Dr. Chapa's OBGYN No Spin Podcast

Home Self-Check Urine Protein for gHTN?

Should patients check their own urine protein at home when they have a gestational hypertension DX? After all, home-based BP monitoring is an established part of HDP care. Is there data on home urine protein dipstick tests in gestational hypertension? What do professional guidelines say? And what are the pros and cons of home self-monitoring of urine protein? Thank you, SJ, for the podcast topic suggestion. FListen in for details. 1. ACOG PB 222 2. Jayawardena L, Mcnamara E. Diagnosis and Management of Pregnancies Complicated by Haemolysis, Elevated Liver Enzymes and Low Platelets Syndrome in the Tertiary Setting.Internal Medicine Journal. 2020. 3. Tucker KL, et al. (2022). "Effect of self-monitoring of blood pressure on diagnosis of hypertension during higher-risk pregnancy: the BUMP 1 randomized clinical trial. JAMA 4. Chappell LC, et al. (2022). "Effect of self-monitoring of blood pressure on blood pressure control in pregnant individuals with chronic or gestational hypertension: The BUMP 2 Randomized Clinical Trial. JAMA 5. UDIP (Urinary Dipstick In Pregnancy) trial. 2022 May 12;129(13):2142–2148. doi: 10.1111/1471-0528.17180

Is OB HPBM “Evidence-Based”? BUMP1&2 vs SMFM Special Statement

The vast majority of the time, “community standard of care” reflects evidence-based recommendations. This means that both the predominance of clinical data and what is clinically practice align one with another period but at times, clinical standard practice doesn't always align with what the data shows. How is this possible? This is exactly the case for home blood pressure monitoring in pregnancy (HBPM). This episode idea comes from an OB PGY-3, soon PGY-4, who asked his attending this brilliant question: “If the BUMP1 and BUMP2 clinical trials did not show a benefit with HBPM, why are we still doing it?” That is a complicated question that has a solid answer! Unsatisfied with his response, he asked for our opinion. Listen in for details. 1. Tucker KL, et al. (2022). "Effect of self-monitoring of blood pressure on diagnosis of hypertension during higher-risk pregnancy: the BUMP 1 randomized clinical trial. JAMA 2. Chappell LC, et al. (2022). "Effect of self-monitoring of blood pressure on blood pressure control in pregnant individuals with chronic or gestational hypertension: The BUMP 2 Randomized Clinical Trial. JAMA 3. SMFM Special Statement (2023): Society for Maternal-Fetal Medicine Special Statement: Telemedicine in obstetrics—quality and safety considerations; AJOG

Patient Self-Titration of Insulin for GDM?

Outside of pregnancy, guidelines emphasize diabetes self-management education and support to facilitate informed decision making, self-care behaviors, problem solving, and active collaboration with health care professionals. This includes, in those with good health literacy, the concept of patient-led self-titration of basal insulin results which has data that it improves glycemic management compared with clinician-led titration for type 2 diabetes among nonpregnant adults. But what about for GDM? Can patient’s self manage their BASAL insulin? In this episode, we will review a new RCT published in April 2026 in the Green Journal on this very subject. As novel as this is, it is not the first to report on this as it was also published (retrospective study in the UK) in 2022. This is a novel approach to insulin in GDM but there are some questions that remain. Listen in for details. 1. Boonpattharatthiti K, Wechkunanukul K, Mayang N, et al . Comparison of Insulin Titration Strategies for Glycemic Control in Type 2 Diabetes: A Systematic Review and Network Meta-Analysis.Diabetes Care. 2025. 2. Valent, Amy M. DO, MCR; Barbour, Linda A. MD, MSPH. Insulin Management for Gestational and Type 2 Diabetes in Pregnancy. Obstetrics & Gynecology 144(5):p 633-647, November 2024. | DOI: 10.1097/AOG.0000000000005640 3. Wang, Xiao-Yu MD; Gabbe, Steven MD; Landon, Mark B. MD; Venkatesh, Kartik K. MD, PhD et al. Patient-Led Insulin Titration for Glycemic Management With Gestational Diabetes Mellitus: A Randomized Controlled Trial. Obstetrics & Gynecology 147(4):p 501-509, April 2026. 4. McGovern AP, Hirwa KD, Wong AK, et al. Patient-led rapid titration of basal insulin in gestational diabetes is associated with improved glycaemic control and lower birthweight. Diabet Med. 2022;39:e14926. doi: 10.1111/dme.14926

VOMIT Trial: Mirtazapine vs Ondansetron for HG

Hyperemesis gravidarum (HG) represents the most severe end of the nausea and vomiting of pregnancy spectrum. It has a reported incidence of approximately 0.3–3% of pregnancies and is the most common cause of hospitalization in early pregnancy and the second most common cause of hospitalization in pregnancy overall. In June 2024, the ACOG published a Clinical Expert series summarizing the inpatient management of HG. In that guidance, it describes mirtazapine as an “alternative pharmacologic” option. How effective is this medication compared to ondansetron? A new study (published ahead of print on 12/30/25 and officially out June 2026), out of Denmark, sheds some new light on this medication. This trial is the first double-blind RCT comparing mirtazapine to ondansetron AND placebo. Although a BIG limitation of this study exists (which we will discuss), it does provide some interesting insights. Listen in for details. 1. (ACOG CES) Clark, Shannon M. MD; Zhang, Xue MD; Goncharov, Daphne Arena MD. Inpatient Management of Hyperemesis Gravidarum. Obstetrics & Gynecology 143(6):p 745-758, June 2024. | DOI: 10.1097/AOG.0000000000005518 2. Ostenfeld, AnneDroogh, Marjoes et al.Mirtazapine or ondansetron for hyperemesis gravidarum. A randomized placebo-controlled trial. American Journal of Obstetrics & Gynecology, June 2026

The “Half-Cm” Cervical Exam: Is that a thing? (With our PGY1 Guest)

Cervical exams can be tricky for the novice practitioner. Think about this: it’s a blind exam, we measure that distance using only two fingers, through a layer of tissue, sometimes with a patient moving up on the bed as we examine. That is the reality of a cervical exam. Intrapartum, some nursing staff and clinicians use qualitative descriptors like "a tight 4" or "a generous 5" to convey nuance. In line with this, some report cervical examinations in “half- centimeters”. This sounds like this: “well, her last cervical exam was 5cm but now she is 5 and a half”. Is that a thing? What does the data say? Listen in for details. 1. Hamilton EF, Zhoroev T, Warrick PA, et al. New Labor Curves of Dilation and Station to Improve the Accuracy of Predicting Labor Progress. American Journal of Obstetrics and Gynecology. 2024. 2. Hanidu A, Kovalenko M, Usman S, et al. Intrapartum Ultrasound for Cervical Dilatation: Inter- And Intra-Observer Agreement. Acta Obstetricia Et Gynecologica Scandinavica. 2024. 3. Abedi, P. (n.d.). Accuracy of ultrasound methods versus other methods for detecting of cervical dilatation during labor, a protocol for systematic review. ECronicon.