Procedure Ready: Ob/Gyn (formerly called Pimped Ob/Gyn) is a podcast aimed at medical, PA, and NP students who are entering their clinical rotation in Ob/Gyn. It covers topics including Your Ob/Gyn Survival Guide-Tips and Tricks, Labor and Delivery, Vaginal deliveries, C-sections, Hysterectomies, and more.
Each podcast walks you through a portion of what you’ll experience during your clinical rotations, gives you tips for excelling, preps you for the clinical questioning that’ll occur, and sets you up to overall Honor the rotation!
Email podcasts@procedureready.com with comments, questions, and episode ideas.
##Legal Disclaimer## The opinions expressed within this content are solely the speakers' and do not reflect the opinions and beliefs of their employers or affiliates. The information in this podcast is for educational purposes only and is intended for medical professionals in training. It does not constitute medical advice or establish a doctor-patient relationship.
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
Concern for shoulder dystocia/cephalo-pelvic dysproportion
9 Jun 2023
Induction of Labor
Indications:
Post-dates (42+wks)
Late Term (41+ wks)
Elective 39+wks
Diabetes
Hypertension
Many more - check out ACOG Medically indicated delivery (https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2021/07/medically-indicated-late-preterm-and-early-term-deliveries)
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 risks
Many pregnant people are now offered a 39wk IOL rather than waiting for spontaneous labor
The IOL Process:
Evaluate and Prep:
Full H&P
Ultrasound for position - Vertex
VE for cervical exam: dilation/effacement/Station, also position and consistency
Calculate Bishops Score → help determine mode of IOL
Options for IOL: if biship score <8 for prime or <6 for multip, ripen first!
Mechanical cervical ripening (balloon)
Chemical cervical ripening (misoprostol or cervidil)
Best yet--both!
Contractions (pitocin)
Prime: Pitocin alone if Biship 8 or higher
Mulitp: Pitocin alone if bishop 6 or higher&n
8 Jun 2023
Shoulder dystocia
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 interference. Calmly explain what is happening and what the docs are doing.
Offer to be the Timekeeper. Write down times and what is happening. Announce every 2 minutes.
What you’ll see:
Prep: Hypothesize shoulder orientation for suprapubic pressure, place stool
Announce problem- call for help
Maneuvers - McRobers, suprapubic
Posterior arm
Rotational: Wood’s screw, Rubin
Gaskins- all 4s
Episiotomy
Zavanelli
Reach and audience
Public platform figures. Ratings count people who left a rating, not total listeners.
Apple Podcasts (US)
4.9 / 5
273 ratings
Spotify
5.0 / 5
176 ratings
Podcast Authority Score: 5 / 100
A composite of feed quality, social presence, YouTube performance and engagement. Read the methodology.
Quality
0
Social presence
0
YouTube
0
Engagement
27
Contact Procedure Ready: Ob/Gyn
Guest appearances
Does not typically book guests
Based on episode analysis; this does not confirm that the show is currently accepting guests.
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