Incidence: 3.3% as of 2013 Indications: Prolonged second stage Risk of fetal compromise Shortening 2nd stage for maternal benefit (ex: cardiac conditions) Consent: Comparison is c-section typically Failure rate of OVD is ~3-6% Forceps has higher success rate over vacuum, but also higher risk 3rd/4th degree tear Risks to both mom and baby Prep: Fetus appropriate station/position Anesthesia Empty bladder Assess Pelvis/Passenger sizes/fit OR Ready Peds available Episiotomy – NO! Contraindications F...
Jun 09, 2023•14 min•Season 1Ep. 21
Indications: Post-dates (42+wks) Late Term (41+ wks) Elective 39+wks Diabetes Hypertension Many more - check out ACOG Medically indicated delivery 39week induction ARRIVE Trial - Multicenter RCT showing benefit to 39wk IOL over expectant management to ~41wks Included Primips No medical indications for IOL prior to 40+5 Results IOL group had LOWER c-section rate than expectant group Neonatal composite outcome had a trend (not statistically significant) toward lower neonatal compilations in IOL gr...
Jun 09, 2023•18 min•Season 1Ep. 20
Definition: Failure to deliver fetal shoulders with normal downward traction Why we care: Baby hypoxia, brachial plexus injuries, maternal injuries Risk factors: DM, excessive weight gain in pregnancy, S>D, Large baby Hx of shoulder dystocia (~10-15% recurrence) Turtling while pushing Prevention No real prevention as SD is very hard to predict Offer cesarean delivery if EFW is >5000g and no DM, or >4500g and any type of DM What do to: Step back. If comfortable, can help minimize family ...
Jun 08, 2023•17 min•Season 1Ep. 10
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. Lung: 55-80 with 30pack-year hx, annua...
Aug 15, 2018•12 min•Season 1Ep. 17
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. Serum Syphilis : Painless chancre followed by latent, th...
Aug 15, 2018•19 min•Season 1Ep. 16
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. Lugols: Iodine rich-reacts with glycogen in normal squamous cells so they appear dark. Non-staining cells are abnormal. HPV — changes Col...
Feb 13, 2018•15 min•Season 1Ep. 14
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, discuss TOLAC if needed 36wks – GBS screening, birth expectations, US for position 38-40wks – VE, “sweep membranes”...
Feb 11, 2018•13 min•Season 1Ep. 19
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 dairy, large fish (swordfish, shark, king mackerel, tilefish, bigeye tuna etc), uncooked meat/sea...
Feb 08, 2018•18 min•Season 1Ep. 18
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•10 min•Season 1Ep. 13
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 ...
Jan 07, 2018•21 min•Season 1Ep. 8
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 13, 2017•25 min•Season 1Ep. 9
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+w...
Dec 13, 2017•21 min•Season 1Ep. 7
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...
Dec 03, 2017•16 min•Season 1Ep. 6
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 03, 2017•20 min•Season 1Ep. 15
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 Let’s talk about important steps: The round ligament: What artery runs inside the round? Sampson’s. What structure conceals the bl...
Nov 20, 2017•21 min•Season 1Ep. 12
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 for the scrub, open carefully or get help if unsure Abx: If entering uterus or vagina ie hyst Prep: infection prevention with chloraprep or somethin...
Nov 19, 2017•29 min•Season 1Ep. 11
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 19, 2017•24 min•Season 1Ep. 5
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 ...
Nov 14, 2017•26 min•Season 1Ep. 4
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 Bleedi...
Oct 29, 2017•23 min•Season 1Ep. 3
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 count...
Oct 29, 2017•23 min•Season 1Ep. 2
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 ...
Oct 23, 2017•26 min•Season 1Ep. 1
