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 email@example.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.
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
Obstetrics and Gynecology by Beckmann
Pimped App – Clinical questions to expect in the OR and on the wards
LactMed – medications safe in breastfeeding
ASCCP: Cervical cancer screening
CDC STI guidelines
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.
Gestational age Preterm vs term
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
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.
Before Your First: Cesarean Section
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
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
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
Hemolysis, Elevated Liver (enzymes), Low Platelets
Eclampsia — Seizures
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
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
-Breech, transverse, compound
I love this podcast and it helped me so much with my third year clerkship for medical school. I got asked about Samson artery! Thank you!
Love love love this podcast.
Not a med student (yet) but I have a background in OBGYN and wanted to learn more while waiting to hear back about post interview decisions. This podcast has been so informative and interesting. Can’t wait to re-listen when I get to MS3. ❤️
I found this podcast recently and love it!!! So sad to see there are no more episodes. Absolutely love your app too!