Dr. Chapa’s OBGYN Clinical Pearls

The belief that IV dextrose is necessary to clear ketones in hyperemesis gravidarum originated from a logical, and now known to be outdated, extrapolation of basic starvation ketosis physiology and the treatment paradigm for diabetic ketoacidosis (DKA). The original experiments that led to this conclusion go back to the 1960s (Foster data). Not only is this outdated, but it is also physiologically incorrect. We’ve learned a lot about IV fluid replacement about hyperemesis gravidarum in the last several years- in the last data review was in January 2026 in Lancet. Even the correction of hyponatremia has evolved. Should we be following urine ketones for patients being treated for HG? Is Dextrose needed? Listen in for details.
1. Nana M, Painter R, Williamson C et al. Hyperemesis gravidarum. The Lancet, Jan 2026; 407, 78-89
2. Clark SM, Zhang X, Goncharov DA. Inpatient Management of Hyperemesis Gravidarum. Obstet Gynecol. 2024 Jun 1;143(6):745-758. doi: 10.1097/AOG.0000000000005518. Epub 2024 Feb 1. PMID: 38301258.
3. Ayus JC, et al.Correction rates and clinical outcomes in hospitalized adults with severe hyponatremia: a systematic review and meta-analysis. JAMA Intern Med. 2025;185(1):38-51.
4. ACOG Clinical Epert Series: Inpatient Management of Hyperemesis Gravidarium. Obstet Gynecol; 2024

AUDIO EXCERPT from our recent Instragm post on this Social Media trend. Silly or Science? Listen in for details.

Uterine compression sutures are effective, uterus-sparing techniques for managing severe postpartum hemorrhage (PPH) due to atony, avoiding hysterectomy. Keytypes include the B-Lynch suture (vertical, brace-like), Hayman suture (simplified vertical), and Pereira sutures (multiple, comprehensive sutures), and Cho Compression (quadrant square anterior to posterior closures), are applied when pharmacological methods fail. But these, while helpful with atony, do not address the LUS bleeding from previa which are below these applications. Even the O’Leary lateral sutures are often higher tha the bleeding and thin, anterior LUS affected by previa. Previa is a significant risk factor for PPH. In this episode, we will highlight 3 novel suture techniques which have been in print (TWO as recent as January 2026) which can be effective in stopping the LUS bleeding and avoiding hysterectomy. We will highlight the transverse circumferential purse string, the simple transverse Nausicaa suture, and theLUS WaveForm suture. These are easy to use and may be lifesaving.
1.   Shih J, Li J, Kang J .The Nausicaä suture in the management of the placenta accreta spectrum. AJOG. Jan 2026: 233, S671-S688 S
2.   Transverse Purse String Suture for Placenta Previa in the Presence of Previous Cesarean Section, Experience in Northern Borders Saudi Arabia. 2022
3.    Zhou L et alWave compression suture: A modifieduterus-preserving treatment for placenta previa by reconstruction of the lower uterine segment. Medicine (Baltimore). 2026 Jan 30;105(5):e47468.

(From our Instagram Video Post): A very quick recap of the brand new ACOG Cervcial Caner Screening Update from April 24, 2026.

Just a VERY QUICK episode in rsponse to my sweet friend's question. Kerri is an MFM in another part of the country and she had KEEN insights on our recent episode on "Best Perioperative ose for Ketorolac at CS". Listen in for more good stuff!