Thomas Jefferson UniversitySidney Kimmel Medical College

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OB/GYN

This six-week rotation involves Gynecologic Surgery, Obstetrics, and Outpatient Gynecology. Depending on the location of your rotation, you may have the opportunity to participate in or observe the specialties of Maternal Fetal Medicine, Urogynecology, Reproductive Endocrinology and Infertility, and Gynecological Oncology.  Provided that you show interest, the residents are more than willing to allow you to participate in deliveries.

The pelvic exam can be a nervous experience for the patient and the new student alike. At the beginning of the rotation, you will receive a patient teaching session on the gynecological exam. During the patient teaching session, you are given the proper method of doing the exam as well as tips on how to council your patient.  Communicating with your patient is perhaps as important as doing the actual exam.  Say things like, “every thing is healthy and normal” after the breast exam and stay away from, “every looks and feels great!”

Call

Most sites ask for a week of night float on labor and delivery in place of call. You may be the only student on call so take advantage of the constant activity and hands-on opportunities.  Get involved with all aspects of OB/GYN such as MFM admissions, ER calls for an ectopic pregnancy, and stat C-Section deliveries.  Make sure you get sleep during the day while on night float – it is considered poor form to sleep during your time at the hospital.

The OB/GYN Department provides an excellent handout of useful information. Perhaps the most useful is a pocket-sized packet which gives examples of admission notes, delivery notes, pre- and post-op notes, and progress notes. Also, this packet has listings of general procedures and concepts you should encounter and participate in over the course of the rotation.   You will also receive a pocket handbook on contraception that is a great resource during your time spent in the outpatient office.

Textbooks – texts in bold are highly recommended

  • Blueprints for OB/GYN is a great reference book for the rotation covering all the basics of obstetrics and gynecology.
  • Obstetrics, Gynecology & Infertility (Gordon) (the little red book) is probably the best pocket book for the rotation.  It is chock full of useful information for immediate patient care.
  • Essentials of Obstetrics and Gynecology (Hacker & Moore) is the recommended text for this rotation. It is well written and covers all of the essential topics but is a time commitment.
  • Obstetrics and Gynecology (Beckman) is slowly gaining popularity among students. Great text if you can get through it.  There are 40-100 questions at the end of every chapter that are an excellent review for what should have been gained from the text.
  • Obstetrical Pearls/Gynecology Pearls are small, pocket-sized, easy-to-read, quick references. Not comprehensive, but good to read before the rotation starts.

  • Gynecology and Obstetrics - Current Clinical Strategies (Chan and Winkle) is jammed with quick facts and reference items. It is helpful on a daily basis and for reinforcement of details glossed over in your reading.

Notes

You will find that most OB/GYN patients will stay approximately 2 days after a vaginal delivery and 3 to 4 days after Cesarean section. Notes tend to be very brief and to-the-point. The following note covers just about everything your resident would want to know following childbirth. Operative notes for a TAH/BSO or C-Section are the same as the surgery op note. Be sure to include, however, the sex, weight, and Apgar scores of the baby (or babies) somewhere in the note.

0600 MSIII OB/GYN Progress Note
S: Mrs./Ms. _____ is a __ y/o G_now P_ who delivered by ___ at __ weeks on (date) now PPD/POD #. Prenatal course complicated by ____. This morning complains of _____. Tolerating _____ diet, +/- nausea/vomiting, +/- flatus/BM. Pain control (excellent/fair). Voiding/Foley. Infant status: breast/bottle feeding, in the well-baby nursery/NICU.
Ambulating? (Y/N)
O: Vitals (T/Tmax) BP/RR/HR, Ins/Outs (Mg and C-Section patients)
CV:
PULM:
ABD: Fundal height (usually measured by "U" meaning from umbilicus; e.g. U+5), consistency and tenderness, incision comments (c/d/i)
GU: Lochia, episiotomy
EXT: Homan's sign, edema, reflexes (especially Mg patients)
MEDS:
LABS: (mainly HCT, also Mg level, sometimes electrolytes)
A/P: Just like the surgery note, but make sure to include contraceptive plans as well.

Don’t worry if the sample note looks like gibberish right now – you will get the hang of things quickly once the rotation starts!  Dr. Wolf will go over a sample note on the first day of the rotation that will help things become a little more clear.

Exams

This rotation uses the written NBME shelf examination.  Pre-Test or Appleton & Lange’s question books are recommended for preparation.

Additionally, a clinical OSCE exam is given at the end of the clerkship that emphasizes basic physical exam techniques and procedures in OB/GYN.

Abbreviations

No other field of medicine has as many abbreviations as the field of OB/GYN. You may want to print out the following segment of this guide and carry it around with you on your OB/GYN rotation.

AFP - Alpha Feto Protein
IUGR - Intrauterine Growth Retardation
AMA - Advanced Maternal Age IUPC - Intrauterine Pressure Catheter
AROM - Artificial Rupture Membranes L & D - Labor and Delivery
ASCUS - Atypical Squamous Cells of Undetermined Significance LAVH - Laparoscopic Assisted Vaginal Hysterectomy

BPD - Bi-Parietal Diameter LMP - Last Menstrual Period
BPP - Biophysical Profile LOF - Leak of Fluid
CPD - Cephalo-Pelvic Disproportion LTC - Low Transverse Caesarian Section
CS - Caesarian Section LTC - Low Transverse Caesarian Section
CST - Contraction Stress Test MAC - Maternal Age Considerations
CTX - Contractions NST - Non-Stress Test
CVS - Chorionic Villus Sampling PIH - Pregnancy-Induced Hypertension
CX - Cervix PPD - Post-Partum Day
DR - Delivery Room PPROM - Preterm, Premature Rupture of Membranes
DUB - Dysfunctional Uterine Bleeding PROM - Premature Rupture of Membranes
EDC - Estimated Date of Confinement PTL - Preterm Labor
EDC - Estimated Date of Confinement SROM - Spontaneous Rupture of Membranes
FH - Fundal Height STV - Short Term Variability
FHT - Fetal Heart Tones SVD - Spontaneous Vaginal Delivery
FL - Femur Length TAH/BSO - Total Abdominal Hysterectomy Bilateral Salpingo-oophrectomy
FM - Fetal Movement TL - Tubal Ligation
GBS - Group B Strep TVH - Total Vaginal Hysterectomy
GTT - Glucose Tolerance Test VBAC - Vaginal Birth After C-Section
  VTX - Vertex