Pimped: Ob/Gyn

By Jennifer Doorey, MD, MS

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Category: Medicine

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Email podcast@pimpedmed.com or tweet @pimpedmed with comments, questions, and episode ideas. 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 Pimping that’ll occur and sets you up to overall Honor the rotation!

Episode Date
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. […]
Aug 15, 2018
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. […]
Aug 15, 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. […]
Feb 13, 2018
Return 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, […]
Feb 11, 2018
First 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 […]
Feb 08, 2018
Before Your First: Hysteroscopy
Hysteroscopy = looking inside the uterus with a scope Steps: Dilate the cervix Distend the uterus with fluid Look around, identify pathology, identify tubal ostia, remove pathology if using an operative scope or Myosure or another resectoscope. Feared complication: Hyponatremia from excessive hypotonic fluid absorption.
Jan 10, 2018
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 […]
Jan 08, 2018
Postpartum Hemorrhage
Causes (Four T’s): Tone: Atony Pitocin Misoprostol: CI-allergy, SI-transient hyperthermia Methergine: CI-HTN, SE-HTN Hemabate: CI-asthma. SE-diarrhea Tamponade: bakri/utah balloons Trauma: Lacerations Tissue: Retained POC (placenta or membranes) Thrombin: Coagulopathy   Other: Involution
Dec 14, 2017
Who’s that collar?
Hello from Addison and Lundy.
Dec 14, 2017
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 […]
Dec 14, 2017
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 […]
Dec 04, 2017
Birth Control
Resources: https://www.bedsider.org/methods   Table: http://www.womenscommunityclinic.org/wp-content/uploads/Bedsider-Birth-Control-Effectiveness-Poster.jpg Spanish: http://s3.amazonaws.com/providers/images/images/000/000/032/center/Spanish_tiers_of_effectiveness.png?1464661802
Dec 04, 2017
Before Your First: Hysterectomy
What approach: Abdominal, laparoscopic, vaginal or combination Taking or leaving the tubes and ovaries? Tubes: What benefit do they provide? Risk? Ovaries: What benefit do ovaries provide? What about after menopause? Still have benefit for bones and cardiovascular health. 65yr old cut-off If it’s laparoscopic–listen to the LSC podcast for more details on the approach […]
Nov 21, 2017
Before Your First: Laparoscopy
Review anatomy– you’ll be able to see well! Pimped- Youtube Channel videos for laparoscopic anatomy What case are you doing and why? Review common indications, steps to procedure and potential risks/complications Saying hi to the patient first Being helpful setting up — yellowfins or stirrups for lithotomy Scrubbing in — ask to grab your gown/gloves […]
Nov 20, 2017
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
Nov 20, 2017
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 […]
Nov 15, 2017
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: […]
Oct 30, 2017
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 […]
Oct 30, 2017
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 […]
Oct 23, 2017