Dr. Chapa’s OBGYN Clinical Pearls

As BMIs and weights increase across the US population, there have been increased calls for universal screening for existing DM at entrance to prenatal care, if under 20 weeks. Others, including the ACOG, prefer to screen early those with additional risk factors (like prior GDM HX, prior macrosomia, BMI >30, PCOS, first degree relative with diabetes, or age >40). In July 2024, the ACOG released its publication, “Screening for Gestational and Pregestational Diabetes in Pregnancy and Postpartum”. In this guidance, it states, “At this time, there are insufficient data to support the best screening modality for pregestational diabetes in pregnancy, but consideration can be made to use the same diagnostic criteria as for the nonpregnant population (A1c value 6.5 or higher, or fasting plasma glucose value 126 mg/dL or higher, or 2-hour plasma glucose value 200 mg/dL or higher during a 75-g OGTT, or random plasma glucose value 200 mg/dL or higher in patients with classic hyperglycemia symptoms)”. However, a new proposed protocol has been published in AJOG for early screening for DM in pregnancy. This also describes the differences in diagnosis and care for Standard GDM diagnosed at 24-28 weeks, vs a diagnosis of pregestational DM diagnosis made prior to 20-weeks vs “early” GDM also diagnosed under 20 weeks of gestation. Listen in for details.

1. McLaren, Rodney et al.nA Proposed Classification of Diabetes Mellitus in Pregnancy
American Journal of Obstetrics & Gynecology, Volume 0, Issue 0. Epub Feb 2, 2026; https://www.ajog.org/article/S0002-9378(26)00061-X/fulltext
2. ACOG Clinical Practice Update: Screening for Gestational and Pregestational Diabetes in Pregnancy and Postpartum; July 2024; https://journals.lww.com/greenjournal/abstract/2024/07000/acog_clinical_practice_update__screening_for.34.aspx
3. Simmons, David et al. “Treatment of Gestational Diabetes Mellitus Diagnosed Early in Pregnancy.” The New England journal of medicine vol. 388,23 (2023): 2132-2144. doi:10.1056/NEJMoa2214956

There has been a shift in cervical cancer screening from primary cytology based to HPV based. Even HPV screening has had its evolution from physician collected samples to patient self-collection, either in a clinical setting or at home with an approved collection system. In May 2025, the FDA cleared the first at-home self-collection kit for HPV screening, specifically the Teal Wand by Teal Health. Now, we are seeing the advent of POSSIBLY another avenue for cervical HPV testing- although it is a bit awkward: the use of menstrual blood as an HPV screening test. In this episode we will review a new cross-sectional, population-based study from China which compared testing menstrual blood for human papillomavirus during cervical cancer screening to clinician-collected cervical samples for human papillomavirus (HPV). This concept, and these results, are not new at all! And there are important limitations to consider at this time. Listen in for details.
1. Testing menstrual blood for human papillomavirus during cervical cancer screening in China: cross sectional population based study. BMJ 2026; 392 doi: https://doi.org/10.1136/bmj-2025-084831 (Published 04 February 2026)
BMJ 2026;392:e084831
https://www.bmj.com/content/392/bmj-2025-084831
2. Naseri S, Young S, Cruz G, Blumenthal PD. Screening for High-Risk Human Papillomavirus Using Passive, Self-Collected Menstrual Blood. Obstet Gynecol. 2022 Sep 1;140(3):470-476. doi: 10.1097/AOG.0000000000004904. Epub 2022 Aug 3. PMID: 35926207; PMCID: PMC9377370.
3. Fokom Domgue J, Chandra M, Oladoyin O, Desai M, Yu R, Shete S. Women’s Preferences for Home-Based Self-Sampling or Clinic-Based Testing for Cervical Cancer Screening. JAMA Netw Open. 2026;9(2):e2558841. doi:10.1001/jamanetworkopen.2025.58841

Well podcast family, we are back with another installment of our “You ask, We answer” edition. We've got 2 fascinating and real-world clinical conundrums in this episode, both suggested by two separate podcast family members. The first has to do with RH IG maternal administration. Here's the question: If a patient receives routine, prophylactic RH IG at 28 weeks but then has maternal trauma say 1 or 2 weeks after, does she still require an additional dose of RH IG? That's a good question because it's not as intuitive as you would think. We will explain in this episode and there is a bit of a contradiction in the guidance. The second question has to do with finding an asymptomatic uterine rupture at cesarean section. Is there such a thing as a “partial” (silent) uterine rupture? There's recent data from 2025 about this. Listen in for details.

1. ACOG PB 181; 2017.
2. Baek S, Froese V, Morgenstern B. Risk Profiles and Outcomes of Uterine Rupture: A Retrospective and Comparative Single-Center Study of Complete and Partial Ruptures. J Clin Med. 2025 Jul 15;14(14):4987. doi: 10.3390/jcm14144987. PMID: 40725680; PMCID: PMC12295210.
3. Vandenberghe G, Bloemenkamp K, Berlage S, Colmorn L, Deneux-Tharaux C, Gissler M, Knight M, Langhoff-Roos J, Lindqvist PG, Oberaigner W, Van Roosmalen J, Zwart J, Roelens K; INOSS (the International Network of Obstetric Survey Systems). The International Network of Obstetric Survey Systems study of uterine rupture: a descriptive multi-country population-based study. BJOG. 2019 Feb;126(3):370-381. doi: 10.1111/1471-0528.15271. Epub 2018 Jun 12. PMID: 29727918.

Fetal Microcephaly has an incidence of 2 to 12 in10,000 births in the USA and can be diagnosed prenatally via ultrasound (in second or early third trimester) or postnatally via measurement of head circumference (HC).  Antepartum, this is a unique diagnosis since we are mainly used to using PERCENTAGES for biometrics and for fetal weight, butmicrocephaly is not diagnosed by HC percentage- but by Standard Deviation (SD). Microcephaly has been linked to developmental delay, seizures, as well as feeding, vision and hearing problems.  Prognosis depends on the severityof the microcephaly and whether it is associated with other anomalies. What SD is diagnostic of microcephaly? What are the potential etiologies? What genetic syndromes are most associated with true microcephaly? Is fetal cranial MRIrecommended? Listen in for details.

1.     Sukenik-Halevy R, Golbary Kinory E, Laron KenetT, Brabbing-Goldstein D, Gilboa Y, Basel-Salmon L, Perlman S. Prenatalgender-customized head circumference nomograms result in reclassification ofmicrocephaly and macrocephaly. AJOG Glob Rep. 2023 Jan 29;3(1):100171. doi:10.1016/j.xagr.2023.100171. PMID: 36864987; PMCID: PMC9972400.
2.     SOGC CO (2019) No. 380-Investigation andManagement of Prenatally Identified Microcephaly
3.     Fetal Medicine Foundation: Microcephaly; https://fetalmedicine.org/education/fetal-abnormalities/brain/microcephaly

Stress fractures are common injuries in athletes and military recruits, that’s’ understandable- based on the physical forces placed on the long bones. A stress fracture can be defined as a partial or complete fracture of the bone that is a result from repeated application of stress lower than that required to fracture the bone in a single loading situation. In pregnancy, the body is subjected to various physiological changes that make women more vulnerable. In this pregnancy, we will highlight a REAL patient case which our team cared for on the inpatient service where a simple cough at 34 weeks leads to a painful spontaneous rib fracture! Is there any data published on this? Are serum tests for bone turn-over required as part of this workup? Listen in for clinical pearls!
1. 1962: Long A.E.: “Stress fracture of the ribs associated with pregnancy”. Surg. Clin. North Am., 1962, 42, 909.
2. 2000: Baitner AC, Bernstein AD, Jazrawi AJ, Della Valle CJ, Jazrawi LM. Spontaneous rib fracture during pregnancy. A case report and review of the literature. Bull Hosp Jt Dis. 2000;59(3):163-5. PMID: 11126720. https://pubmed.ncbi.nlm.nih.gov/11126720/
3. 2015: Rib stress fractures in pregnancy: a case report and review of literature. chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/file:///C:/Users/hchapa/Downloads/1575956493464-5157163%20(1).pdf
4. Zhang Y, Li R, Zhang J, Zhou W, Yu F. Changes in Serum Concentrations of Bone Turnover Markers in Healthy Pregnant Women. International Journal of Clinical Practice. 2023.