Procedure Ready: Ob/Gyn

By Jennifer Doorey, MD, MS

Procedure Ready: Ob/Gyn (formerly called Pimped Ob/Gyn) is a podcast aimed at medical, PA, and NP students who are entering their clinical rotation in Ob/Gyn. It covers topics including You... more

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FAQs about Procedure Ready: Ob/Gyn:

How many episodes does Procedure Ready: Ob/Gyn have?

The podcast currently has 35 episodes available.

Procedure Ready: Ob/Gyn episodes:

June 09, 2023Operative Vaginal Deliveries
Incidence:
3.3% as of 2013
Indications:
Prolonged second stage
Risk of fetal compromise
Shortening 2nd stage for maternal benefit (ex: cardiac conditions)
Consent:
Comparison is c-section typically
Failure rate of OVD is ~3-6%
Forceps has higher success rate over vacuum, but also higher risk 3rd/4th degree tear
Risks to both mom and baby
Prep:
Fetus appropriate station/position
Anesthesia
Empty bladder
Assess Pelvis/Passenger sizes/fit
OR Ready
Peds available
Episiotomy – NO!
Contraindications
Fetal conditions, known or supspected: bone disorders (OI), bleeding disorders
Maternal infections: Hep C, HIV, etc
Concern for shoulder dystocia/cephalo-pelvic dysproportion
...more
14min
June 09, 2023Induction of Labor
Indications:
Post-dates (42+wks)
Late Term (41+ wks)
Elective 39+wks
Diabetes
Hypertension
Many more - check out ACOG Medically indicated delivery

39week induction
ARRIVE Trial - Multicenter RCT showing benefit to 39wk IOL over expectant management to ~41wks
Included
Primips
No medical indications for IOL prior to 40+5

Results
IOL group had LOWER c-section rate than expectant group
Neonatal composite outcome had a trend (not statistically significant) toward lower neonatal compilations in IOL group
Conclusion
IOL at 39wks is as safe as expectant management without increased risks
Many pregnant people are now offered a 39wk IOL rather than waiting for spontaneous labor

The IOL Process:

Evaluate and Prep:
Full H&P
Ultrasound for position - Vertex
VE for cervical exam: dilation/effacement/Station, also position and consistency
Calculate Bishops Score → help determine mode of IOL

Options for IOL: if biship score <8 for prime or <6 for multip, ripen first!
Mechanical cervical ripening (balloon)
Chemical cervical ripening (misoprostol or cervidil)
Best yet--both!

Contractions (pitocin)
Prime: Pitocin alone if Biship 8 or higher
Mulitp: Pitocin alone if bishop 6 or higher

Augmentation: AROM

Failed IOL
Failure to reach active labor after 18+hrs ruptured on pitocin (definition varies 12-24hrs ruptured on pitocin)
If reaches active labor (6+cm), no longer failed IOL, now arrest of dilation or descent
...more
18min
June 08, 2023Shoulder dystocia
Definition: Failure to deliver fetal shoulders with normal downward traction
Why we care: Baby hypoxia, brachial plexus injuries, maternal injuries
Risk factors:
DM, excessive weight gain in pregnancy, S>D, Large baby
Hx of shoulder dystocia (~10-15% recurrence)
Turtling while pushing
Prevention
No real prevention as SD is very hard to predict
Offer cesarean delivery if EFW is >5000g and no DM, or >4500g and any type of DM
What do to:
Step back. If comfortable, can help minimize family interference. Calmly explain what is happening and what the docs are doing.
Offer to be the Timekeeper. Write down times and what is happening. Announce every 2 minutes.
What you’ll see:
Prep: Hypothesize shoulder orientation for suprapubic pressure, place stool
Announce problem- call for help
Maneuvers - McRobers, suprapubic
Posterior arm
Rotational: Wood’s screw, Rubin
Gaskins- all 4s
Episiotomy
Zavanelli
...more
17min
August 15, 2018Cancer Screening and Vaccinations (HCM)
Cancer Screening
Cervical: Age 21-65 Cytology q3yrs, co-test q5 if normal.
ASCCP guidelines (there is an app! Or PDF: http://www.asccp.org/Assets/51b17a58-7af9-4667-879a-3ff48472d6dc/635912165077730000/asccp-management-guidelines-august-2014-pdf )
Breast: ACOG: 40-75 annual mammogram
Colon: Colonoscopy, FOBT, FIT. Begin at age 50. If first degree relative with colon cancer begin screening at age 40 or 10yrs prior to youngest diagnosis, whichever is younger.
Lung: 55-80 with 30pack-year hx, annual low-dose CT
Vaccinations
HPV: 3 dose series age 12-26
Influenza: annual
Pneumovax: 1 dose and 1 booster any age if risk factors. After age 65 if no risk factors
Shingles: 2 dose age 50+
Hep B: initial vaccination in youth, vaccination for anyone non-immune
MMR: if not immune
Varicella: if not immune
Tdap: Booster at 10yrs, new parents
...more
13min
August 15, 2018STIs
Swab/Urine
Chlamydia: usually asymptomatic. Screen routinely. Can cause infertility/PID and Fitz-hugh-curtis. Treat with Azithro x1
Gonorrhea: often asymptomatic. Screen routinely. Can cause infertility/PID. Treat with Ceftriaxone and Azithromycin
Trich: frothy/watery discharge. “Strawberry cervix” Can see trich moving on wet mount. Treat Flagyl 2g PO once.
HPV: Cervical dysplasia/cancer and Genital warts. Topical treatments as needed.
Serum
Syphilis: Painless chancre followed by latent, then secondary with palmar/plantar rash. If unsure stage, treat as if latent, PCN IM x3
HIV: Universal screening. PREP if high risk. Referral to ID and counseling if positive.
Hep B: Treatable, not curable. Routine serum screening.
No Routine Screening, diagnose if lesion
HSV: Antivirals as needed for outbreaks, can prophylax if frequent outbreaks/immunosuppressed. Valacyclovir or acyclovir are most common.
...more
20min
August 10, 2018 STIs
Swab/Urine Chlamydia: usually asymptomatic. Screen routinely. Can cause infertility/PID and Fitz-hugh-curtis. Treat with Azithro x1 Gonorrhea: often asymptomatic. Screen routinely. Can cause infertility/PID. Treat with Ceftriaxone and Azithromycin Trich: frothy/watery discharge. “Strawberry cervix” Can see trich moving on wet mount. Treat Flagyl 2g PO once. HPV: Cervical dysplasia/cancer and Genital warts. Topical treatments as needed. […]
...more
14min
August 10, 2018 Cancer Screening and Vaccinations (HCM)
Cancer Screening Cervical: Age 21-65 Cytology q3yrs, co-test q5 if normal. ASCCP guidelines (there is an app! Or PDF: http://www.asccp.org/Assets/51b17a58-7af9-4667-879a-3ff48472d6dc/635912165077730000/asccp-management-guidelines-august-2014-pdf ) Breast: ACOG: 40-75 annual mammogram Colon: Colonoscopy, FOBT, FIT. Begin at age 50. If first degree relative with colon cancer begin screening at age 40 or 10yrs prior to youngest diagnosis, whichever is younger. […]
...more
13min
February 13, 2018 Before Your First: Colposcopy and LEEP
Why: ASCCP guidelines (there is an app! Or PDF)
Cervical dysplasia — caused by HPV
CIN I–CIN3 is a progression
Risk factors: Smoking, other STIs including HIV, immunodeficiency

Histology: Increased Nuclear: cytoplasmic ratio when abnormal
Acetic Acid: exact mechanism unknown, the higher N:C ratio cells (aka abnormal cells) reflect more light and appear white.
Lugols: Iodine rich-reacts with glycogen in normal squamous cells so they appear dark. Non-staining cells are abnormal.

HPV — changes
Colpo:
Increased vascularity, punctations, mosaicism, surface contour changes

LEEP:
Stain abnormality and know where abnormal biopsy was taken
Single pass is ideal–tag a side for orientation
+/- Top Hat depending on ECC result

CKC:
Higher up in cervical canal, but more complications
No electricity– okay if pregnant
...more
16min
February 11, 2018Return OB Visits
Every visit:
Doptones, fundal height, vitals
Four question: Vaginal bleeding, contractions, leaking fluid, fetal movement
By Weeks:
20wks – get and review anatomy US
24wks – order glucola, cbc (check for anemia), discuss normal growing pains
28wks – Tdap and Rhogam if needed, discuss kick counts
32wks – Discuss BCM, sign tubal papers if needed, discuss TOLAC if needed
36wks – GBS screening, birth expectations, US for position
38-40wks – VE, “sweep membranes”
...more
13min
February 08, 2018First Prenatal Visit
Planned/Desired
Options counseling if needed
Exam/pelvic/pap
Ultrasound for dating
Screening options: QUAD, Sequential, NIPS, invasive testing
Pregnancy guidelines
Weight:
BMI under 18.5 should gain 28–40 pounds.
Normal-weight women (BMI, 18.5–24.9) should aim for 25–35
Overweight women (BMI, 25–29.9) should aim for 15–25
Obese women (BMI, 30 or more) should gain only 11–20
Food: Avoid unpasteurized dairy, large fish (swordfish, shark, king mackerel, tilefish, bigeye tuna etc), uncooked meat/seafood, uncooked deli meat, EtOH
Drugs: Nothing unless cleared by MD. Tylenol okay if needed, PNV, Colace, FeSO4. NO NSAIDs!
Exercise: Nothing that could leave a bruise on your belly! Moderate exercise is great.
...more
18min

FAQs about Procedure Ready: Ob/Gyn:

How many episodes does Procedure Ready: Ob/Gyn have?

The podcast currently has 35 episodes available.

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