Dr. Chapa’s OBGYN Clinical Pearls

By Dr. Chapa’s Clinical Pearls

Relevant, evidence based, and practical information for medical students, residents, and practicing healthcare providers regarding all things women’s healthcare! This podcast is intended to be clinica... more

· Science

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The podcast currently has 1,221 episodes available.

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Number 1: Estrogen’s Protection Against Breast CA: The Underappreciated Data
Today, we are taking a deep dive into a medical truth thatsounds completely counterintuitive, almost upside down, based on everything you think you know about women's health. But here’s the kicker: it’s actually nothing new at all. For over two decades, ever since the landmark Women’sHealth Initiative (WHI) study made global headlines back in 2002, the blanket narrative surrounding menopausal hormone therapy has been clear and persistent: hormones equal breast cancer risk. But there is a massive asterisk in thatscience that got completely lost in the media noise. While combination therapy with conjugated equine estrogens paired with medroxyprogesterone acetate (CEE +MPA) did show an increased risk, the story for estrogen-only therapy (mainly CEE) in women wh had a hysterectomy is entirely different. In fact, an overwhelming mountain of growing data shows that estrogen-only therapy is protectiveagainst both breast cancer incidence and breast cancer mortality. In this episode, we’re unpacking the latest high-level evidence that cements this crucial distinction. We'll examine the broad statistical landscape, including a comprehensive meta-analysis by Qing et al. (officially set for the December 2026 issue of Annals of Medicine, following its ahead-of-print release in March 2026). Their work breaks down how randomized controlled trial data consistentlypoint to estrogen-only therapy having a protective effect, in stark contrast to combination therapy. We'll also dive into a brand-new Clinical Perspective published in mid-August 2026 in Obstetrics & Gynecology (the Green Journal) by Drs. Andrew Kaunitz and Jason Wright. They call urgent attention to this phenomenon, highlighting RCT meta-analyses that demonstrate a 23% reduction in breast cancer incidence with estrogen alone (RR = 0.77), alongside striking cohort data showing a dramatic risk reduction even in high-risk populations, like carriers of the BRCA mutation. Listenin for details. 1. Wu Q, Shen L, Hu S, Yang R, Wang Y, Xue D, SunY, Ma H, Dai Z. Relationship between menopausal hormone therapy and incidencerisk of breast cancer: systematic review and meta-analysis. Ann Med. 2026Dec;58(1):2640244. doi: 10.1080/07853890.2026.2640244. Epub 2026 Mar. 2. Kaunitz, Wright. Menopausal Estrogen Therapy andRisk of Breast Cancer. Obstet Gynecol. Aug 2026 3. Chlebowski RT, Aragaki AK, Pan K, et al.Randomized Trials of Estrogen-Alone and Breast Cancer Incidence: AMeta-Analysis. Breast Cancer Research and Treatment. 2024. 4. Writing Group for the Women's Health InitiativeInvestigators. (2002). Risks and benefits of estrogen plus progestin in healthypostmenopausal women: Principal results from the Women's Health Initiativerandomized controlled trial. JAMA, 288(3), 321–333.
August 19, 202618min
Number 2: SC v IV Insulin Intrapartum
Historically, continuous intravenous (IV) insulin infusions were established as the standard of care for pregestational diabetes (Type 1 and Type 2 DM) during labor to prevent acute intrapartum hyperglycemia and minimize the risk of neonatal hypoglycemia. Intravenous insulin offers rapid titration, immediate onset, and a short half-life, allowing precise real-time glycemic control during the physiological stress and fluctuating metabolic demands of labor. Maintaining euglycemia intrapartum is emphasized because elevated maternal blood glucose levels cross the placenta, inducing fetal hyperinsulinemia, which acutely increases the risk of severe post-delivery neonatal hypoglycemia, which can be problematic. Although IV insulin protocols are widely used and are recommended in many practice guidelines, the evidence supporting their superiority over other approaches is limited. Subcutaneous (SC) insulin administration represents a potential alternative strategy to intrapartum glucose management. Continuation of SC insulin, including insulin pump therapy, has been studied most extensively among individuals with type 1 diabetes. However, evidence guiding intrapartum insulin management remains limited for patients with gestational or type 2 diabetes, who represent the majority of pregnancies complicated by diabetes. Institutional protocols frequently default to IV insulin despite limited comparative evidence with SC insulin and the increased workflow burden associated with infusion-based management. Now, a new retrospective study published in SMFM’s PREGANCY journal (25 July 2026; Seattle, Washington) is looking to give routine intrapartum SC insulin some validity. What did the data show? Listen in for details. 1. Savitsky, L.M., Barr, C., Katz, R., Martinez, N., Henderson, J., Saleh, T., White, L. and Simmons, L. (2026), Streamlining intrapartum glycemic control: Subcutaneous insulin for intrapartum diabetes management. Pregnancy, 2: e70371. https://doi.org/10.1002/pmf2.70371
August 16, 202627min
Number 3: What Defines “Refractory” HTN for Preterm sPreE Delivery?
The ACOG PB 222 states, “In women with preeclampsia with severe features at less than 34 0/7 weeks of gestation, with stable maternal and fetal condition, expectant management may be considered”. The expectant management of preeclampsia with severe features before 34 0/7 weeks of gestation is based on strict selection criteria of those appropriate candidates and is best accomplished in a setting with resources appropriate for maternal and neonatal care. BOX 4 in that ACOG guidance lists “Conditions Precluding Expectant management”, with one of the conditions being “Uncontrolled severe-range blood pressures (persistent systolic blood pressure 160 mm Hg or more or diastolic blood pressure 110 mm Hg or more not responsive to antihypertensive medication” (i.,e. persistent and refractory to appropriate medication). But what defines “uncontrolled hypertension”? When is preterm delivery indicated based on that feature? In this episode, we will answer this real-world clinical question. So, for a patient who is otherwise stable, asymptomatic, without HELLP syndrome, whose fetus is stable but is under 34 weeks, when can “uncontrolled hypertension” be diagnosed to prompt delivery? Listen in for details as we highlight the 2022 SMFM Special Report on that matter. 1. ACOG PB 222 2. SMFM Special report: Preeclampsia: a report and recommendations of the workshop of the Society for Maternal-Fetal Medicine and the Preeclampsia Foundation, Nov 2022 3. De Backer J, Haugaa KH, Hasselberg NE, et al. 2025 ESC Guidelines for the Management of Cardiovascular Disease and Pregnancy. European Heart Journal. 2025 4. SOGC Clinical Practice Guideline: Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy: Executive Summary; No. 307, May 2014 5. ISSHP (2018): The hypertensive disorders of pregnancy: ISSHP classification, diagnosis & management recommendations for international practice. Preg Hypertension. chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/http://www.isshp.org/wp-content/uploads/2018/06/1-s2.0-S2210778918301260-main.pdf
September 09, 202619min
Number 4: MOPP & PP BP Control
More than 60% of maternal deaths occur during the postpartum period, and hypertensive disorders of pregnancy are a major, preventable driver of that statistic. For too long, the transition from labor and delivery to home has been a vulnerable blind spot—leading to high rates of avoidablereadmissions. But the landscape has shifting. In this episode, we are diving deep into why OB providers must optimize blood pressure control before and after postpartum discharge. We’ll be breaking down the landmark 2025 MOPP study, which shook up our traditional targets by examining tight versus standard blood pressure control, alongside the recently released May 2026 ACC Expert ConsensusDecision Pathway.What is the actual "goal BP" for a safe postpartum discharge? When should we initiate outpatient tight control, and how do we prevent these patients from bouncing back to the ED? Grab your coffee and pull up a chair. Let’s look at the evidence. 20% DISCOUNT: https://strongcoffeecompany.com/discount/CHAPANOSPINOBG Gibson K, Hameed A. Society for Maternal-Fetal Medicine Special Statement: Checklist forpostpartum discharge of women with hypertensive disorders. AJOG, 2020. Farahi N, Oluyadi F, Dotson AB. Hypertensive Disorders of Pregnancy. American Family Physician. 2024. Lindley KJ, Bello NA, Berlacher KL, et al. Optimization of Postpartum Care for Patients With and at Risk for Premature and Long-Term Cardiovascular Disease: 2026 ACC Expert Consensus. Journal of the American College of Cardiology. May 2026. ACOG Task Force on Hypertension in Pregnancy, 2013 Rosenfeld EB, Sagaram D, Lee R, et al. Management of Postpartum Preeclampsia and Hypertensive Disorders (MOPP): Postpartum Tight vs Standard Blood PressureControl. JACC. Advances. 2025.
June 21, 202619min
Number 5: MS and Pregnancy (Sept 2026 Expert Review)
MS is a complex polygenic disease with over 200 associated genetic variants. The risk of an offspring developing MS if one parent is affected is relatively low at 2% to 3% (though maternal transmission shows slightly higher heritability), with some possible epigenetic influences. The National Multiple Sclerosis Society reports that up to 4 times as many women have MS as men. The average age at MS diagnosis is around 30 years. Studies show this ratio has grown over the past several decades; in the mid-20th century, the ratio was roughly 2:1, but the proportion of affected females has steadily increased due to a combination of environmental, hormonal, and diagnostic factors. MS does not impair natural fertility, so OB providers should be aware of the effect of pregnancy on MS and vice verse. In this episode, we will review a brand new (as of Aug 8, 2026) expert review on the subject which was published in the AJOG. Over the last decade, clinical guidance has shifted from advising women with MS to avoid pregnancy to a more active and permissive stance, largely due to the advent of new pharmacological and biologic therapies. Listen in for details. 1. Balshi A, et al. Management of Multiple Sclerosis During Pregnancy and the Reproductive Years in 2026: An Expert Clinical Review, American Journal of Obstetrics and Gynecology (2026), doi: https://doi.org/10.1016/j.ajog.2026.08.043.
September 12, 202628min