.6. Rice MS, Hankinson SE, Tworoger SS. Tubal ligation, hysterectomy, unilateral oophorectomy, and risk of ovarian cancer in the Nurses' Health Studies. Fertil Steril. 2014 Jul;102(1):192-198.e3. doi: 10.1016/j.fertnstert.2014.03.041. Epub 2014 May 10. PMID: 24825424; PMCID: PMC4074555.7. Wilke RN, Pennington KP, Gootzen TA, Steenbeek MP, de Hullu JA, Long KC, Blank SV, Swisher EM, Lu KH, Norquist B. Salpingectomy in individuals at high risk for tubo-ovarian cancer: consensus and precaution. Am J Obstet Gynecol. 2025 Nov 1:S0002-9378(25)00820-8. doi: 10.1016/j.ajog.2025.10.044. Epub ahead of print. PMID: 41183726.

Platelet-rich plasma (PRP) injections do not have formal FDA approval for specific clinical indications. PRP is regulated as an autologous blood product and is used "off-label" in clinical practice. However, there is substantial clinical evidence supporting its use for certain dental surgeries and musculoskeletal conditions, particularly lateral epicondylitis, knee osteoarthritis, and plantar fasciitis. The American Medical Society for Sports Medicine notes that PRP is primarily used to treat tendinopathies and osteoarthritis, though clinical efficacy results remain mixed due to variability in PRP formulations and preparation methods. As of now, there are no FDA approved uses for PRP for gynecologic use, although there has been some evidence of possible benefit in vulvar dermatoses and possiblt ovarian function enhancement. But what about its use in the vagina for sexual pleasure? Injecting into the anterior vaginal wall (around the famed G-Spot location) is nothing new. Over a decade ago, a TV show introduced the masses to the “G-Spot amplication” shot which injected collagen to that area. But there was no data for this. Well, we are back to this idea in a new RCT in the Green Journal. Can PRP light up the vaginal fires of pleasure? Listen in for details. 1. Clarke, Bayley MD; Gaddam, Neha MD; Garcia, Bobby MD; Iglesia, Cheryl B. MD; Podolsky, Robert PhD; Dieter, Alexis A. MD. Vaginal Injection of Platelet-Rich Plasma for Sexual Function: A Randomized Controlled Trial. Obstetrics & Gynecology ():10.1097/AOG.0000000000006256, March 19, 2026. | DOI: 10.1097/AOG.00000000000062562. Finnoff JT, Awan TM, Borg-Stein J, et a American Medical Society for Sports Medicine Position Statement: Principles for the Responsible Use of Regenerative Medicine in Sports Medicine. Clinical Journal of Sport Medicine : Official Journal of the Canadian Academy of Sport Medicine. 2021. 3. Alsousou J, Ali A, Willett K, Harrison P. The Role of Platelet-Rich Plasma in Tissue Regeneration.Platelets. 2012.

Podcast family, welcome to Quickie #4. This one will be fun: A. Medicine changes, and changes fast. I trained with and learned the Grannum grading placental system (grades 0-III based on ultrasound appearance). Is that still a thing? We recently found a “grade III placenta at 34 weeks” as an incidental finding. Is there specific management considerations for this? Listen in for details. B. What do we do when a patient has “two GBS results” in one pregnancy hat are discordant. Listen in for that as well!1. Jaiman S, Romero R, Pacora P, et al. Disorders of Placental Villous Maturation Are Present in One-Third of Cases With Spontaneous Preterm Labor. Journal of Perinatal Medicine. 2021. 2. European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2017. Sentilhes L, Sénat MV, Ancel PY, et al. Prevention of Spontaneous Preterm Birth: Guidelines for Clinical Practice From the French College of Gynaecologists and Obstetricians (CNGOF).3. Brink LT, Roberts DJ, Wright CA, et al. Placental Pathology in Spontaneous and Iatrogenic Preterm Birth: Different Entities With Unique Pathologic Features. Placenta. 2022. 4. Chitlange SM, Hazari KT, Joshi JV, Shah RK, Mehta AC. Ultrasonographically Observed Preterm Grade III Placenta and Perinatal Outcome.International Journal of Gynaecology and Obstetrics: The Official Organ of the International Federation of Gynaecology and Obstetrics. 1990. 5. Mirza FG, Ghulmiyyah LM, Tamim H, et al. To Ignore or Not to Ignore Placental Calcifications on Prenatal Ultrasound: A Systematic Review and Meta-Analysis. The Journal of Maternal-Fetal & Neonatal Medicine : The Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians. 2018. 6. Quinlan RW, Cruz AC, Buhi WC, Martin M. Changes in Placental Ultrasonic Appearance. II. Pathologic Significance of Grade III Placental Changes. American Journal of Obstetrics and Gynecology. 1982. 7. Karen M. Puopolo Group B Streptococcal Disease. https://orcid.org/0000-0002-5581-8825; Published February 25, 2026 N Engl J Med 2026;394:896-905ACOG 797

Well, it's no doubt we live in a culture of immediate gratification. When we need to know something, we must know it immediately! This even applies to couples seeking pregnancy and their desire to find out if their monthly attempts have been successful. However, there is a problem with trying to prove pregnancy too promptly. In this episode, we will review a new publication just released on March 1st, 2026 out of the Green journal. These authors evaluated a prospective cohort (PRESTO cohort) of pregnancy planners to analyze their pregnancy test taking behaviors and their outcomes. The results are eye-opening. So, when is the best time to check a pregnancy test? Listen in for details. 1. Sundermann AC, Jasper EA, Jukic AMZ, Rothman KJ, Wise LA. Pregnancy Test Use and Timing of Pregnancy Detection in a Prospective Cohort of Pregnancy Planners. Obstet Gynecol. 2026 Mar 1;147(3):394-403. doi: 10.1097/AOG.0000000000006157. Epub 2026 Jan 8. PMID: 41505757; PMCID: PMC12788791.2. Wilcox AJ, Baird DD, Dunson D, McChesney R, Weinberg CR. Natural Limits of Pregnancy Testing in Relation to the Expected Menstrual Period. The Journal of the American Medical Association. 2001.