Dr. Chapa’s OBGYN Clinical Pearls

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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Well podcast family welcome to the first installment of what will be a periodic recurrence, of our episode called, “QUICKIE”. These are meant to be quick snippet episodes to give a quick fact or medical /clinical reminder in contrast to our regular episodes which are a little bit more in detail and lengthy. In this first installment of our first QUICKIE episode, we're going to tackle the distinction between the diagnosis of fetal growth restriction based on abdominal circumference vs estimated fetal weight and how this affects management.
1. ACOG CO 831
2. ACOG PB 227

Probiotics. They are often marketed as the end of all and be all for all our health issues. And they CAN do some real good. There is NO DOUBT a connection with overall heath and gut health…and NO ONE can deny that. But probiotics gets grey for some women’s health issues. A new prospective, single-arm, non-blinded, multicenter study across 31 hospitals in Japan is making some pretty dramatic claims regarding oral probiotics and recurrent spontaneous preterm birth (ePUB). Can oral probiotics reduce spontaneous recurrent preterm birth? Listen in for details.
1. Prevention of Recurrent Spontaneous Preterm Delivery Using Probiotics: Results from a Prospective, Single-Arm, Multicenter Trial. PPP trial Collaborators et al.
American Journal of Obstetrics & Gynecology, Volume 0, Issue 0
2. Grev J, Berg M, Soll R. Maternal probiotic supplementation for prevention of morbidity and mortality in preterm infants. Cochrane Database Syst Rev. 2018 Dec 12;12(12):CD012519. doi: 10.1002/14651858.CD012519.pub2. PMID: 30548483; PMCID: PMC6516999.
3. Jarde A, Lewis-Mikhael AM, Moayyedi P, Stearns JC, Collins SM, Beyene J, McDonald SD. Pregnancy outcomes in women taking probiotics or prebiotics: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2018 Jan 8;18(1):14. doi: 10.1186/s12884-017-1629-5. PMID: 29310610; PMCID: PMC5759212.
4. Othman M, Neilson JP, Alfirevic Z. Probiotics for preventing preterm labour. Cochrane Database Syst Rev. 2007 Jan 24;2007(1):CD005941. doi: 10.1002/14651858.CD005941.pub2. PMID: 17253567; PMCID: PMC9006117.
5. Timing of Probiotic Milk Consumption During Pregnancy and Effects on the Incidence of Preeclampsia and Preterm Delivery: A Prospective Observational Cohort Study in Norway.
6. Nordqvist M, Jacobsson B, Brantsæter AL, Myhre R, Nilsson S, Sengpiel V. Timing of probiotic milk consumption during pregnancy and effects on the incidence of preeclampsia and preterm delivery: a prospective observational cohort study in Norway. BMJ Open. 2018 Jan 23;8(1):e018021. doi: 10.1136/bmjopen-2017-018021. PMID: 29362253; PMCID: PMC5780685.
7. Gao Q, Sun Y, Qu Y, Li F, Li P. The effect of probiotic supplementation during pregnancy on pregnancy complications: An umbrella meta-analysis. Medicine (Baltimore). 2025 Dec 19;104(51):e46409. doi: 10.1097/MD.0000000000046409. PMID: 41430994; PMCID: PMC12727282.

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