Dr. Chapa’s OBGYN Clinical Pearls

• No OB Hep C RX: Time For Change

  Major health organizations, including the CDC and ACOG, recommend universal Hepatitis C Virus (HCV) screening for all pregnant women during each pregnancy and at time of delivery. Ideally, pregnant women should be screened for hepatitis C virus infection at the first prenatal visit of each pregnancy. If the antibody screen result is positive, hepatitis C virus RNA polymerase chain reaction testing is done to confirm the diagnosis. The risk of perinatal transmission of HCV is up to 9%, with at least one-third of transmissions occurring antenatally. While antiviral therapy is recommended for Hepatitis B in pregnancy with a viral load greater than 200,000 international units/mL to decrease the risk of vertical transmission, the same is not the case for Hep C. According to the ACOG CPG #6 from September 2023, there are no standard treatment protocols for Hep C in pregnancy but a new publication from the PINK journal (7 Dec 2025) is calling for a change. That new publication is, “Hepatitis C Treatment During Pregnancy: Time for a Practice Change”. Listen in for details. 1. ACOG CPG #6; Sept 20262. Bhattacharya D, Aronsohn A, Price J, Lo Re V. Hepatitis C Guidance 2023 Update: AASLD-IDSA Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 2023;:ciad319. doi:10.1093/cid/ciad319.3. Chappell CA, Kiser JJ, Brooks KM, et al. Sofosbuvir/¬Velpatasvir Pharmacokinetics, Safety, and Efficacy in Pregnant People With Hepatitis C Virus. Clinical Infectious Diseases : An Official Publication of the Infectious Diseases Society of America. 2025;80(4):744-751. doi:10.1093/cid/ciae595.4. Reau N, Munoz SJ, Schiano T. Liver Disease During Pregnancy. The American Journal of Gastroenterology. 2022;117(10S):44-52. doi:10.14309/ajg.0000000000001960.5. Dutra, Karley et al. Hepatitis C Treatment During Pregnancy: Time for a Practice Change. American Journal of Obstetrics & Gynecology MFM, Volume 0, Issue 0, 1018656. Society for Maternal-Fetal Medicine Consult Series #56: Hepatitis C in Pregnancy-Updated Guidelines: Replaces Consult Number 43, November 2017. Society for Maternal-Fetal Medicine (SMFM). Electronic address: [email protected], Dotters-Katz SK, Kuller JA, Hughes BL. American Journal of Obstetrics and Gynecology. 2021;225(3):B8-B18. doi:10.1016/j.ajog.2021.06.008

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• Freebirth, Wildbirth, and the Price of Autonomy

  Welcome to the no spin podcast. In today's episode, we're tackling a subject that's gaining traction but carries significant risks: the freebirth and wildbirth movement. We'll explore the rising trends of unassisted childbirth, where individuals choose to forgo professional medical care during labor and delivery- or during the prenatal period altogether, and the potential devastating outcomes associated with these practices. Join us as we unpack the motivations behind these choices, the lack of evidence supporting their safety, and the serious harms that can arise for both parent and baby. We'll be examining medical guidelines, and real-world consequences to provide a comprehensive and nuanced understanding of this complex issue. It’s a balance between patient autonomy, advocacy, and potentially allowing an atrocity. Listen in for details. 1. Apr 20, 2020 ACOG Statement on Birth Settings: https://www.acog.org/news/news-releases/2020/04/acog-statement-on-birth-settings2. Planned Home Birth ACOG CO 6973. https://www.theguardian.com/world/ng-interactive/2025/nov/22/free-birth-society-linked-to-babies-deaths-investigation4. https://birthguidechicago.com/wp-content/uploads/2018/07/home_births_rcog_rcm0607.pdf

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• ACS Update on Self-Collected VAGINAL HPV Tests

  In 2024, the ASCCP updated their guidance to include DualStain technology as part of primary HPV cervical cancer screening. Now, on December 4, 2025, the ACS has updated their guidance regarding patient self-collectionof vaginal specimens for primary HPV screening. This is fascinating and proves medicine moves fast! Should a negative self-collection test result have a repeatscreen in 1, 3 or 5 years, or later? Listen in for details.1.     Self-collected vaginal specimens for humanpapillomavirus testing and guidance on screening exit: An update to theAmerican Cancer Society cervical cancer screening guideline2.     https://open.spotify.com/episode/5x4J3TQJPdkHtV9RLTUi5oSTRONG COFFEE PROMO:https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

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• The Reverse Løvset Maneuver For SD

  In the original Løvset maneuver (described for breech presentations), the fetus is rotated in one direction to facilitate arm delivery. For shoulder dystocia, the reverse Løvset applies rotation in the opposite direction—specifically rotating the posterior shoulder toward a "belly down" position through up to 180 degrees of rotation. These maneuvers were first described by Norwegian obstetrician Jørgen Løvset in the 1940s. Now, in the current November 2025 AJOG, this maneuver is back in the spotlight. In this episode, we will review the reverse Løvset maneuver for shoulder dystocia and review its effectiveness. Which maneuver is more likely to result in fetal brachial plexus injury? Listen in for details. 1. A critical evaluation of the external and internal maneuvers for resolution of shoulder dystocia, March 2024; AJOG. https://www.ajog.org/article/S0002-9378(23)00022-4/fulltext2. Grindheim, Sindre et al.Reverse Løvset maneuver for shoulder dystocia, American Journal of Obstetrics & Gynecology, Volume 233, Issue 5, 505.e1 - 505.e43. Leung TY, Stuart O, Suen SS, Sahota DS, Lau TK, Lao TT. Comparison of perinatal outcomes of shoulder dystocia alleviated by different type and sequence of manoeuvres: a retrospective review. BJOG. 2011 Jul;118(8):985-90. doi: 10.1111/j.1471-0528.2011.02968.x. Epub 2011 Apr 12. PMID: 21481159.4. Grobman WA, Miller D, Burke C, Hornbogen A, Tam K, Costello R. Outcomes associated with introduction of a shoulder dystocia protocol. Am J Obstet Gynecol. 2011;205(6):513−517.STRONG COFFEE PROMO CODE:https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

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• Titrated Oral MISO Solution For Labor Augmentation?

  Misoprostol, as an E1 prostaglandin, is primarily used in obstetrics for cervical ripening (when the Bishop Score is under 6) and/or for labor INDUCTION (to begin labor). IV oxytocin is the principal agent used to augmentlabor, as needed, once labor has begun. In the US, misoprostol is not typically used after 4-6 cm cervical dilation. However, in a patient who requires augmentation,and who declines Pitocin while asking or oral misoprostol, can that be used? Is that evidence-based? The data may surprise you. Listen in for details. 1.     SOGC Guideline No. 432c: Induction of Labour Robinson,Debbie Campbell, Kim Hobson, Sebastian R. MacDonald, W. Kim Sawchuck, DianeWagner, Brenda et al. Journal of Obstetrics and Gynaecology Canada , Volume 45, Issue 1, 70 - 77.e32.     Bracken H, Lightly K, Mundle S, et al. OralMisoprostol Alone Versus Oral Misoprostol Followed by Oxytocin for Labour Induction in Women With Hypertension in Pregnancy (MOLI): Protocol for a Randomised Controlled Trial. BMC Pregnancy and Childbirth. 2021;21(1):537.doi:10.1186/s12884-021-04009-8.3.     Bleich AT, Villano KS, Lo JY, et al. OralMisoprostol for Labor Augmentation: A Randomized Controlled Trial. Obstetrics and Gynecology. 2011;118(6):1255-1260. doi:10.1097/AOG.0b013e318236df5b.4.     Ho M, Cheng SY, Li TC. Titrated Oral MisoprostolSolution Compared With Intravenous Oxytocin for Labor Augmentation: A Randomized Controlled Trial. Obstetrics and Gynecology. 2010;116(3):612-618. doi:10.1097/AOG.0b013e3181ed36cc. STRONG COFFEE PROMO CODE:https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

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