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.

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.

What happens at every prenatal visit – and what changes as the pregnancy progresses? This episode covers the routine assessments performed at every appointment, plus the key milestones and screenings organized by gestational age from 20 weeks through delivery.

Show Outline:

• Every Visit – Doptones, fundal height, vitals. Four questions: vaginal bleeding, contractions, leaking fluid, fetal movement.
• By Gestational Age
  • 20wks – Get and review anatomy ultrasound
  • 24wks – Order glucola, CBC (check for anemia), discuss normal growing pains
  • 28wks – Tdap and RhoGAM if needed, discuss kick counts
  • 32wks – Discuss birth control method, sign tubal papers if needed, discuss TOLAC if needed
  • 36wks – GBS screening, birth expectations, ultrasound for position
  • 38–40wks – Vaginal exam, “sweep membranes”

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.

Hysteroscopy lets you look directly inside the uterus to diagnose and treat intrauterine pathology. This episode covers the three basic steps of the procedure, the difference between diagnostic and operative hysteroscopy, and the most feared complication – hyponatremia from fluid overload.

Show Outline:

• What Is Hysteroscopy? – Looking inside the uterus with a scope
• Steps
  1. Dilate the cervix
  2. Distend the uterus with fluid
  3. Look around – identify pathology and tubal ostia. Remove pathology if using an operative scope, Myosure, or another resectoscope.
• Feared Complication – Hyponatremia from excessive hypotonic fluid absorption

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.

Postpartum hemorrhage is one of the most critical obstetric emergencies. This episode organizes the causes using the "Four T's" framework, walks through the uterotonic medication options – including their contraindications and side effects – and covers mechanical interventions like intrauterine tamponade balloons.

Show Outline:

• Causes – The Four T's
  1. Tone (Atony) – Pitocin; Misoprostol (CI: allergy, SE: transient hyperthermia); Methergine (CI: HTN, SE: HTN); Hemabate (CI: asthma, SE: diarrhea); Tamponade (Bakri/Utah balloons)
  2. Trauma – Lacerations
  3. Tissue – Retained products of conception (placenta or membranes)
  4. Thrombin – Coagulopathy
• Other – Involution

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.