Jennifer Doorey - Podcast Details

Shows

Procedure Ready: Ob/GynOperative Vaginal Deliveries 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 Fetal conditions, known or supspected: bone disorders (OI), bleeding disorders Maternal infections: Hep C, HIV, etc Concer...2023-06-0913 min

Procedure Ready: Ob/GynInduction of LaborIndications: 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 group Conclusion IOL at 39wks is as safe as expectant management without increased ri...2023-06-0917 min

Procedure Ready: Ob/GynShoulder dystociaDefinition: 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 interference. Calmly explain what is happening and what the docs are do...2023-06-0816 min

Procedure Ready: Ob/GynCancer 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. […]2018-08-1512 min

Procedure Ready (fka Pimped Ob/Gyn)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. […]2018-08-1512 min

Procedure Ready (fka Pimped Ob/Gyn)STIsSwab/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. […]2018-08-1513 min

Procedure Ready: Ob/GynSTIsSwab/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, then secondary with palmar/plantar rash. If unsure stage, treat as if latent, PCN IM x3 HIV: Universal screening. PREP if high risk. Referral to ID and counseling if posi...2018-08-1519 min

Procedure Ready: Ob/GynBefore Your First: Colposcopy and LEEPWhy: 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. […]2018-02-1300 min

Procedure Ready (fka Pimped Ob/Gyn)Before Your First: Colposcopy and LEEPWhy: 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. […]2018-02-1314 min

Procedure Ready: Ob/GynReturn OB VisitsEvery 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, […]2018-02-1112 min

Procedure Ready (fka Pimped Ob/Gyn)Return OB VisitsEvery 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, […]2018-02-1112 min

Procedure Ready (fka Pimped Ob/Gyn)First Prenatal VisitPlanned/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 […]2018-02-0817 min

Procedure Ready: Ob/GynFirst 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 dairy, large fish (swordfish, shark, king mackerel, tilefish, bigeye tuna etc), uncooked meat/seafood, uncooked deli meat, EtOH Drugs: 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. 2018-02-0817 min

Procedure Ready (fka Pimped Ob/Gyn)Before your first: HysteroscopyHysteroscopy = 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.2018-01-1010 min

Procedure Ready: Ob/GynBefore your first: HysteroscopyHysteroscopy = 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.2018-01-1000 min

Procedure Ready: Ob/GynBefore Your First: HysteroscopyHysteroscopy = 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. 2018-01-1010 min

Procedure Ready (fka Pimped Ob/Gyn)Peripartum FeversIntrapartum 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 […]2018-01-0821 min

Procedure Ready: Ob/GynPeripartum FeversIntrapartum 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 […]2018-01-0800 min

Procedure Ready (fka Pimped Ob/Gyn)Postpartum HemorrhageCauses (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 2017-12-1417 min

Procedure Ready: Ob/GynPostpartum HemorrhageCauses (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 2017-12-1400 min

Procedure Ready (fka Pimped Ob/Gyn)Who's that collar?Hello from Addison and Lundy.2017-12-1400 min

Procedure Ready: Ob/GynWho's that collar?Hello from Addison and Lundy.2017-12-1400 min

Procedure Ready (fka Pimped Ob/Gyn)Preterm Labor and PPROMACOG 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 […]2017-12-1420 min

Procedure Ready: Ob/GynPreterm Labor and PPROMACOG 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 […]2017-12-1400 min

Procedure Ready: Ob/GynPreterm Labor and PPROMACOG Practice bulletin: # 171 PTL or TPTL: Preterm 2017-12-1320 min

Procedure Ready (fka Pimped Ob/Gyn)Indications for a c-section during laborNonreassuring 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 […]2017-12-0416 min

Procedure Ready: Ob/GynBirth ControlResources: 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 2017-12-0400 min

Procedure Ready (fka Pimped Ob/Gyn)Birth ControlResources: 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 2017-12-0419 min

Procedure Ready: Ob/GynIndications 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 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...2017-12-0315 min

Procedure Ready (fka Pimped Ob/Gyn)Before Your First: HysterectomyWhat 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 […]2017-11-2120 min

Procedure Ready: Ob/GynBefore Your First: HysterectomyWhat 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 blood flow to the ovary? The IP ligament (formerly the suspensory ligament of the ovar...2017-11-2020 min

Procedure Ready (fka Pimped Ob/Gyn)Before Your First: LaparoscopyReview 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 […]2017-11-2029 min

Procedure Ready (fka Pimped Ob/Gyn)Hypertension in PregnancyHypertension 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 2017-11-2024 min

Procedure Ready: Ob/GynHypertension in PregnancyHypertension 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 2017-11-2000 min

Procedure Ready: Ob/GynBefore Your First: LaparoscopyReview 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 something EtOH based, needs to evaporate before draping...2017-11-1929 min

Procedure Ready (fka Pimped Ob/Gyn)Before Your First: Cesarean SectionWhy? 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 […]2017-11-1524 min

Procedure Ready: Ob/GynBefore Your First: Cesarean SectionWhy? 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 i...2017-11-1425 min

Procedure Ready (fka Pimped Ob/Gyn)Before Your First: Vaginal DeliveryCardinal 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: […]2017-10-3022 min

Procedure Ready: Ob/GynBefore Your First: Vaginal DeliveryCardinal 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: […]2017-10-3000 min

Procedure Ready (fka Pimped Ob/Gyn)Labor and Delivery TriageThe 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 […]2017-10-3022 min

Procedure Ready: Ob/GynBefore 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. 2017-10-2922 min

Procedure Ready: Ob/GynLabor 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 2017-10-2922 min

Procedure Ready: Ob/GynYour Ob/Gyn Survival Guide: Tips and TricksHigh 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 […]2017-10-2300 min

Procedure Ready (fka Pimped Ob/Gyn)Your Ob/Gyn Survival Guide: Tips and TricksHigh 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 […]2017-10-2315 min