Procedure Ready: Ob/Gyn

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.

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.

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 depending on ECC result. Cold-Knife Cone (CKC) – For pathology higher in the cervical canal; more complications. No electricity – okay if pregnant. 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.

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 – 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.

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, atelectasis, URI Womb – Endomyometritis Wound – Infection, cellulitis Water – UTI, pyelo Walking – DVT/PE Weaning – Engorgement, mastitis Wonder drugs 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.

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 days, then PO Erythro/Amoxicillin × 5 days) Magnesium, betamethasone, PCN NO tocolysis NICU consult 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.

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 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.

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 – Diagnostic LSC (endometriosis, adhesions), tubal ligation or bilateral salpingectomy, cystectomy, BSO, hysterectomy Closing – Close fascia on ports >5mm (hernia risk) Post-Op – Many cases are same-day. Check nausea/vomiting, eating/drinking, voiding, flatus, ambulation, UOP, BPs. 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.

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 clamping, deliver placenta Manage atony with same meds as vaginal delivery Possibly exteriorize uterus to see better – depends on scarring How to Be Helpful – Visualization! Bladder blade, suction, and clean with laps between sutures Closure Two-layer hysterotomy if future labor desired Peritoneum – optional, no evidence either way Muscle – do NOT close (risk of hematoma) Fascia – close! Key nerves: ilioinguinal, iliohypogastric Subcutaneous fat – close if >2cm depth Skin – staples, suture, or absorbable staples 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.

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 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.