Dr. Chapa’s OBGYN Clinical Pearls

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!

The ACOG recommends a multimodal approach to postoperative pain that includes nonsteroidal NSAIDs, acetaminophen, and opioids. Ketorolac is a favored NSAID for postop pain control. However, the optimal dose of ketorolac after cesarean delivery has not been determined. In this episode, we will summarize a brand new randomized, controlled, single-blind trial of pregnant women undergoing cesarean delivery under regional anesthesia at a large academic medical center between June 2022 and October 2023. Enrolled participants were randomized to receive an initial loading dose of 60 mg (intervention) or 30 mg (control) of intravenous ketorolac in the operating room at the end of surgery.

1. Pharmacologic Stepwise Multimodal Approach for Postpartum Pain Management: ACOG Clinical Consensus No. 1. Obstetrics and Gynecology. 2021.
2. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstetrics and Gynecology. 2020.
3. Eid, Joe MD; Caplan, Madeleine MD; Goel, Nidhi MD; Poirier, Marie-Veronique MD; Montaine-O'Brien, Skyler MS; Rood, Kara M. MD; Costantine, Maged M. MD. Two Perioperative Ketorolac Dosing Regimens After Cesarean Delivery and Opioid Use: A Randomized Controlled Trial. O&G Open 3(2):e159, April 2026. | DOI: 10.1097/og9.0000000000000159