Dr. Chapa’s OBGYN Clinical Pearls

• IUD, Cytology, and Actinomyces: Management.

  Actinomyces species are considered part of the normal vaginal and urogenital tract flora. The percentage of Pap smears containing Actinomyces-like organisms varies but is most commonly reported as approximately 7% among women using IUDs. That number is supported by multiple sources, including the Infectious Diseases Society of America guideline and several clinical studies. The incidence can be higher or lower depending on the type of IUD; for example, copper IUDs have been associated with rates up to 20%, while levonorgestrel-releasing IUDs show lower rates around 2.9%. In women with an IUD, who are found to have this finding on their liquid-based Pap smear, what is the appropriate management? In this episode, which comes from one of our podcast family members, we will discuss this topic and it’s management in both symptomatic and symptomatic (pelvic pain) IUD wearing women. 1. McHugh KE, Sturgis CD, Procop GW, Rhoads DD. The Cytopathology of Actinomyces, Nocardia, and Their Mimickers. Diagnostic Cytopathology. 2017;45(12):1105-1115. doi:10.1002/dc.23816.2. Practice Bulletin No. 186: Long-Acting Reversible Contraception: Implants and Intrauterine Devices. Obstetrics and Gynecology. 2017;130(5):e251-e269. doi:10.1097/AOG.0000000000002400.3. Miller JM, Binnicker MJ, Campbell S, et al. Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2024 Update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 2024; ciae104. doi:10.1093/cid/ciae104.5. Carrara J, Hervy B, Dabi Y, et al. Added-Value of Endometrial Biopsy in the Diagnostic and Therapeutic Strategy for Pelvic Actinomycosis. Journal of Clinical Medicine. 2020;9(3):E821. doi:10.3390/jcm9030821.

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• LDA for Unexplained Recurrent SABs?

  Recurrent pregnancy loss (RPL) affects approximately 5% of couples and is an emotional burden on those affected. There is some evidence that vaginal progesterone supplementation may be considered in patients with recurrent pregnancy loss who are experiencing vaginal bleeding during the first trimester. But what about prophylactic low dose aspirin in the first trimester, or preconceptionally, for unexplained RPL? Is that evidence-based? A new publication from the SMFM’s journal Pregnancy has examined this. Listen in for details. 1. 22 November 2025: Low-dose aspirin in unexplained recurrent pregnancy loss: A systematic review and meta-analysis (Pregnancy): https://obgyn.onlinelibrary.wiley.com/doi/10.1002/pmf2.700992. American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice, T. Flint Porter, Cynthia Gyanff-Bannerman, Tracy Manuck. Low-Dose Aspirin Use During Pregnancy. American College of Obstetricians and Gynecologists (2018)3. Naimi AI, Perkins NJ, Sjaarda LA, et al. The Effect of Preconception-Initiated Low-Dose Aspirin on Human Chorionic Gonadotropin-Detected Pregnancy, Pregnancy Loss, and Live Birth : Per Protocol Analysis of a Randomized Trial. Annals of Internal Medicine. 2021;174(5):595-601. doi:10.7326/M20-0469.4. Lee EE, Jun JK, Lee EB.Management of Women With Antiphospholipid Antibodies or Antiphospholipid Syndrome During Pregnancy. Journal of Korean Medical Science. 2021;36(4):e24. doi:10.3346/jkms.2021.36.e24.5. de Assis V, Giugni CS, Ros ST. Evaluation of Recurrent Pregnancy Loss. Obstet Gynecol. 2024 May 1;143(5):645-659. doi: 10.1097/AOG.0000000000005498. Epub 2024 Jan 4. PMID: 38176012.

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• Change Gloves After Placenta at CS? Yes, and No.

  Having data is sometimes different than having clinically applicable data. This is exactly the issue with the proposed plan to reduce surgical site infection (SSI) by changing surgical gloves after placental delivery at C-Section. Just 24 hours ago, we received the question from a PGY4 OBGYN resident asking whether the practice of changing surgical gloves at C-Section after placental delivery to reduce SSI was evidence-based. So, in this episode, we will review the data - which is timely since this was recently published on November 13, 2025 in the J Hospital Infection. This study follows a statement on this practice released by FIGO in September 2025. It’s an interesting proposal, and there is clearly data in support of this, yet the ACOG and CDC do not recommend this practice as of Nov 2025. Is there a disconnect? Listen in for details. 1. FIGO: https://www.figo.org/news/new-ijgo-review-provides-comprehensive-framework-preventing-post-caesarean-sepsis (International Journal of Gynecology & Obstetrics)2. Stanberry B, Jordan L, Pullyblank A, Hargreaves J. Glove change during caesarean birth: impact on maternity service budgets and capacity. J Hosp Infect. 2025 Nov 13:S0195-6701(25)00354-8. doi: 10.1016/j.jhin.2025.10.033. Epub ahead of print. PMID: 41241232.3. Narice BF, Almeida JR, Farrell T, Madhuvrata P. Impact of Changing Gloves During Cesarean Section on Postoperative Infective Complications: A Systematic Review and Meta-Analysis. Acta Obstetricia Et Gynecologica Scandinavica. 2021;100(9):1581-1594. doi:10.1111/aogs.14161.4. Routine Sterile Glove and Instrument Change at the Time of Abdominal Wound Closure to Prevent Surgical Site Infection (ChEETAh): A Pragmatic, Cluster-Randomised Trial in Seven Low-Income and Middle-Income Countries.NIHR Global Research Health Unit on Global Surgery. Lancet (London, England). 2022;400(10365):1767-1776. doi:10.1016/S0140-6736(22)01884-0.5. Gialdini C, Chamillard M, Diaz V, Pasquale J, Thangaratinam S, Abalos E, Torloni MR, Betran AP. Evidence-based surgical procedures to optimize caesarean outcomes: an overview of systematic reviews. EClinicalMedicine. 2024 May 19;72:102632. doi: 10.1016/j.eclinm.2024.102632. PMID: 38812964; PMCID: PMC11134562.

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• Refresher of Genetic MD

  Muscular dystrophy (MD) is a group of genetic diseases that affect about 16 to 25 per 100,000 people in the US, with the most common childhood form being Duchenne muscular dystrophy (DMD) and the most common adult form being myotonic dystrophy. The prevalence of DMD is estimated at around 1 in 3,500 live male births. Prenatal carrier screening for this is part of the ACMG Tier 3 expanded carrier panel. This is different from spinal muscular atrophy (SMA). As we recently had a patient who was a MD carrier, with affected male children, who we cared for, we decided to do a quick review of muscular dystrophy: its prevalence, genetics, and evaluation of asymptomatic maternal carriers.1. https://www.mda.org/disease/duchenne-muscular-dystrophy/causes-inheritance2.https://www.nichd.nih.gov/health/topics/musculardys/conditioninfo/causes3. https://www.nhs.uk/conditions/muscular-dystrophy/4. ACMG: https://thednaexchange.com/2022/03/30/acmg-carrier-screening-guideline-the-hypothetical-tier-3-panel/#:~:text=The%20goal%20of%20this%20ACMG,1%20in%2040%2C000%20or%20higher.

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• Use GA at CS Electively? Maybe, Maybe.

  Regional anesthesia, typically with a spinal or epidural, haslong been favored for cesarean births due in part to concerns about the effects that general anesthesia (GA) may have on newborns at delivery. However, data has shown that up to 1 in 6 women may experience pain with a “topped-off”labor epidural, during the cesarean. A new publication in the journal Anesthesia is now being interpreted as implying that general anesthesia may be a valid alternative electively. Is that what this new study found? Has GA been linked to postpartum depression? What about later child neurodevelopmental delays? This is a fascinating topic…Listen in for details. 1.     Langer, Sarah M.D.1; Lim, Grace M.D., M.Sc.2;Qiu, Yue M.D.3; Biaesch, Jingyuan D.O.4; Neuman, Mark D. M.D., M.Sc.5. NeonatalOutcomes with Regional versus General Anesthesia for Cesarean Delivery: AMeta-analysis of Randomized Controlled Trials. Anesthesiology():10.1097/ALN.0000000000005785, November 12, 2025. | DOI:10.1097/ALN.00000000000057852.     Guglielminotti J, Monk C, Russell MT, Li G.Association of General Anesthesia for Cesarean Delivery with PostpartumDepression and Suicidality. Anesth Analg. 2025 Sep 1;141(3):618-628. doi:10.1213/ANE.0000000000007314. Epub 2024 Dec 4. PMID: 39630595; PMCID:PMC12134152.3.     Chen, YC., Liang, FW., Tan, PH. et al.Association between general anesthesia for cesarean delivery and subsequentdevelopmental disorders in children: a nationwide retrospective cohort study.BMC Med 23, 119 (2025). https://doi.org/10.1186/s12916-025-03886-64.     https://www.pennmedicine.org/news/new-study-challenges-fears-about-general-anesthesia-during-c-section

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