Show Notes
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
More from Dr. Chapa’s OBGYN Clinical Pearls
Here is a sobering fact: Iron deficiency is one of the most common health conditions in the world. Iron deficiency affects an estimated one in three people, yet many go undiagnosed and untreated despite widespread treatment options. Iron deficiency can progress to iron deficiency anemia. If you’ve been listening for a while, you know we have banged the drum on this podcast time and time again about why serum ferritin matters. We’ve talked about how so many people suffer from low iron stores even when their basic blood work comes back looking "normal," and why we have to look way beyond just standard iron deficiency anemia. Well, guess what? The medical establishment is officially catching up! In September 2026, the American Society of Hematology (ASH) released brand new, evidence-based recommendations that are set to completely change how we diagnose iron deficiency. Published in ASH’s prestigious, peer-reviewed journal Blood Advances, these new guidelines were brought together by a multidisciplinary team of experts across multiple medical specialties to redefine critical thresholds- especially for women and during pregnancy. Today, we are diving deep into what these new guidelines actually mean for us. Listen in for details 1. https://www.hematology.org/newsroom/press-releases/2026/ash-sets-new-standards-for-diagnosing-iron-deficiency 2. https://ashpublications.org/bloodadvances/article/doi/10.1182/bloodadvances.2025015950/570502/American-Society-of-Hematology-2026-guidelines-for
Innie vs Outies: no, we are not referring to bellybuttons. In this episode, we’re talking about the labia of the Volva! Does it actually matter? Which one is more common? Now, this episode was actually sparked by a brilliant listener who sent us her question to our IG inbox (as a non-clinician): “Can having an innie labia actually cause me to have recurrent bacterial vaginosis?” Such a good question, right? So today, we’re going to break down what the medical literature actually says about anatomy and BV. Plus, well answer the question: What is ACOG’s stance on elective labioplasty? Grab a cup of coffee, get comfortable, and let’s normalize the normal. 1. Lykkebo AW, Drue HC, Lam JUH, Guldberg R. The Size of Labia Minora and Perception of Genital Appearance: A Cross-Sectional Study. J Low Genit Tract Dis. 2017 Jul;21(3):198-203. doi: 10.1097/LGT.0000000000000308. PMID: 28369012. 2. Aydın A, Atılgan AE, Sönmez MG, Sönmez L, Boğa MS, Balasar M. Do variations in labial anatomy have an effect on recurrent urinary tract infection? Int Urogynecol J. 2020 Oct;31(10):2129-2136. doi: 10.1007/s00192-020-04310-8. Epub 2020 May 9. PMID: 32388633. 3. Elective Female Genital Cosmetic Surgery. American College of Obstetricians and Gynecologists. 2020. Committee on Gynecologic PracticeGuideline 4. ACOG Committee Opinion 795: Elective Female Genital Cosmetic Surgery; 2020 (reaffirmed 2026)
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.