Dr. Chapa’s OBGYN Clinical Pearls

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.

In this quickie episode, we will answer a question from one of our podcast family members: “Can a virgin get BV?”. It’s a complicated question, that needs explanation. PLUS, we will relate this to a former “event” from a past president- so listen until the end!
1. Kim ES, Waltmann A, Duncan JA, Hood-Pishchany I.Advances in Treating Bacterial Vaginosis: Recognizing Sexual Transmission and Pipeline of Therapies. Current Opinion in Infectious Diseases. 2026.
2. Liu D, Zhang X, Zhao X, et al. Bacterial Vaginosis: Advancing Insights Into Microbial Dysbiosis. Critical Reviews in Microbiology. 2026.
3. Verstraelen H, Verhelst R, Vaneechoutte M, Temmerman M. The Epidemiology of Bacterial Vaginosis in Relation to Sexual Behaviour. BMC Infectious Diseases. 2010.
4. Verstraelen H, Verhelst R, Vaneechoutte M, Temmerman M. The Epidemiology of Bacterial Vaginosis in Relation to Sexual Behaviour. BMC Infectious Diseases. 2010.

For preterm prelabor rupture of membranes, the standard protocol for latency augmentation has remained IV amoxicillin and erythromycin for 2 days, followed by oral amoxicillin and erythromycin for 5 additional days. Nonetheless, azithromycinhas largely replaced erythromycin in PPROM management due to supply shortages and tolerability.  Previous retrospective studies (2019) have found no difference in latency between single-dose and multi-day azithromycin regimens, but these studies did not measure actual drugconcentrations at the site of action. In that 2019 retrospective study, there was also no difference in incidence of chorioamnionitis, or neonatal outcomes when comparing different dosing regimens of the azithromycin with erythromycin, with the exception of respiratory distress syndrome being more common in the 5 day azithromycin group. However, a 2024 single-center,retrospective study from Annals Pharmacotherapy found significantly higher rates of histologic chorioamnionitis with single-dose azithromycin compared to 5-day regimens(62.6% vs 46.4%, P=0.006), despite similar latency periods. So, it’s complicated. A 2025 systematic review of international guidelines found that 6 out of 17 clinical practice guidelines acknowledged uncertainty about the optimal antibiotic regimen. This was published in the AJOG. In this episode, wewill review a new publication from March 2026 in the AJOG which sought to compare the pharmacokinetic parameters of 1 g once vs 500 mg daily dosing of azithromycin in the setting of preterm prelabor rupture of membranes and simulate various dosing regimens to identify the optimal regimen that maintains amniotic fluid concentration of azithromycin over the minimum inhibitory concentration of common GU pathogens associated with intraamniotic infection orinflammation. But there is a BIG limitation. Listen in for details.
 
1.    Navathe R, Schoen CN, Heidari P, Bachilova S, Ward A, Tepper J, Visintainer P, Hoffman MK, Smith S, Berghella V, Roman A. Azithromycin vs erythromycin for the management of preterm premature rupture of membranes. Am J Obstet Gynecol. 2019 Aug;221(2):144.e1-144.e8. doi: 10.1016/j.ajog.2019.03.009. Epub 2019 Mar 20.PMID: 30904320.
2.    Kua S, Roman A, Harbinson L, Groom K, Whitehead C. Systematic review of nationaland international clinical practice guidelines for management of preterm prelabor rupture of membranes. Am J Obstet Gynecol. 2025 Nov 22:S0002-9378(25)00866-X.
3.    Day KN, Vircks JA, Henricks CE, Reaves KM, Holmes AK, Florio KL. Latency Antibiotics in Preterm Prelabor Rupture of Membranes: A Comparison of Azithromycin Regimens. Ann Pharmacother. 2024 Mar;58(3):234-240. doi:10.1177/10600280231181135. Epub 2023 Jun 26. PMID: 38124306.
4.   Boelig, Rupsa C. et al. Azithromycin in preterm prematurerupture of membranes: population pharmacokinetics and dose optimization. AmericanJournal of Obstetrics & Gynecology, March 2026.
 
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