Dr. Chapa’s OBGYN Clinical Pearls

Welcome back to the show. Let’s take a quick step back in time. Think about how far we’ve come: we went from pressing a classic OB fetoscope up against a pregnant belly just to catch a faint, muffled thumping, to relying on advanced, continuous electronic monitoring. We live in an era of high-tech obstetrics. But even with all these modern advancements, room for error still exists, especially during the high-stakes chaos of the second stage of labor. In fact, this exact vulnerability was flagged as a critical warning in ACOG’s Clinical Practice Guideline Number 10. The issue? Relying on an external fetal heart rate Doppler that can silently mistake the maternal heart rate for the fetal heart rate. And now, a team of authors from New York writing in the AJOG are bringing even sharper focus to this danger, introducing a brand-new term for your clinical radar: "The Dolphin Sign." It’s a striking visual descriptor for a phenomenon born from maternal-fetal Doppler ambiguity—and if it goes unrecognized, it can leave a child at a devastating risk of acidosis. If you want to know how to spot it, what it means for your delivery room management, and how to protect your patients, you're going to want to stay tuned.
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1. ACOG CPG #10, October 2025
2. VINTZILEOS A, CHAVEZ M. The Dolphin Sign on fetal heart rate tracing: maternal-fetal signal ambiguity during the second stage of labor. American Journal of Obstetrics & Gynecology, 2026; 0
3. Kiely, D.J., Oppenheimer, L.W. & Dornan, J.C. Unrecognized maternal heart rate artefact in cases of perinatal mortality reported to the United States Food and Drug Administration from 2009 to 2019: a critical patient safety issue. BMC Pregnancy Childbirth 19, 501 (2019). https://doi.org/10.1186/s12884-019-2660-5

Now, if you’ve been in OB care for more than a month, you know that preeclampsia is one of those topics we talk about constantly. We have endless guidelines, algorithms, and diagnostic criteria plastered all over our unit walls. But here’s the truth: despite all the literature out there, the real world doesn't always read the textbook. The clinical nuances… The gray areas…That’s where things get tricky. Take a classic labor and delivery scenario: Your patient in active labor throws a blood pressure in the severe range. You follow protocol and get a repeat BP 15 minutes later—and it’s back down in the non-severe range. So, what now? Does that initial single severe reading still count toward a diagnosis of preeclampsia with severe features, or does severe range have to be sustained? And let’s make it even more interesting: What if later in the shift, she hits another severe-range BP, but again, it drops to non-severe on the 15-minute recheck- yet both of those spikes under that standard 4-hour window? Is that officially preeclampsia with severe features? That right there is the absolute peak of clinical nuance. It’s the difference between blindly following a chart and actually delivering sharp, nuanced bedside care. So, grab your coffee, settle in, and let's break down the details.

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​ ACOG PB 222
​ Countouris ME, Bello NA. Advances in Our Understanding of Cardiovascular Diseases After Preeclampsia. Circ Res. 2025 Mar 14;136(6):583-593. doi: 10.1161/CIRCRESAHA.124.325581. Epub 2025 Mar 13. PMID: 40080539; PMCID: PMC11921930.

Yes, we have covered cervical cancer screening many, many times on this show. It is truly a testament to science and research just how far we have come from using slide-based cytology for cervical cancer screening. Primary high-risk HPV, as a screening modality, has been favored for many years and is now officially part of the age-based, ACOG cervical cancer screening guideline (July 2026). We will summarize that update in this episode. Plus, we will also review about what to do when the hrHPV expanded genotype panel returns positive for 56/59/66. Modern cervical screening reports frequently refer to HPV 56, 59, and 66, typically grouping them together into a single pooled result (often labeled as a trio "HPV 56/59/66"). This is due to the widespread adoption of extended HPV genotyping technology. WE, what do we do with that? Listen in for details.
1. ACOG Committee Statement No. 28: Screening for Cervical Cancer; July 2026
2. Massad LS, Clarke MA, Perkins RB, Garcia F, Chelmow D, Cheung LC, Darragh TM, Egemen D, Lorey TS, Nayar R, Newman M, Risley C, Smith RA, Wentzensen N; Enduring Consensus Cervical Cancer Screening and Management Guidelines Committee. Applying Results of Extended Genotyping to Management of Positive Cervicovaginal Human Papillomavirus Test Results: Enduring Guidelines. J Low Genit Tract Dis. 2025 Apr 1;29(2):134-143. PMC11939109.

If you work in women’s health, you already know the golden rule: just when you think you’ve got a guideline memorized, the ink dries, and the updates drop. Medicine moves fast, and this month is no exception. Today, we are diving straight into the fresh-off-the-press October 2026 ACOG Practice Advisory on Premature Ovarian Insufficiency. Now, if you’re thinking, 'Wait, didn’t ACOG just reaffirm their POI guidance last year in 2025?'- you aren't crazy! They did. But clinical evidence doesn't wait around. ACOG has officially updated its stance to align directly with international consensus from ESHRE-the European Society of Human Reproduction and Embryology. So, what actually changed? How are we shifting our diagnostic thresholds, workups, and long-term hormone replacement strategies for these patients? We're covering all of it-the new shifts, the clinical pearls, and what you need to change in your practice starting today. Let’s get into it.
1. ACOG PA POI October 2026
2. ACOG Committee Opinion No. 605, Primary Ovarian Insufficiency in Adolescents and Young Women; July 2014.

Back in 2021, we discussed the FDA approval of a combination GNRH antagonist (relagolix) with estradiol and norethindrone. This was originally approved to treat uterine fibroid related heavy menstrual bleeding. It is also now approved for endometriosis care. In theory, this should also be an effective contraceptive agent. However, the FDA label strictly cautions against its use for birth control. In this episode, we will discuss data from the recent ASRM 2026 annual conference that looked at this medication's ability to possibly function as hormonal contraception. But there is a catch. Listen in for details.
1. https://www.medscape.com/viewarticle/fibroid-drug-relugolix-may-act-contraceptive-2026a10015db
2. Myfembreehcp.com