Dr. Chapa’s OBGYN Clinical Pearls

The March 2026 ACC/AHA Guideline on the Management of Dyslipidemia made a major pivot regarding Lipoprotein(a) by establishing a formal recommendation for universal screening in adults. This 2026 guideline, published in the Journal of the American College of Cardiology, issued a Class 1 recommendation stating that every adult should have their Lp(a) measured at least once in their lifetime. Because Lp(a) levels are genetically determined and remain highly stable throughout a person's life, a single lifetime check is sufficient for the vast majority of the population to establish their baseline risk. Well, that’s great for Family medicine or internal medicine, but how does that affect us in women’s health? Well, it’s complicated: lipoprotein(a) has been associated with an increased risk of VTE and has also been associated, in some studies, with FGR, preeclampsia, and preterm birth! So, can these patients receive oral contraceptives? What about Perioperative and postop care? Do these patients require anticoagulation? What about pregnancy- is LDA recommended here? And lastly, what about TXA use in patients with HMB? This podcast topic comes from one of our podcast family members who is an OBGYN military personnel caring for our wonderful troops overseas. Listen in for details!
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1. Ezzat, D., Lopez, D. M., Claggett, B. L., Li, L., Mohammadnia, N., Schuermans, A., Hemeryck, J., Chang, A., Murillo, S., O'Donoghue, M. L., Bikdeli, B., Yu, Z., Natarajan, P., Patel, A. P., Pabon, M. A., & Honigberg, M. C. (2026). Lipoprotein(a) and incident venous thromboembolism in pre- and postmenopausal women, and in men. European Heart Journal, ehag252. https://doi.org/10.1093/eurheartj/ehag252
2.ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Dyslipidemia Writing Committee. (2026). 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia. Circulation, 153, e1155–e1300. https://doi.org/10.1161/CIR.0000000000001423
3. CDC MEC
4. Prevention of Venous Thromboembolism in Gynecologic Surgery: ACOG Practice Bulletin, Number 232. Obstetrics and Gynecology. 2021. Committee on Practice Bulletins—Gynecology
5. Sofi F, Marcucci R, Abbate R, Gensini GF, Prisco D.Lipoprotein(a) as a Risk Factor for Venous Thromboembolism: A Systematic Review and Meta-Analysis of the Literature.Seminars in Thrombosis and Hemostasis. 2017. Dentali F, Gessi V, Marcucci R, et al. Lipoprotein (A) and Venous Thromboembolism in Adults: The American Journal of Medicine. 2007.

Hey everyone, thanks for tuning in. If you’ve spent any time in the OR during a cesarean delivery, you know that the choice between uterine exteriorization and in situ repair usually comes down to how you were trained or personal surgeon preference. It’s a debate as old as modern obstetrics. But a major piece of clarity is coming down the pipeline. This episode, we are getting a sneak peek at a brand-new systematic review and meta-analysis dropping this July 2026 in the European Journal of OBGYN. We’re asking the big question: is this the study that finally settles the debate once and for all? Grab your coffee, stick around, and let’s find out.

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​ Coutinho, I. C., Ramos de Amorim, M. M., Katz, L., & Bandeira de Ferraz, Á. A. (2008). Uterine exteriorization compared with in situ repair at cesarean delivery: A randomized controlled trial. Obstetrics & Gynecology, 111(3), 639–647. https://doi.org/10.1097/aog.0b013e31816521e2 . (One of the most heavily cited clinical trials on the subject. It established that women in the exteriorized group experienced a 41% greater risk of moderate-to-severe pain at 6 hours postoperatively compared to the non-exteriorized cohort).
​ Tan, H. S., Taylor, R. C., Sharawi, N., Sultana, R., Barton, K. D., & Habib, A. S. (2021). Uterine exteriorization versus in situ repair in Cesarean delivery: A systematic review and meta-analysis. Canadian Journal of Anaesthesia, 69(2), 216–233. https://doi.org/10.1007/s12630-021-02142-8
​ Fonseca Queiroz L, Lemos M, Pereira da Silva D . Uterine exteriorization versus in-situ uterine repair during cesarean delivery: a systematic review and meta-analysis of randomized controlled trial. European Journal of Obstetrics and Gynecology and Reproductive Biology, 2026; 323

In the ACOG PB 231, Multifetal Gestations Twin Triplet and Higher-Order Multifetal Pregnancies, it states, “based on the improved outcomes reported in singleton gestations, the National Institutes of Health recommends that, unless a contraindication exists, a course of antenatal corticosteroids should be administered to all patients who are at risk of delivery within 7 days and who are between 24 weeks and 34 weeks of gestation, irrespective of the fetal number”. But a BRAND NEW meta-analysis is saying the exact opposite- with a catch. Listen in for details.
1. ACOG PB 231
2. Felippe, Carolina Alves MS; Ruiz, Sinrraim dos Santos Chaves MD; de Souza, Rebeca Ferreira MS; de Lima, Aliny Silva MS; dos Santos, Priscila Luiza MS; Fonseca, Pandora Eloa Oliveira MS; de Almeida Silva, Ingryd MS; Montes-de-Oca-Saucedo, Carlos Roberto MD; Santana, Ana Cecília Oliveira MS; Veta Darkovski, Jasmina MD; Matlaw, Hadas Rachel MD; Fonseca Queiroz, Laura MD. Antenatal Corticosteroid Use in Twin Pregnancies: A Systematic Review and Meta-analysis. Obstetrics & Gynecology ():10.1097/AOG.0000000000006344, June 4, 2026. | DOI: 10.1097/AOG.0000000000006344
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Historically we were taught as surgeons that 1-centimeter bites that between suture throws on a Pfannenstiel (low transverse) fascial closure was enough to prevent hernia formation and optimize facial healing. But is this still evidence based? We can extrapolate data from a May 2026 systematicreview/meta-anlysis as well as a separate study from the Dutch published in 2021. Both of these studies were in the journal Hernia. The evidence does favor one technique over the other! Listen in for details.
1.     Golling M, Baumann P, Kuger F, Fortelny RH.Impact of the SUture BIte TEchnique on clinical outcomes after midlinelaparotomy closure: SUBITE-a systematic review and meta-analysis. Hernia. 2026May 19;30(1):221. doi: 10.1007/s10029-026-03700-z. PMID: 42154339; PMCID:PMC13186860.
2.     Paulsen CB, Zetner D, Rosenberg J. Variation inabdominal wall closure techniques in lower transverse incisions: a nationwidesurvey across specialties. Hernia. 2021 Apr;25(2):345-352. doi:10.1007/s10029-020-02280-w. Epub 2020 Aug 8. PMID: 32770366.

Today, we are talking about a true paradigm shift in prenatal genetics. For decades, we’ve relied on cell-free DNA for screening, but when it came to definitive confirmation of fetal aneuploidy, we’ve had to counsel our patients through the anxiety and physical risks of invasive procedures like amniocentesis and CVS. But what if the line between screening and confirmation just blurred? In this episode, we are diving into an avant-garde, first-of-its-kind maternal blood test that is now actively in clinical use and may prove to rival traditional invasive testing for fetal aneuploidy confirmation: the Unity CONFIRM test. To break down the cutting-edge science, the clinical validity, and exactly what this means for your daily practice, I am thrilled to welcome Jen Hoskovec, the Vice President of Medical Affairs for BillionToOne. You might have recently seen her insights featured alongside Dr. Haywood Brown in Contemporary OB/GYN, and today, she’s here with us. We’re going to discuss the availability of this test, the technology that makes it possible, and what the next concrete steps are for integrating this into modern obstetrical care. Grab your coffee. Let’s get into the science.
1. https://www.contemporaryobgyn.net/view/haywood-brown-md-jennifer-hoskovec-explain-new-non-invasive-confirmatory-test
2. Screening for Fetal Chromosomal Abnormalities PA; January 2026