Procedure Ready: Ob/Gyn

Operative vaginal delivery with forceps or vacuum is uncommon but high-stakes. This episode covers the current incidence, indications, consent considerations, preparation checklist, and contraindications – including what to say about forceps vs. vacuum success rates and laceration risk. Show Outline: Incidence – 3.3% as of 2013 Indications – Prolonged second stage, risk of fetal compromise, shortening 2nd stage for maternal benefit (e.g., cardiac conditions) Consent – Comparison is typically c-section. Failure rate of OVD is ~3–6%. Forceps has a higher success rate over vacuum but also higher risk of 3rd/4th degree laceration. Risks to both mom and baby. Preparation Fetus at appropriate station/position Anesthesia Empty bladder Assess pelvis/passenger sizes/fit OR ready Pediatrics available Episiotomy – NO! (Not routinely indicated.) Contraindications – Fetal conditions, known or suspected: bone disorders (OI), bleeding disorders. Maternal infections: Hep C, HIV, etc. Concern for shoulder dystocia or…

Induction of labor is one of the most common procedures on L&D. This episode covers the indications (including the landmark ARRIVE trial for 39-week elective induction), the Bishop score for determining readiness, cervical ripening options, pitocin protocols, and the criteria for failed induction. Show Outline: Indications – Post-dates (42+wks), late term (41+wks), elective 39+wks, diabetes, hypertension, and many more per ACOG ARRIVE Trial – Multicenter RCT showing 39wk IOL in low-risk primips had a LOWER c-section rate vs. expectant management to ~41wks, with a trend toward fewer neonatal complications. Many pregnant people are now offered a 39wk IOL. Evaluate and Prep – Full H&P, ultrasound for vertex position, cervical exam (dilation/effacement/station/position/consistency), calculate Bishop score Options for IOL If Bishop <8 (primip) or <6 (multip) → ripen first! Mechanical cervical ripening (balloon) Chemical cervical ripening (misoprostol or cervidil) Best yet – both! Contractions (Pitocin) – Primip:…

Shoulder dystocia is an unpredictable obstetric emergency where seconds matter. This episode covers the definition, risk factors, prevention counseling, exactly what you'll see in the delivery room, and how you as a student can be most useful – including timekeeping and supporting the family. Show Outline: Definition – Failure to deliver fetal shoulders with normal downward traction Why We Care – Baby hypoxia, brachial plexus injuries, maternal injuries Risk Factors – Diabetes, excessive weight gain, S>D, large baby, history of shoulder dystocia (~10–15% recurrence), turtling while pushing Prevention – Difficult to predict. Offer cesarean if EFW >5000g (no DM) or >4500g (with DM). Your Role – Step back. Help minimize family interference with calm explanations. Offer to be the timekeeper – write down times and events, announce every 2 minutes. What You'll See Hypothesize shoulder orientation, suprapubic pressure, place stool Announce the problem and call for help Maneuvers: McRoberts, suprapubic pressure,…

Cancer screening and vaccinations are essential components of health care maintenance in Ob/Gyn. This episode provides a quick-reference summary of current screening guidelines for cervical, breast, colon, and lung cancer, plus the key vaccination schedules every student should know. Show Outline: Cancer Screening Cervical – Age 21–65, cytology q3yrs, co-testing q5yrs if normal. Follow ASCCP guidelines (there's an app!). Breast – ACOG: 40–75, annual mammogram Colon – Colonoscopy, FOBT, FIT. Begin at age 50 (or 40 / 10yrs prior to youngest first-degree relative's diagnosis, whichever is younger). Lung – 55–80 with 30 pack-year history, annual low-dose CT Vaccinations HPV: 3-dose series, age 12–26 Influenza: annual Pneumovax: 1 dose + 1 booster if risk factors (any age); after 65 if no risk factors Shingles: 2-dose series, age 50+ Hep B: initial vaccination in youth; vaccinate anyone non-immune MMR: if not immune Varicella: if not immune Tdap: booster every 10yrs, new parents About the Speaker: Jennifer…

Sexually transmitted infections are a core part of gynecologic care. This episode provides a rapid-fire review of the most common STIs organized by diagnostic method – swab/urine vs. serum vs. clinical diagnosis – covering screening recommendations, classic presentations, and first-line treatments. Show Outline: Swab/Urine STIs Chlamydia – Usually asymptomatic. Screen routinely. Can cause infertility/PID and Fitz-Hugh-Curtis syndrome. Treat with Azithromycin ×1. Gonorrhea – Often asymptomatic. Screen routinely. Can cause infertility/PID. Treat with Ceftriaxone + 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 STIs Syphilis – Painless chancre → latent → secondary (palmar/plantar rash). If unsure of stage, treat as latent: PCN IM ×3. HIV – Universal screening. PrEP if high risk. Referral to ID and counseling if positive. Hep B – Treatable, not…

Abnormal Pap? This episode covers the colposcopy and LEEP procedures from start to finish – why we do them (ASCCP guidelines), the histology and staining principles behind acetic acid and Lugol's iodine, what cervical dysplasia looks like through the colposcope, and how LEEP and cold-knife cone excisions differ. Show Outline: Why – ASCCP guidelines (there's an app!) Cervical Dysplasia – Caused by HPV. CIN I → CIN III is a progression. Risk factors: smoking, other STIs including HIV, immunodeficiency. Histology – Increased nuclear-to-cytoplasmic ratio in abnormal cells Staining Principles Acetic acid: higher N:C ratio cells reflect more light and appear white (acetowhite) Lugol's iodine: reacts with glycogen in normal squamous cells (appear dark); non-staining cells are abnormal Colposcopic Findings – Increased vascularity, punctations, mosaicism, surface contour changes LEEP – Stain the abnormality, know where the abnormal biopsy was taken. Single pass is ideal – tag a side for orientation. +/- Top Hat…

What happens at every prenatal visit – and what changes as the pregnancy progresses? This episode covers the routine assessments performed at every appointment, plus the key milestones and screenings organized by gestational age from 20 weeks through delivery. Show Outline: Every Visit – Doptones, fundal height, vitals. Four questions: vaginal bleeding, contractions, leaking fluid, fetal movement. By Gestational Age 20wks – Get and review anatomy ultrasound 24wks – Order glucola, CBC (check for anemia), discuss normal growing pains 28wks – Tdap and RhoGAM if needed, discuss kick counts 32wks – Discuss birth control method, sign tubal papers if needed, discuss TOLAC if needed 36wks – GBS screening, birth expectations, ultrasound for position 38–40wks – Vaginal exam, “sweep membranes” About the Speaker: Jennifer Doorey, MD, MS – Academic Ob/Gyn at The Johns Hopkins University School of Medicine. As the founder of MedReady, Dr. Doorey seeks to advance clinical medical education by developing resources for…

The first prenatal visit sets the tone for the entire pregnancy. This episode walks through everything you'll need to cover – from confirming the pregnancy and dating ultrasound, to screening options, weight gain targets by BMI, food and medication safety, and exercise recommendations. Show Outline: Initial Assessment – Planned/desired pregnancy, options counseling if needed, full exam/pelvic/Pap Ultrasound – Dating scan Screening Options – QUAD, Sequential, NIPS, invasive testing Weight Gain Targets by BMI BMI <18.5: gain 28–40 lbs BMI 18.5–24.9: gain 25–35 lbs BMI 25–29.9: gain 15–25 lbs BMI ≥30: gain 11–20 lbs Food Safety – Avoid unpasteurized dairy, large fish (swordfish, shark, king mackerel, tilefish, bigeye tuna, etc.), uncooked meat/seafood, uncooked deli meat, alcohol Medications – 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. About the Speaker: Jennifer Doorey, MD, MS –…

Hysteroscopy lets you look directly inside the uterus to diagnose and treat intrauterine pathology. This episode covers the three basic steps of the procedure, the difference between diagnostic and operative hysteroscopy, and the most feared complication – hyponatremia from fluid overload. Show Outline: What Is Hysteroscopy? – Looking inside the uterus with a scope Steps Dilate the cervix Distend the uterus with fluid Look around – identify pathology and tubal ostia. Remove pathology if using an operative scope, Myosure, or another resectoscope. Feared Complication – Hyponatremia from excessive hypotonic fluid absorption About the Speaker: Jennifer Doorey, MD, MS – Academic Ob/Gyn at The Johns Hopkins University School of Medicine. As the founder of MedReady, Dr. Doorey seeks to advance clinical medical education by developing resources for medical students and clinical educators. Procedure Ready: Ob/Gyn is a podcast aimed at medical, PA, and NP students entering their clinical rotation in Ob/Gyn. The views…

A fever during or after delivery triggers a critical differential. This episode covers the intrapartum workup – from epidural fevers to chorioamnionitis (Triple-I) – along with antibiotic regimens by PCN allergy status, and the postpartum fever mnemonic (the W's) to systematically identify the source. Show Outline: Intrapartum Fever Differential – Epidural fever (transient), DVT/PE (prolonged IOL or limited mobility), UTI, intraamniotic infection (with or without ROM) Chorioamnionitis / Triple-I Criteria One temp >39.0°C One temp 38.0–39.0°C plus risk factors Two temps >38.0°C 30+ mins apart Treatment – Ampicillin/Gentamicin until delivery. Tylenol prn, IVF for tachycardia, cooling blanket as needed. Mild PCN allergy: Ancef/Gent. Severe: Gent/Clinda or Gent/Vanc. After Vaginal Delivery – No evidence that continued abx postpartum provide benefit After C-Section – Add clindamycin to Amp/Gent. Continue at least 1 dose postpartum; clinical judgment on duration. Postpartum Fever Differential (The W's) Wind – PNA,…

Postpartum hemorrhage is one of the most critical obstetric emergencies. This episode organizes the causes using the "Four T's" framework, walks through the uterotonic medication options – including their contraindications and side effects – and covers mechanical interventions like intrauterine tamponade balloons. Show Outline: Causes – The Four T's Tone (Atony) – Pitocin; Misoprostol (CI: allergy, SE: transient hyperthermia); Methergine (CI: HTN, SE: HTN); Hemabate (CI: asthma, SE: diarrhea); Tamponade (Bakri/Utah balloons) Trauma – Lacerations Tissue – Retained products of conception (placenta or membranes) Thrombin – Coagulopathy Other – Involution About the Speaker: Jennifer Doorey, MD, MS – Academic Ob/Gyn at The Johns Hopkins University School of Medicine. As the founder of MedReady, Dr. Doorey seeks to advance clinical medical education by developing resources for medical students and clinical educators. Procedure Ready: Ob/Gyn is a podcast aimed at medical, PA, and NP students entering their clinical…

Preterm labor and preterm premature rupture of membranes (PPROM) are critical diagnoses on L&D. This episode reviews the evaluation approach – from sterile speculum exam to fetal fibronectin – and the management protocols including magnesium for neuroprotection, betamethasone, tocolysis, and latency antibiotics. Based on ACOG Practice Bulletin #171. Show Outline: PTL/TPTL – Preterm (<37wks) with cervical change Evaluation – SSE first: collect GC/CT cultures, FFN (no gel, blood, or semen), GBS, evaluate for rupture if needed. SVE for dilation/effacement changes. If tPTL Magnesium for neuroprotection (<32wks to decrease CP rates) Betamethasone for fetal lung development PCN Tocolysis for the steroid window (48hrs) if <34wks (indomethacin if <32wks, nifedipine if 32+wks) IV fluids NICU consult PPROM – Preterm (<37wks) with ruptured membranes. Confirm with pooling, nitrazine, ferning. If PPROM – Delivery at 34wks or at diagnosis if chorio/34+wks Latency antibiotics (Erythromycin/Azithromycin + Ampicillin × 2…

When does a laboring patient need a cesarean delivery? This episode covers the six key indications – from nonreassuring fetal heart tracings to cord prolapse – including the specific time criteria for arrest disorders and what fetal heart rate findings are the most concerning. Show Outline: Nonreassuring Fetal Heart Tracing – Category 2 remote from delivery; minimal/absent variability as the most significant predictor of fetal acidemia; Category 3 at any time is emergent delivery Failed IOL – Most commonly defined as 12–24hrs ruptured membranes on pitocin without active labor Arrest of Dilation – Must be in active labor (6cm+). Adequate contractions (IUPC with MVUs >200–250): no change over 4hrs. Inadequate or no IUPC: no change over 6hrs Arrest of Descent – Primip with epidural: 3hrs; without: 2hrs. Multip with epidural: 2hrs; without: 1hr Cord Prolapse – Emergency! Malpresentation – Breech, transverse, compound About the Speaker: Jennifer Doorey, MD, MS – Academic Ob/Gyn at The Johns Hopkins University…

Contraception counseling is one of the most common and impactful conversations in Ob/Gyn. This episode provides a comprehensive overview of birth control options – from LARCs to barrier methods – along with key resources and visual tools for patient-centered counseling, including in Spanish. Resources/Links: Bedsider – Birth Control Methods – Comprehensive patient-friendly resource for comparing options Bedsider Birth Control Effectiveness Poster – Visual tiers-of-effectiveness chart for counseling Spanish Tiers of Effectiveness – Same chart in Spanish Links: Bedsider – Birth Control Methods: https://www.bedsider.org/methods Bedsider Birth Control Effectiveness Poster: http://www.womenscommunityclinic.org/wp-content/uploads/Bedsider-Birth-Control-Effectiveness-Poster.jpg Spanish Tiers of Effectiveness: http://s3.amazonaws.com/providers/images/images/000/000/032/center/Spanish_tiers_of_effectiveness.png?1464661802 About the Speaker: Jennifer Doorey, MD, MS – Academic Ob/Gyn at The Johns Hopkins University…

Hysterectomy is one of the most common major surgeries in gynecology. This episode reviews the different surgical approaches, the decision to take or leave the tubes and ovaries, the critical surgical steps – including the four sites of ureteral injury – and key anatomy like the IP ligament, uterine artery, and round ligament. Show Outline: Approach – Abdominal, laparoscopic, vaginal, or combination Tubes and Ovaries – What benefit do they provide? Ovaries still benefit bones and cardiovascular health even after menopause (65yr old cut-off for removal). Key Surgical Steps Round Ligament – Sampson's artery runs inside IP Ligament (formerly suspensory ligament of the ovary) – Conceals ovarian blood supply from the aorta. If transected before fully sealed, can hemorrhage while retracting into the retroperitoneum. Four Levels of Ureteral Injury – (1) Pelvic brim, (2) medial to IP ligament, (3) under the uterine artery (“water under the bridge”), (4) lateral to vaginal cuff closure Uterine Arteries – Ligate and…

Your first time in the OR for a laparoscopic case can feel high-stakes. This episode covers everything from how to be helpful during setup and patient positioning, to the anatomy you'll see on screen, entry techniques, port placement, common GYN procedures, and what to watch for in post-op recovery. Show Outline: Before the Case – Review anatomy, know the case and why, greet the patient, help set up stirrups/yellowfins, scrub in properly Prep – Abx if entering uterus or vagina (i.e., hyst). Chloraprep or similar (EtOH-based – must evaporate before draping!). Vaginal prep with betadine or chlorhexidine. Uterine Manipulators – Many sizes/shapes/types. Vagina is dirty – can't go from vagina to abdomen. Abdominal Entry – Typically in the umbilicus. Options: direct visualization with Hasson, Visiport, Veress needle. Insufflate with CO2. Palmer's Point if needed. Port Placement – Middle ⅓ between ASIS and umbilicus. Avoid superficial vessels and inferior epigastric arteries – watch from below. Common Procedures –…

Hypertensive disorders of pregnancy exist on a spectrum – from chronic hypertension to eclamptic seizures. This episode breaks down the classifications, blood pressure thresholds, antihypertensive options, severe features to watch for, and the HELLP syndrome. Show Outline: The Spectrum – Hypertension in pregnancy as one large continuum Blood Pressure Thresholds – Mild range: 140/90; Severe range: 160/110 Classifications – CHTN → SIPE (superimposed preeclampsia); gHTN → Pre-E (preeclampsia) BP Medications – Methyldopa, labetalol, hydralazine, nifedipine Severe Features – Severe-range BPs, neurologic symptoms, lab abnormalities HELLP Syndrome – Hemolysis, Elevated Liver enzymes, Low Platelets Eclampsia – Seizures in the setting of preeclampsia About the Speaker: Jennifer Doorey, MD, MS – Academic Ob/Gyn at The Johns Hopkins University School of Medicine. As the founder of MedReady, Dr. Doorey seeks to advance clinical medical education by developing resources for medical students and clinical educators.…

Whether it's scheduled or called urgently during labor, the cesarean section is one of the most common surgeries you'll see on Ob/Gyn. This episode covers the indications, abdominal wall anatomy layer by layer, the key surgical steps from hysterotomy to closure, and how you can be the most helpful in the OR. Show Outline: Scheduled Indications – Repeat cesarean, hx of uterine surgery, abnormal placentation (placenta previa, vasa previa, accreta, etc.), malpresentation (not cephalic), multiple gestation In-Labor Indications – Arrest of dilation, arrest of descent, nonreassuring fetal heart tones, elective Anatomy – Layers of the anterior abdominal wall: skin, subcutaneous tissue, superficial fascia (Camper's, Scarpa's), external oblique, internal oblique, transversus abdominis, transversalis fascia, preperitoneal tissue, and peritoneum Key Surgical Steps Clear surgical field and adhesions, bladder flap Hysterotomy in the lower uterine segment (avoid lateral uterine vessels) Deliver baby with delayed cord…

Your first vaginal delivery can be exhilarating and nerve-wracking all at once. This episode walks you through the cardinal movements of labor, how to assist with pushing, delivering the baby and placenta, managing bleeding, and what to expect in the immediate postpartum period. Show Outline: Cardinal Movements of Labor – Engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion Complete Dilation – Station assessment, labor down vs. push 2nd Stage: 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. Three signs of placental detachment. Bleeding – Atony and uterotonic medications Lacerations – Degree classification and repair Postpartum – Fundal tenderness, lochia, voiding, breastfeeding About the Speaker: Jennifer Doorey, MD, MS – Academic Ob/Gyn at…

When a pregnant patient presents to triage, you need a systematic approach. In this episode, we cover the OB one-liner, the four essential triage questions, how to evaluate for labor and rupture of membranes, and when vaginal bleeding becomes a red flag. Show Outline: The OB One-Liner "This is a _ yr old G_ P_ @ _ wks GA here for ____." Example: This is a 34yo G3P2002 @ 38wks3days GA here for contractions Four Essential Triage Questions Contractions Leaking fluid Vaginal bleeding Fetal movement What Is Labor? – Cervical change and contractions Evaluating for ROM – Pooling, nitrazine (pH), ferning Vaginal Bleeding – In 2nd or 3rd trimester, worry about placental causes: abruption, previa, vasa previa Decreased Fetal Movement (DFM) – NSTs, BPPs, kick counts About the Speaker: Jennifer Doorey, MD, MS – Academic Ob/Gyn at The Johns Hopkins University School of Medicine. As the founder of MedReady, Dr. Doorey seeks to advance clinical medical education by developing resources for medical students and clinical…

Kicking off your Ob/Gyn clerkship and not sure where to start? In this episode, Dr. Doorey walks through the high-yield resources, essential apps, and practical study tips you'll need to hit the ground running on Labor & Delivery and in the OR. Show Outline: Recommended Resources Free Procedure Ready App – Clinical questions to expect in the OR and on the wards YouTube Playlist: bit.ly/pimped-ob Books: Netter's; Obstetrics and Gynecology by Beckmann Apps: UpToDate, Epocrates, GoodRx, LactMed, ASCCP, CDC STI guidelines, ACOG, OB Wheel Tips and Tricks Be proactive – talk to students who just finished the rotation about ways to be helpful and the day-to-day logistics Set expectations early and clarify as needed Be self-sufficient, but ask for help when appropriate Before leaving, ask when to come in, who to pre-round on, and where to meet Ask for feedback once or twice a week Labor and Delivery Basics Gravidity and parity (Gs & Ps) Primips vs. multips Gestational age: preterm vs. term About the Speaker:…