Procedure Ready: Ob/Gyn

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Procedure Ready: Ob/Gyn

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 Your Ob/Gyn Survival Guide-Tips and Tricks, Labor and Delivery, Vaginal deliveries, C-sections, Hysterectomies, and more. Each podcast walks you through a portion of what you’ll experience during your clinical rotations, gives you tips for excelling, preps you for the clinical questioning that’ll occur, and sets you up to overall Honor the rotation! Email podcasts@procedureready.com with comments, questions, and episode ideas. ##Legal Disclaimer## The opinions expressed within this content are solely the speakers' and do not reflect the opinions and beliefs of their employers or affiliates.

  1. EPISODE 1

    Your Ob/Gyn Survival Guide: Tips and Tricks

    High yield resources and tips for your Ob/Gyn clerkship. Youtube Playlist: http://bit.ly/pimped-ob Books: Netters Obstetrics and Gynecology by Beckmann Apps: Pimped App – Clinical questions to expect in the OR and on the wards Uptodate Epocrates GoodRx LactMed – medications safe in breastfeeding ASCCP: Cervical cancer screening CDC STI guidelines ACOG app/website OB Wheel or dating Tips and Tricks: Be Proactive—talk to students who just finished the rotation about ways to be helpful and the day to day logistics. Expectations: Ask for them to be set at the beginning. Clarify as needed. Be Self-sufficient, but ask for help when appropriate Before leaving for the day, ask when you should come in to round, who to pre-round on and where to meet. Once or twice a week ask for feedback when everyone has a down moment. Labor and Delivery: Gs & Ps aka Gravity and Parity. Primes, multips Gestational age Preterm vs term

    26 min

  2. EPISODE 2

    Labor and Delivery Triage

    The OB One-Liner: “This is a _ yr old G_ P_ @_ wks GA here for ____.” Ex: This is a 34yo G3P2002 @ 38wks3days GA here for contractions Triage: 4 essential questions to ask every pregnant woman in triage Contractions, leaking fluid, vaginal bleeding, fetal movement What is labor? Cervical change and contractions Evaluate for ROM: Pooling, nitrazine (pH), ferning. Vaginal bleeding—when do we care? 2nd or 3rd trimester worry about placenta: abruption, previa, vasa previa DFM: NSTs, BPPs, Kick counts

    23 min

  3. EPISODE 3

    Before Your First: Vaginal Delivery

    Cardinal movements of labor: engagement, descent, flexion, internal rotation, extension, external rotation and expulsion Complete dilation, now station: Labor down vs push 2nd Stage of labor: Pushing Offer to help with maternal positioning—holding ankle/leg Delivery—downward traction on head, thumbs to nose, anterior shoulder, posterior shoulder, body. Skin to skin. Delayed cord clamping. 3rd stage placenta: Active management, Pitocin, gentle cord traction. 3 signs of placental detachment Bleeding: Atony, meds Lacerations: degree, repair Postpartum: Fundal tenderness, lochia, voiding, BMC.

    23 min

  4. EPISODE 4

    Before Your First: Cesarean Section

    Why? Scheduled: Repeat cesarean, hx of uterine surgery, abnormal placentation (placenta previa, vasa previa, accrete, etc) malpresentation (not cephalic), multiple gestation In labor: arrest of dilation, arrest of descent, nonreassuring fetal heart tones, elective Anatomy: Layers of anterior abdominal wall: skin, subcutaneous tissue, superficial fascia (Campers, scarpa’s), external oblique muscle, internal oblique muscle, transversus abdominis muscle, transversalis fascia, preperitoneal adipose and areolar tissue, and peritoneum. Nerves, blood vessels, and lymphatics are present throughout. Now you’re at the uterus — or should be. Clear the surgical field, take down adhesions, bladder flap if needed. Hysterotomy — lower uterine segment, lateral uterine vessels to avoid Delivery baby — delay cord clamp, placenta Likely lots of bleeding — same atony meds as vaginal delivery Clean inside of uterus to remove all membranes etc. Possibly exteriorize uterus to see better — depends on scaring How can you be helpful — visualization! Bladder blade back in, suction or clean with lap between when surgeon placing sutures. Two layers to hysterotomy if they might ever want to labor again or if needed for hemostasis. Clean up the abdomen–irrigation vs moist laps vs suction Now to close: Peritoneium — either way, close or not– no evidence either way Muscle– don’t close, evidence that closing it can cause hematoma Fascia–Close! Closing Fascia: Nerves at the lateral edges of the fascial incision are ilioingiunal, iliohypogastric Subcutaneous fat — if >2cm depth, close to reduce risk of seroma/hematoma/infection Skin closure — stables, suture, absorbable stables

    26 min

  5. EPISODE 5

    Hypertension in Pregnancy

    Hypertension in Pregnancy — One large spectrum Mild range: 140/90 Severe range 160/110 CHTN → SIPE gHTN → Pre-E BP meds: Methyldopa, labetalol, hydralazine, nifedipine Severe features: BPs Neurologic symptoms Lab findings: HELLP Hemolysis, Elevated Liver (enzymes), Low Platelets Eclampsia — Seizures

    24 min

  6. EPISODE 6

    Indications for a c-section during labor

    Nonreassuring fetal heart tracing Category 2-remote from delivery Minimal/absent variability is most significant predictor of fetal acidemia Category 3 any time is emergent deliver Failed IOL Many different definitions: Most commonly 12-24hrs ruptured membranes on pitocin without active labor Arrest of dilation Can only meet criteria once in active labor 6cm or greater Do you know if her contractions are adequate? IUPC with MVUs>200-250 If the contractions are adequate, no change over 4hrs If contractions are inadequate or no IUPC, no change over 6hrs Arrest of descent Prime with epidural 3hrs Prime without epidural-2hrs Mutlip with epidural 2hrs Multip without epidural 1hr Cord prolapse -Emergency! Malpresentation -Breech, transverse, compound

    16 min

  7. EPISODE 7

    Preterm Labor and PPROM

    ACOG Practice bulletin: # 171 PTL or TPTL:  Preterm 37wks, cervical change Evaluation: SSE first: Collect GC/CT cultures, FFN (no gel, blood or semen), GBS, eval for rupture if needed SVE: Cervical change–can dilation or effacement changes FFN: Fetal fibronectin If tPTL: Magnesium for neuroprotection if 32wks, decrease CP rates Betamethasone for fetal lung development PCN Tocolysis for steroid window (48hrs) if 34wks, questionable if 34-36+6. Indocin if 32 wks, Nifidipine if 32+wks IV fluids NICU consult PPROM: Preterm 37wks, Ruptured membranes SSE: Confirm rupture with Pooling, nitrazine ferning. Collect GC/CT and GBS. If PPROM: Delivery at 34wks or at diagnosis if chorio or 34+wks Latency antibiotics: Erythromycin/Azithromycin, Ampicillin x 2 days, PO Erythro/Amoxicillin x 5 days Magnesium for neuroprotection if 32wks, decrease CP rates Betamethasone for fetal lung development PCN NO Tocolysis NICU consult

    21 min
  8. Peripartum Fevers

    EPISODE 8

    Peripartum Fevers

    Intrapartum Differential diagnosis for Temp >38.0C Epidural fever (transient), DVT/PE (if prolonged IOL or limited mobility), UTI, Intraamniotic infection (with or without ROM), etc   Chorioamnionitis aka IAI aka Triple-I (intrapartum intraamniotic Infection) One temp >39.0C One temp 38.0C-39.0C AND one or more risk factors Two temps >38.0C 30+ mins apart Tx: the standard is Ampicillin/Gentamycin until delivery. Tylenol prn temp>38C, IVF for maternal/fetal tachycardia, cooling blanket if needed to decrease temp.   If mild PCN allergy: Ancef/Gent If severe PCN allergy: gent/clinda or gent/vanc   If vaginal delivery: No evidence that continued abx postpartum provide benefit.   If c-section: Add clindamycin to Amp/Gent. Continue at least 1 dose postpartum. Clinical judgment on when to d/c. Some do 1 dose, some 24hrs afebrile, until clinical improvement, etc.   Postpartum Wind – PNA, atelectasis, URI Womb – Endomyometritis — Gent/Clinda x 24hrs afebrile Wound – Superficial wound infection, cellulitis — eval for collection, probe wound/fascia if able Water – UTI, Pyelo — get UA Walking – DVT/PE Weening – Engorgement or mastitis Wonder drugs

    21 min
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About

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 Your Ob/Gyn Survival Guide-Tips and Tricks, Labor and Delivery, Vaginal deliveries, C-sections, Hysterectomies, and more. Each podcast walks you through a portion of what you’ll experience during your clinical rotations, gives you tips for excelling, preps you for the clinical questioning that’ll occur, and sets you up to overall Honor the rotation! Email podcasts@procedureready.com with comments, questions, and episode ideas. ##Legal Disclaimer## The opinions expressed within this content are solely the speakers' and do not reflect the opinions and beliefs of their employers or affiliates.

Information

  • Channel
    Med Ready
  • Creator
    Jennifer Doorey, MD, MS
  • Episodes
    21
  • Seasons
    1
  • Rating
    Clean
  • Copyright
    © 2022 Heroic Ventures, LLC dba MedReady
  • Show Website
    Procedure Ready: Ob/Gyn

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