Podcast Summary: Dr. Chapa’s Clinical Pearls – “What Did You Say?!” (October 7, 2025)
Main Theme:
This dynamic episode of Dr. Chapa’s Clinical Pearls tackles three real-life questions posed by residents and staff, each leading Dr. Chapa to his signature exclamation, “What did you say?!” The episode covers common misconceptions and clarifies clinical guidelines on:
- Cord blood collection in monochorionic twin pregnancies
- Modified vs. full biophysical profile (BPP) in assessing fetal well-being
- Breastfeeding guidance in mothers using cannabis postpartum
Dr. Chapa uses humor and memorable anecdotes to illuminate these often-confusing topics, referring directly to recent evidence and the latest guideline updates.
Key Discussion Points & Insights
1. Cord Blood Collection in Monochorionic Monozygotic Twin Pregnancies
Timestamp: 08:49–13:29
- The Misconception: One of the labor and delivery nurses asked if only a single cord blood sample is needed at birth for monochorionic, monozygotic twins (i.e., "identical" twins, sharing one placenta), as their blood types should be identical.
- Dr. Chapa’s Reaction:
“No, no, no, no, no, no... You need to collect cord blood from each individual, from each child.” (12:42)
- Clarification:
- AAP Guidelines: The American Academy of Pediatrics (AAP) mandates individual cord blood sampling for EACH twin, regardless of placental configuration or presumed “identical” status.
- Even though monozygotic twins share most of their DNA, epigenetic or mutational changes can occur post-zygotically, meaning small genetic differences may exist.
- Clinical Relevance: Individual assessment is crucial for accurate detection of potential blood type discrepancies, infectious disease, antibodies, hemoglobin/hematocrit, or high-risk conditions.
- Notable Reference:
- Clinical Report: Postnatal Cord Blood Sampling (AAP, 2024/2025 updates)
- Memorable Quote:
“You should have seen my face. I almost–almost!–popped the head gauge and almost lost it.” (13:19)
2. Modified Biophysical Profile (MBPP) vs. Full Biophysical Profile (BPP)
Timestamp: 13:29–19:07
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The Question: Should clinicians use a modified BPP (NST + amniotic fluid index) or a full BPP (adding fetal movement, tone, and breathing) for antepartum fetal surveillance, especially after decreased fetal movement?
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Guidance from Dr. Chapa:
- A reactive modified BPP (normal NST plus normal amniotic fluid) is just as effective as full BPP for ruling out imminent fetal compromise.
- Evidence-Based Numbers:
“The risk of stillbirth after a reactive modified biophysical profile...is 0.8 per thousand. The rate for a full biophysical profile is 0.8 per thousand.” (15:24)
- Modified BPP is acceptable for clinical decision-making when both components are normal. Opt for a full BPP only if one part is abnormal.
- If isolated oligohydramnios (low amniotic fluid) is found, protocols for further evaluation or even delivery at ≥36 weeks may be warranted.
- Reference:
- ACOG Practice Bulletin 229: “Antepartum Fetal Surveillance” (2021/2025)
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Teaching Moment:
“If you’re doing a modified and both are normal, you’re good. The rate of stillbirth is absolutely the same compared to the full.” (17:10)
- Residents should still know how to perform a full BPP for training and skill maintenance, but in routine practice, a modified BPP is sufficient if reassuring.
3. Cannabis Use and Breastfeeding
Timestamp: 19:07–23:04
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The Dilemma: Is breastfeeding contraindicated in women who continue to use cannabis postpartum?
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Resident’s (incorrect) Assumption: Cannabis use = no breastfeeding allowed.
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Dr. Chapa’s Evidence-Based Answer:
- Recent ACOG Guidance (Consensus #10, Oct 2025) clarifies that, despite the lipid solubility of THC and its presence in breast milk (about 10% of maternal serum), continued cannabis use in the postpartum interval is NOT a contraindication to breastfeeding.
- Patient Counseling: Providers should encourage cessation of cannabis for optimal outcomes, but the benefits of breastfeeding outweigh the uncertain and, so far, limited risks associated with transfer of THC through milk.
- Direct Reference from ACOG:
“Obstetrician, gynecologists and other health care professionals should advise cessation of cannabis use during pregnancy and lactation. However, continued cannabis use is not a contraindication to breastfeeding, and lactation should be encouraged regardless of cannabis use.” (21:43)
- Key Caveat: Do not smoke cannabis in the presence of the child to avoid secondhand exposure.
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Memorable Moment:
“Are you saying that they can continue to use marijuana and breastfeed?”
“Yes, because the benefit of lactation is so good as long as, once again, they're not taking a little dooby dooby at the same time that the kid's on the breast so the kid doesn't get wacky by secondhand smoke.” (22:23–22:30)
Notable Quotes
- On Cord Blood Testing:
“The indication for cord blood sampling for newborn testing has nothing to do with zygosity and has nothing to do with the configuration of the placenta. So they have to be treated individually for each individual lab test.” (11:43)
- On Mod/Full BPP Equivalence:
“If both of those [NST and AFI] are reassuring, the rate of stillbirth is 0.8 per 1000. Extremely small... The rate with a full biophysical profile is absolutely, 100%, the same.” (15:03–15:25)
- On Cannabis and Lactation:
“Because of the benefit, overall benefit for breastfeeding, a patient who elects to continue lactating, who elects to continue using cannabis, can continue to lactate, can continue to breastfeed. It's okay.” (20:10)
Timestamps for Major Segments
- [00:00–06:10] Opening, Episode Rationale, and “What did you say?!” premise
- [08:49–13:29] Cord Blood in Monochorionic Twin Gestations
- [13:29–19:07] Modified vs. Full Biophysical Profile (BPP)
- [19:07–23:04] Cannabis Use & Breastfeeding Guidance
- [23:13–23:32] Closing remarks, gratitude for listeners
Tone and Approach
Dr. Chapa’s tone is punchy, humorous, and direct, using real-life resident mishaps as springboards for high-yield clinical teaching—peppered with pop culture references and personality.