Dr. Chapa’s OBGYN Clinical Pearls

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.

What an AMAZING lesson, Podcast Family, in this impromptu episode, we will hear from one of my former medical students, now BOARD-CERTIFIED OBGYN...and an incredible OB case she just had. Sometimes....we find ZEBRAS! Great job, Lauren!

Podcast family we've all heard the rumors that oursmartphones are “LISTENING TO US”. Well, some of that is actually true, and trust me I'm not a conspiracy theorist. Our smartphones are capable of remarkable things. A new publication from the Green journal (released ahead ofprint on 03/05/2026 ) is proposing that it may now be able to detect fetal movement, fetal breathing, and even fetal hiccups when placed over the abdomen! Yep, it's not science fiction... it's science innovation. While this is not ready for prime time just yet, the science is absolutely astounding. In this quicky episode we will briefly summarize a fascinating new innovative study which proposes that our iPhones may be able to be a fetal movement detector.
1.     Moise, Kenneth Jr MD; Gaither, Kelly PhD;Madden-Rusnak, Anna PhD; Lowry, Kathy RN, MSN; Hutson, Emily RN, MSN; Bruns, Danielle RDMS; Valero, Reinaldo MD, RDMS. Smartphone Detection of FetalMovements Using Artificial Intelligence. Obstetrics & Gynecology ():10.1097/AOG.0000000000006228, March 5, 2026. | DOI:10.1097/AOG.0000000000006228
2.     Lai J, Woodward R, Alexandrov Y, et al Performanceof a Wearable Acoustic System for Fetal Movement Discrimination. PloS One. 2017.
3.     Ashik AK, Gutierrez R, Ashraf F, et al. AMachine Learning Model for Assessing Fetal Health During Pregnancy. Frontiers in Bioengineering and Biotechnology. 2025.
4.     Antepartum Fetal Surveillance: ACOG PracticeBulletin, Number 229. Obstetrics and Gynecology. 2021.
5.     Monitoring a Pregnancy at Home With a SmartphoneThis wearable device provides real-time ECG monitoring of a fetus: https://spectrum.ieee.org/pregnancy-heartbeat-monitor-smartphone

Neuraxial analgesia (epidural or spinal) combined withtocolytic therapy is the pain control method that best increases the success rate of external cephalic version (ECV), according to the ACOG’s PB 221. However, some patients may be reluctant to use regional anesthesia and may askabout IV analgesia. A new study in the AJOG (released as an ePub on March 5, 2026) provides some insights that may be helpful for patient consultation. These investigators compared the success of external cephalic version, modes of delivery, maternal pain, and complications using three strategies: intravenous analgesia with remifentanil, epidural anesthesia, and a stepwise approach in which epidural anesthesia was administered only if intravenous analgesia was unsuccessful. Listen in for details.
1.     ACOG PB 221
2.     Aiartzaguena, Amaia et al. Comparativeeffectiveness of intravenous remifentanil, epidural anesthesia and a two-stepanalgesic approach for external cephalic version: a large prospectivesingle-center cohort study. American Journal of Obstetrics & Gynecology,Volume 0, Issue 0
3.     Hao Q, Hu Y, Zhang L, et a l. A SystematicReview and Meta-Analysis of Clinical Trials of Neuraxial, Intravenous, andInhalational Anesthesia for External Cephalic Version. Anesthesia andAnalgesia. 2020.
4.     Wilson MJA, MacArthur C, Hewitt CA, et al.
5.     Intravenous Remifentanil Patient-ControlledAnalgesia Versus Intramuscular Pethidine for Pain Relief in Labour (RESPITE):An Open-Label, Multicentre, Randomised Controlled Trial. Lancet. 2018.

The ACOG 2025 guideline specifically recommends either oral or vaginal misoprostol for cervical ripening; it does not include buccal administration among its endorsed routes. With the rising rates of both obesity and labor induction, understanding the optimal agents for induction in obese patients is crucial. In a new study released ahead of print on March 4, 2026, in the AJOG, investigators from Indianapolis released findings from a secondary analysis of the IMPROVE trial (2019, AJOG) looking at the effect of obesity on buccal vs vaginal doses of misoprostol for cervical ripening. Listen in for details.
1. Haas DM, Daggy J, Flannery KM, Dorr ML, Bonsack C, Bhamidipalli SS, Pierson RC, Lathrop A, Towns R, Ngo N, Head A, Morgan S, Quinney SK. A comparison of vaginal versus buccal misoprostol for cervical ripening in women for labor induction at term (the IMPROVE trial): a triple-masked randomized controlled trial. Am J Obstet Gynecol. 2019 Sep;221(3):259.e1-259.e16. doi: 10.1016/j.ajog.2019.04.037. Epub 2019 May 7. PMID: 31075246; PMCID: PMC7692024.
2. ACOG July 2025: Cervical Ripening in Pregnancy, ACOG Clinical Practice Guideline No. 9
3. Bynarowicz, Taylor M. et al. The impact of body mass index on misoprostol dosing for labor induction: a comparison of vaginal and buccal dosage forms
American Journal of Obstetrics & Gynecology, Volume 0, Issue 0: https://www.ajog.org/article/S0002-9378(26)00126-2/fulltext
4. Etrusco A, Sfregola G, Zendoli F, et al. Effect of Maternal Age and Body Mass Index on Induction of Labor Using Oral Misoprostol in Late-Term Pregnancies: A Retrospective Cross-Sectional Study. Gynecologic and Obstetric Investigation. 2024.
5. Prostaglandin Versus Mechanical Dilation and the Effect of Maternal Obesity on Failure to Achieve Active Labor: A Cohort Study.
6. Beckwith L, Magner K, Kritzer S, Warshak CR. 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. 2017.