Care for the Patient with Ob/Gyn Needs

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Headshot of Dawn Kopp, Assistant Professor, Vice-Chair—OB/GYN
Dawn Kopp
Assistant Professor, Vice-Chair—OB/GYN
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Table of Contents

How do I get ready for labor and delivery?

Please watch the following videos.

Please read

Blueprints Obstetrics and Gynecology, 7th ed. Chapter 4: Normal Labor and Delivery.

Know the stages of labor and be able to define the start and end of each.
  1. Dilation
  2. Expulsion
  3. Placental
Know the components of the cervical exam that go into the Bishop's score and be able to define each.

Dilation 
Effacement 
Station 
Consistency 
Position 

Know the components of a fetal heart rate tracing and be able to define each.

Baseline 
Variability 
Accelerations 
Decelerations 

Electronic Fetal Monitoring Tracing Game. Can you recognize the strip elements?

How do I get ready for the operating room?

Scrubbing in the OR

The great Michigan scrub-off

How do I get ready for the Ob/Gyn ambulatory clinic?

Clinical correlation

Blueprints Obstetrics and Gynecology, 7th ed. Chapter 22: Abnormalities of the Menstrual Cycle.

Prenatal care table

Gestational ageBefore conception

Recommended testing/screening

  • Rubella titer
  • Varicella titer

Recommended immunization(s)

  • Rubella
  • Varicella

Recommended counseling/anticipatory guidance

  • Smoking cessation
  • Prenatal Vitamins
Gestational ageAt every visit

Recommended testing/screening

  • Weight
  • BP
  • FHR
  • Fundal height (starting at 20 wga)
  • +/–Urinalysis

Recommended immunization(s)

  • Influenza (pending season)
  • COVID-19 (pending season)

Recommended counseling/anticipatory guidance

  • Nutrition/exercise, weight gain
Gestational ageAt first appointment

Recommended testing/screening

  • BMI
  • Blood type/Rh
  • Hgb/Hct
  • Rubella titer
  • CT/GC
  • Hep BsAg
  • Hep C Antibody
  • Syphilis
  • +/– Varicella titer
  • Urine culture
  • HIV
  • Pap +/– HPV (if due based on history/age)
  • NIPS (if desired starting at 10 WGA)
  • Carrier Screening (if desired)
  • Early 1 hour GTT (if high risk)

Recommended counseling/anticipatory guidance

  • Intimate Partner Violence
  • Depression
Gestational age10–12 WGA

Recommended testing/screening

  • NT/sequential/integrated screen (if desired and NIPS declined)

Recommended risk-reduction treatments

  • Low-dose aspirin for Preeclampsia prevention if high risk (13–36 wga)
Gestational age15–20 WGA

Recommended testing/screening

  • AFP optional for fetal oNTD screening
Gestational age24–28 WGA

Recommended testing/screening

  • Rh (if neg)
  • Gestational diabetes screening (if not currently diagnosed with diabetes)
  • CBC

Recommended risk-reduction treatments

  • Rhogam if Rh negative

Recommended immunizations

  • TdaP (27–32 weeks)
Gestational age35–37 WGA

Recommended testing/screening

  • GBS
  • Check fetal presentation
  • Check cervix (optional)

Recommended risk-reduction treatments

  • HSV prophylaxis starting at 36 weeks-delivery if history of genital HSV lesions

Recommended immunizations

  • RSV if 32–36 wga and due September–January (the vaccine should be administered during weeks 32–36 weeks of pregnancy from September through January)
Gestational agePostpartum

Recommended testing/screening

  • Pap +/– HPV (if due based on history/age)

Recommended risk-reduction treatments

  • Rhogam (if patient Rh negative and infant Rh positive)

Recommended immunizations

  • Rubella (if non-immune)

Helpful tips to succeed in care of the patient with Ob/Gyn needs

  • What can I do to make your day better? 
  • What else can I help with? 
  • “I’m working on improving my Gynecologic history/other WBA skill. Can you help me find a patient today where you could observe this and we could discuss my WBA on this afterward together?” 
  • “I know we haven’t had an appropriate patient for me to practice performing a supervised pelvic exam yet. Can you help identify an appropriate patient for this today so I can get feedback and improve?” 

 What are some downloadable resources that I can use?

  1. Ob-Gyn Notes
    Includes:
    • Sample labor and delivery admit note
    • Sample vaginal delivery note
    • Sample operative note
    • Sample post-partum note: Vaginal delivery
    • Ob postpartum note: Cesarean delivery
    • Sample gynecologic history and physical
    • Sample new obstetrics presentation in the clinic/ambulatory setting
    • Sample return obstetrics presentation in the clinic/ambulatory setting
    • Sample labor and delivery triage presentation
    • Sample labor and delivery admission presentation
    • Sample inpatient postpartum patient presentation example
    • New gynecology patient/gynecology consultation presentation
    • Return gynecology patient to clinic/ambulatory setting
    • Sample presentation of gynecology post-operative patient