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 cephalopelvic disproportion.

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 expressed are the speaker's own and do not constitute medical advice.

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: alone if Bishop ≥8. Multip: alone if Bishop ≥6.

Augmentation – AROM (amniotomy)

Failed IOL – Failure to reach active labor after 18+hrs ruptured on pitocin (definition varies 12–24hrs). If she reaches active labor (6+cm), it's no longer failed IOL – now it's arrest of dilation or descent.

Resources/Links:

ACOG – Medically Indicated Late-Preterm and Early-Term Deliveries

Links:

ACOG – Medically Indicated Delivery: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2021/07/medically-indicated-late-preterm-and-early-term-deliveries

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 expressed are the speaker's own and do not constitute medical advice.

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, posterior arm delivery, rotational (Wood's screw, Rubin), Gaskin's (all fours), episiotomy, Zavanelli (last resort)

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 expressed are the speaker's own and do not constitute medical advice.

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 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 expressed are the speaker's own and do not constitute medical advice.

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 curable. Routine serum screening.

No Routine Screening (diagnose if lesion)

HSV – Antivirals for outbreaks; prophylaxis if frequent outbreaks or immunosuppressed. Valacyclovir or acyclovir most common.

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 expressed are the speaker's own and do not constitute medical advice.