Dr. Chapa’s OBGYN Clinical Pearls

Marfan syndrome is an autosomal dominant, connective tissue disorder. Because it’s autosomal dominant, an affected parent has a 50% chance of passing the genetic mutation to their offspring in every pregnancy. Approximately 25% of cases actually stem from spontaneous, de novo mutations with no prior family history. In the United States, the prevalence of Marfan syndrome is estimated at roughly 1 in 5,000 individuals. It affects males and females equally across all ethnic backgrounds. Although this topic and condition might sound rare at first glance- Marfan syndrome in pregnancy- it is in our communities, and we need to be ready for the potential complications that come with it. When is vaginal delivery allowable here? Do these patients need any maintenance meds during pregnancy? What about postpartum surveillance? Grab your coffee, get comfortable, and let's jump right in!
1. Elkayam U et al. High-Risk Cardiac Disease in Pregnancy: Part II. J Am Coll Cardiol. 2016 Aug 2;68(5):502-516. doi: 10.1016/j.jacc.2016.05.050.
2. Milleron O, Arnoult F, Delorme G, et al. Pathogenic FBN1 Genetic Variation and Aortic Dissection in Patients With Marfan Syndrome. J Am Coll Cardiol. 2020 Mar 3;75(8):843-853.
3. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022 Dec 13;80(24):e223-e393.
4. Narula N. et al. Pregnancy-Related Aortic Complications in Women With Marfan Syndrome. J Am Coll Cardiol. 2021 Aug 31;78(9):870-879.

If you’ve ever managed postpartum preeclampsia, you know the clinical gray zone: after an initial intrapartum course of magnesium sulfate, when do you actually restart it for a postpartum, readmission exacerbation? Always? There’s no standard national guidance on this. Every unit seems to do something a little different. In this episode, we’re summarizing a new study looking at practice patterns across the country. This study is actually a survey of US MFM fellowship directors across the ACOG Districts. This publication will be officiallyreleased/published in the Journal of Maternal-Fetal and Neonatal Medicine in December 2026. We’ll break down what these fellowship directors would do, why the variation exists, and what this means for your clinical practice. Let’sget into it.
1.    Dellapiana G, Thompson K, Gregory KD. Repeatadministration of magnesium for an exacerbation of postpartum preeclampsia: anational survey. J Matern Fetal Neonatal Med. 2026 Dec;39(1):2738315. doi:10.1080/14767058.2026.2738315. Epub 2026 Sep 28. PMID: 42805980.

If you’ve been listening for a while, you might remember an episode we ran about two years ago where we dove deep into the use of low-titer O-positive whole blood in emergency resuscitation. At the time, the consensus in trauma care was leaning heavily "pro"—advocating for getting O-positive blood into bleeding patients fast, especially given the persistent and severe shortages of O-negative inventory. Fast forward to today, and the conversation around balancing immediate survival against downstream risks has taken center stage. In just the last two months, two major publications have come out with seemingly conflicting perspectives on this exact issue. First, in July 2026, the American College of Surgeons released their consensus guidance, which attempts to strike a delicate balance between saving lives in acute trauma and mitigating future reproductive risks associated with Rh sensitization in patients of childbearing potential. But then, in September 2026, Obstetrics & Gynecology—the Green Journal—published an editorial by Jacobs et al. offering a very different lens on the practice. In today's episode, we’re unpacking both papers, comparing where they align, where they clash, and what this evolving debate means for trauma protocols, blood bank management, and patient care on the front lines. Let’s dive in.
​Post-Transfusion Management of RhD-Negative Females of Childbearing Potential Who Receive RhD-Positive Low-Titer Group O Whole Blood and Red Blood Cells During Trauma Resuscitation: A Joint Position Statement and Resource Document of the American College of Surgeons Committee on Trauma (ACS-COT), Prehospital Blood Transfusion Coalition (PBTC), National Association of Emergency Medical Services Physicians (NAEMSP), Trauma Hemostasis and Oxygenation Research (THOR) Network, and Allo Hope Foundation (AHF). J Am Coll Surg. July 2026.2. Jacobs, J. W., Callum, J., Adkins, B. D., Abels, E. A., Raza, S., Sharma, D., Wheeler, A. P., Osmundson, S. S., Chooljian, D. M., & Booth, G. S. (2026). RhD-Positive Whole Blood for Patients With Reproductive Potential After Two Randomized Trials of Prehospital Trauma Resuscitation; Obstetrics & Gynecology.

In June 2026, the ASRM released its updated guidance on recurrent pregnancy loss. This is the most updated guidance in over a decade and includes a decision tree algorithm that starts with a pivotal test. In this episode we will review this “first pass” triage test and provide clinical implications.
1. ASRM CO: https://www.asrm.org/practice-guidance/practice-committee-documents/recurrent-pregnancy-loss-a-committee-opinion-2026/
2. de Assis V, Giugni CS, Ros ST. Evaluation of Recurrent Pregnancy Loss. Obstet Gynecol. 2024 May 1;143(5):645-659. doi: 10.1097/AOG.0000000000005498. Epub 2024 Jan 4. PMID: 38176012.

Currently, the CDC U.S. Medical Eligibility Criteria (USMEC) rate CHCs as category 4 (unacceptable health risk) for migraine with aura, versus category 2 for migraine without aura; ACOG similarly recommends avoiding estrogen-containing contraception in migraine with aura. But, recent data published in August 2026 from the UK seems to show no increased risk with “modern”/low-dose combination birth control pills when compared to progesterone only options. Is the CDC contraindication out outdated? Not quite. Listen in for details.
1. https://www.podcastrepublic.net/podcast/1412385746Ihara K, et al. Estrogen exposure from modern contraceptives and vascular risk in women with migraine: A nationwide electronic medical record database study. Cephalalgia. 2025 Dec;45(12):3331024251404924. doi: 10.1177/03331024251404924. Epub 2025 Dec 17.
2. Gibbs LR, Fox MP, Aparicio HJ, Jick S. Combined Oral Contraceptives and Stroke Risk in Individuals With Migraine With Aura. Obstet Gynecol. 2026 Aug 1;148(2):160-170. doi: 10.1097/AOG.0000000000006306. Epub 2026 May 7.