Intern Ready: Ob/Gyn

Induction of labor now accounts for roughly 1 in 3 deliveries in the U.S., so as an intern you'll be part of inductions almost every shift, whether scheduled or a same-day plan from triage. In this episode, Dr. Veena Bhagavathi walks through who gets induced and why, how to use the Bishop score, the cervical ripening options, what to do once the cervix is favorable, and how long to wait before calling an induction "failed." Indications & Contraindications Elective induction means induction at 39 weeks without a medical indication. 39 weeks is the cutoff because the neonatal risks of late-preterm and early-term birth are well established. ARRIVE trial: in low-risk nulliparas, induction at 39 0/7–39 4/7 weeks reduced cesarean delivery (18.6% vs 22.2%, RR 0.84) and hypertensive disorders of pregnancy (9.1% vs 14.1%, RR 0.64), with no significant difference in neonatal outcomes. Induction between 41 0/7 and 42 0/7 weeks can be considered; induction by 42 6/7 weeks is recommended given increased perinatal…

Placing an IUD is one of the most common procedures you'll be asked to help with as an intern — and one of the easiest to feel unprepared for if you haven't reviewed the device differences ahead of time. In this episode, Dr. Lillian Chen breaks down the five IUDs you'll encounter, how their insertion mechanics differ, what changes in the postpartum and postabortion setting, and the high-yield points you're likely to be tested on. IUD Types at a Glance Mirena — LNG-IUD, 52 mg levonorgestrel, FDA-approved for 8 years (effective 8+ years), 4.4 mm tube, 6–10 cm uterine sound range. Lighter bleeding/amenorrhea common. FDA-approved for heavy menstrual bleeding (HMB). Liletta — LNG-IUD, 52 mg levonorgestrel, FDA-approved for 8 years (effective 8+ years), 4.8 mm tube, 6–10 cm uterine sound range. Lighter bleeding/amenorrhea common. Uses a different inserter than the Bayer products. Kyleena — LNG-IUD, 19.5 mg levonorgestrel, FDA-approved for 5 years, 3.8 mm tube, 6–10 cm uterine sound range. Less bleeding and less…

Preeclampsia complicates roughly 10% of pregnancies and accounts for up to 9% of pregnancy-related deaths in the U.S. — which makes it one of the highest-stakes diagnoses you'll manage as an intern. In this episode, Dr. Anna Jarvis walks through the hypertensive spectrum, how to get the diagnosis right, when to worry about severe features or HELLP syndrome, how to rule out the mimics, and how fast you need to move when things get acute. Resources: ACOG Practice Bulletin No. 222 — Gestational Hypertension and Preeclampsia (2020) Magee LA, Nicolaides KH, von Dadelszen P. "Preeclampsia." N Engl J Med. 2022;386:1817–1832 Sibai BM. "Imitators of Severe Preeclampsia." Obstet Gynecol. 2007;109(4):956–66 ACOG/SMFM Practice Advisory — Low-Dose Aspirin Use for Prevention of Preeclampsia (2021, reaffirmed) Topics to Review Over Time: Chronic hypertension in pregnancy: antihypertensive selection and BP targets Low-dose aspirin prophylaxis — who qualifies and when to start Eclampsia: seizure management and post-seizure…

Gynecologic oncology clinic can feel intimidating for a new intern — the patients are complex and the terminology is dense. In this episode, Dr. Liang breaks down the three visit types you'll encounter (new patient, chemo clearance, and surveillance), what to prechart, and what your role is as the resident in each one. Visit Type 1: New Patient Visits BEFORE CLINIC — PRECHARTING Ask: Why are they here? Confirmed cancer diagnosis (pathology in hand)? Concern for cancer only — no pathology yet? Seeking second opinion after treatment elsewhere? Hereditary cancer syndrome (Lynch, BRCA)? HPI — how did the patient present? What symptoms? Workup by primary cancer type: Uterine: endometrial sampling, TVUS, CT abdomen/pelvis Ovarian: CA-125, imaging Cervical/vulvar: Pap history, colposcopy, biopsies, LEEP, CKC Medical & surgical history — comorbidities, medications, prior abdominal surgeries Family history — relatives affected, cancer type, age at diagnosis Preventive screening — Pap, mammogram, colonoscopy up to…

Walking into your first infertility clinic visit and not sure what to expect? In this episode, Dr. Valdez-Sinon walks through the definition of infertility, how to take a thorough history for both partners, the key workup for ovulatory, tubal, uterine, and male factors, and when to refer to REI. Definition What is infertility? Failure to achieve pregnancy after 12 months of regular unprotected intercourse — for patients under 35 Shorten to 6 months for patients 35 and older Anyone 40+ should be seen as soon as they start trying — don't wait Immediate evaluation warranted for: Oligomenorrhea or amenorrhea Known uterine or tubal disease Stage III/IV endometriosis Resource: ACOG Committee Opinion No. 781 and ASRM guidelines History & Exam HISTORY — PATIENT Comprehensive medical and surgical history Menstrual history — are cycles regular? (regular cycles suggest ovulation, but ~1/3 of regular cyclers can still be anovulatory) Full GYN history — pelvic infections, STIs, known fibroids, endometriosis Prior…

Headed into the OR for your first hysteroscopy? In this episode, we walk through everything you need to know before you scrub in — from indications and pre-op preparation to OR equipment, distension media, fluid deficit management, and how to handle complications when they arise. I. Introduction & Learning Goals Purpose: Guidance for an intern's first hysteroscopy in the OR. Objectives: Review indications, pre-op preparation, OR setup/equipment, fluid media, and complications. II. Indications for Hysteroscopy Diagnostic Hysteroscopy: Abnormal uterine bleeding (AUB) or postmenopausal bleeding Infertility workup Evaluation of abnormal imaging findings Operative Hysteroscopy: Polypectomy (removal of polyps) Myomectomy (removal of submucosal fibroids) Septum resection Lysis of adhesions (Asherman syndrome) Foreign body removal (e.g., "lost" IUD) III. Pre-Operative Preparation Chart Review Checklist: Indication: Understand the clinical reason for the procedure Imaging (US/MRI): Confirm uterine size (to avoid…

Fetal therapy is a subspecialty of maternal-fetal medicine focused on treating fetal disease before birth — from prenatal cures (anemia, TTTS) to improving outcomes (myelomeningocele, CDH), optimizing conditions at birth, and transplacental therapy (SVT, congenital heart block). In this episode, Dr. Michelle Kush walks us through the major fetal therapy procedures you may encounter as an OB/GYN resident and what your role will be. Topics Covered: What Is Fetal Therapy? – Subspecialty of MFM treating fetal conditions before birth. Contact the fetal therapy team at 844-543-3825. Fetal Anemia and Intrauterine Transfusion Busiest fetal transfusion center in the Mid-Atlantic (600+ transfusions to date). Most common indications: alloimmunization, parvovirus infection, hydrops/hereditary spherocytosis. Performed on L&D once fetus reaches viability, with betamethasone course completed. Risks: preterm labor, PROM, fetal bradycardia, emergent delivery (<1%). General care path: arrive → H&P → OB anesthesiology → NPO,…

Your first Labor & Delivery triage shift is coming up — here's how to handle it. In this episode, we walk through the full workflow: from chart-checking a patient before you walk in the room, to gathering a focused history, performing your exam, staffing efficiently, and writing a solid triage note. Topics Covered: Where to Start Chart check the patient — age, parity, gestational age, medical and OB problems. Confirm dating with your own eyes. Trust but verify. Skim prior encounters for chronic conditions and what's worked before. Check if they're up to date on routine OB care (e.g., GBS swab at 36 weeks). Start a note using premade templates to save time. Bring your ultrasound, stethoscope, mask, and something to keep notes. If the patient is on the NST, don't wait for it to complete before performing your sono. Gather a focused but detailed history, then do a focused physical exam. Perform a pelvic exam as indicated (with patient consent), with or without your chief. Most Common Chief Complaints Rule out…

Join this episode to learn about postmenopausal bleeding (PMB) — the incidence, the etiologies, and the diagnostic approach to a patient presenting with uterine bleeding after menopause. A special focus is placed on endometrial hyperplasia and endometrial malignancy, including associated risk factors and the use of transvaginal ultrasound and endometrial sampling in the evaluation. Critical evaluation of PMB is important as the leading concern is cancer until proven otherwise in this patient population. Keywords: Postmenopausal bleeding, Transvaginal ultrasound, Endometrial hyperplasia, Endometrial malignancy/cancer, Endometrial sampling Topics Covered: Overview of PMB – Definition, incidence (5% of office GYN visits, 4–11% of menopausal patients), and why the leading concern is endometrial cancer until proven otherwise. Etiologies Polyp (~35%) – Localized overgrowths stimulated by estrogen; mostly benign but higher concern for malignancy/hyperplasia in PMB patients. Atrophy (~30%) – Low estrogen leads to…

Your first day in benign GYN clinic is fast-paced and can feel overwhelming. In this episode, we cover what to expect, what to review ahead of time, and practical tips for running an efficient, patient-centered clinic visit — even when you only have 15 minutes. Topics Covered: What to Expect on Your First Day – A mix of new patients, annuals, return visits, and problem-based appointments. Common complaints include contraception, AUB, pelvic pain, abnormal discharge, STI testing, and post-op checks. Expect a fast pace and feeling slow at first. What to Review Ahead of Time Well woman visit guidelines AUB basics (PALM-COEIN) and the initial workup ASCCP guidelines (brief overview) Contraceptive options and the Medical Eligibility Criteria app Vaginal discharge workup — STI testing, wet prep Tips for a Smooth, Efficient Clinic Pre-chart! Check for recent ED visits, PCP discussions, last pap, imaging, STI results. Document as you go — brief notes while talking, make them complete later. Optimize your EMR —…

Your pager goes off — the ED has a GYN consult. Now what? In this episode, we walk through exactly how to triage, evaluate, and staff a benign gynecology consult in the emergency department, from the moment you get the call to closing the loop with your team. Topics Covered: Triage Procedures Logistics: Know the ED layout — pelvic exam rooms, supply locations. Clinical Assessment: Determine hemodynamic stability, active bleeding, starting hemoglobin, and the consulting physician's level of concern. Hemodynamically Unstable Patients: Immediate bedside evaluation. Coordinate 2 IVs, Type and Screen/Cross, coags, bedside FAST exam, and NPO status for potential surgery. Hemodynamically Stable Patients: Chart check, review imaging (TVUS), read up on the differential (UpToDate, ACOG), and inform your senior team. Patient Evaluation Introduce the GYN team and provide context to the patient. Gather a full history: HPI, PMH/PSH/OB-GYN history, medications, allergies, social history, and barriers to follow-up. Prepare…

Starting OB/GYN residency can feel overwhelming. In this episode, we break down the practical survival tips every incoming intern needs — from managing patients on Labor & Delivery and Gynecology, to studying efficiently, thriving in the OR, and protecting your wellbeing through a demanding first year. Topics Covered: Your Job as an Intern – Be open to feedback, manage multiple patients, ask for help early, and set expectations with your chief. On Labor & Delivery – Fetal heart rate interpretation, cervical exams, induction algorithms, magnesium management, and postpartum hemorrhage protocols. Golden rule: if you're thinking "should I call my senior?" — call. On Gynecology – AUB workup by age, pregnancy of unknown location, ectopic pregnancy, ovarian torsion, and the post-op fever differential (5 W's). How to Study Without Burning Out – Read about your patients, review bad outcomes, keep a "Learning Points" note, and use quick resources like UpToDate and ACOG Practice Bulletins. In the OR – Know the surgical…