Dr. Chapa’s OBGYN Clinical Pearls

Today we are diving into a topic that is incredibly close to my heart—one that has the potential to fundamentally change how we approach prenatal care and protect pregnant patients. We’re talking about low-dose aspirin for the prevention of hypertensive disorders of pregnancy. Now, if you follow current formal guidelines, you probably know the standard protocol: 81 milligrams a day, prescribed based on specific risk factors. But there’s a growing body of evidence suggesting we might be underdosing—and under-prescribing. What if 162 milligrams taken universally across the board is actually far more effective?In today’s episode, we’re unpacking a brand-new, groundbreaking study published in the American Journal of Obstetrics & Gynecology. And I’m especially excited to cover this one because it comes straight out of my alma mater, Parkland Hospital! This study takes a bold look at real-world outcomes by comparing a period of universal 162-milligram aspirin use directly against a historical period when aspirin wasn’t recommended at all. Did a higher, universal dose significantly cut down on hypertensive disorders? And just as importantly …were there any adverse safety events we need to be aware of? Grab your coffee, settle in, and let's get into the details.
1. Duryea E, Ambia A, Pruszynski J. et al. Universal Aspirin Dispensation for Prevention of Preeclampsia in a High-Risk Population. AJOG, 2026; ePub 8/27/28
2. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013 Nov;122(5):1122-1131.
3. ACOG Issues Updated Hypertension Guidance, Discusses New ACC/AHA Criteria (2018): https://www.acog.org/news/news-releases/2018/12/acog-issues-updated-hypertension-guidance
4. Low-Dose Aspirin Use During Pregnancy, ACOG Committee Opinion Number 743 (2018)
5. Low-Dose Aspirin Use for the Prevention of Preeclampsia and Related Morbidity and Mortality. ACOG Practice Advisory; December 2021

Today, we are tackling a massive grey area in obstetrics/maternal-fetal medicine: What happens after early fetal growth restriction resolves? When a baby bounces back on the growth chart during the second or third trimester, are they completely out of the woods? Or is there a hidden, lingering risk we aren’t talking about enough? To find out, we’re doing a deep dive into two major publications that dropped just this month, in August 2026 in sister journals (AJOG and AJOG MFM). Both are retrospective, both ask the exact same burning question…and get this: they arrive at completely opposing conclusions. How is that possible? Listen in for details.
1. Melamed B, Mei-Dan E, Aviram A. Sonographic fetal weight estimation percentiles should be interpreted with caution in the second trimester. Int J Gynaecol Obstet. 2026 May;173(2):930-939. doi: 10.1002/ijgo.70693. Epub 2025 Nov 25. PMID: 41288086.
2. Ramos SZ, Has P, Gimovsky AC, Danilack VA, Savitz DA, Lewkowitz AK. Outcomes among Neonates after a Diagnosis of Persistent or Transient Fetal Growth Restriction Delivered at Term. Am J Perinatol. 2024 May;41(S 01):e1470-e1477. doi: 10.1055/a-2051-3859. Epub 2023 Mar 9. Erratum in: Am J Perinatol. 2024 May;41(S 01):e1478. doi: 10.1055/s-0044-1786526. PMID: 36894159; PMCID: PMC10562520.
3. Keller N, Jackson F, Abelman S .Neonatal morbidity following resolution of fetal growth restriction diagnosed at second-trimester anatomy ultrasound. American Journal of Obstetrics & Gynecology MFM, 2026; Aug 8.
4. Cenac LA, Wodoslawsky S, Patel V, McLaren Jr. R, Aghai ZH, Makhamreh MM, Al-Kouatly HB, Persistent, Resolved, and Absent Fetal Growth Restriction: A Comparison of Neonatal Outcomes, American Journal of Obstetrics and Gynecology (2026), doi: https:// doi.org/10.1016/j.ajog.2026. Aug 19

The word CERCLAGE comes from the French word, cercle, meaning "hooping" or "encirclement". Cerclage was traditionally reserved for cervical insufficiency but is now a recognized option for patients with a history of preterm birth and a short cervix noted on ultrasound between 16-24 weeks. There are three (3) main indications for obstetrical, cervical cerclage: History-Based, Ultrasound-Based, and Physical- Exam Based. In this episode, we will summarize the key takeaways from the new ACOG CPG on OBSTETRICAL CERCLAGE, being released in September 2026.
1. ACOG CPG, Obstertrical Cerclage, Sept 2026
2. ACOG Practice Bulletin #234: Prediction and Prevention of Spontaneous Preterm Birth, 2021

As of August 20th, 2026, the ACOG has released an updated Clinical Practice Update on opportunistic salpingectomy. Here’s why this matters so much: we now know that the vast majority of high-grade serous epithelial ovarian cancers actually start not in the ovaries, but in the fallopian tubes. By removing those tubes during routine pelvic, obstetric, or even non-gynecologic abdominal surgeries, we aren't just performing standard procedures—we are drastically cutting the lifetime risk of epithelial ovarian cancer by up to 78%. Today, we’re breaking down what’s inside ACOG’s latest guidance, how surgical practices are shifting, and why this simple step is saving lives. Let’s dive in!"
1. ACOG CPU (Aug 20, 2026): https://www.acog.org/news/news-releases/2026/08/acog-strengthens-recommendations-supporting-salpingectomy-ovarian-cancer-prevention
2. ACOG CO 774: Opportunistic Salpingectomy as a Strategy for Epithelial Ovarian Cancer Prevention (2019, reaffirmed 2024)

ACOG recommends the use of oral or vaginal misoprostol, vaginal dinoprostone (either gel or insert), or mechanical methods for cervical ripening. Plus, it states, “Combination methods (pharmacologic and mechanical) are also effective”. The July 2026 ACOG CPG 9 states this regarding vaginal misoprostol compared to vaginal dinoprostone for labor induction: “Vaginal dinoprostone is effective for cervical ripening; however, vaginal misoprostol has higher efficacy and less need for oxytocin augmentation. The Cochrane database systematic review in 2010 that compared vaginal misoprostol with vaginal dinoprostone in 38 trials (7,022 participants) showed a lower rate of failure to achieve vaginal delivery in 24 hours (RR 0.77) and reduced need for oxytocin augmentation with misoprostol (RR 0.68). There were no differences in the rates of cesarean delivery or tachysystole with FHR changes”. Now, as of August 19, 2026, a new meta-analysis from BJOG is examining this comparison (vaginal miso vs vaginal dino) again. Did they find the same thing? Listen in for details.
1. G. Andersson, B. Greenfield, A. Hunt, et al., “ Vaginal Misoprostol Compared to Vaginal Dinoprostone for Induction of Labour: A Systematic Review and Meta-Analysis,” BJOG: An International Journal of Obstetrics & Gynaecology (2026): 1–12, https://doi.org/10.1111/1471-0528.70314.
2. ACOG Clinical Practice Guideline No. 9: Cervical Ripening in Pregnancy