Prior to starting, I read the Ob/Gyn section of Boards and Wards and knew it backwards and forwards. Very useful for clinic.
A lot of OB is a system. You'll see patients in the AM, and you can help with notes and the discharges. A vaginal delivery can usually go home after 24 hrs (i.e. will probably go home soon after you see them). You can help by writing prescriptions for iron, analgesia, stool softener, etc. (depends on what your institution uses). A C-section usually after 2 days. Talking to your patients usually invovles the same questions: vaginal spotting, do you request birth control afterward, etc. Knowing Spanish is a necessity in some places, but due to the similarity of questions, you can learn it quickly or have it on one page.
For Ob triage, aside from the usual history and physical, it's good to know the basics of fetal heart monitoring, such as the appearance of late decelerations. Also know the big OB emergencies: placental abruption, placenta previa, etc. Know the indications for a C-section (the most common is prior C-section). You may get to participate in the OR, so knowing some knot tying and suturing can help. Since it's your first rotation, however, the new interns and residents will be more aggressive in doing things.
Clinic is a lot about natural fetal development. What happens at what week? What should the U/S show of the fetus? You'll be doing fundal heights, so a good marker is that you should feel the edge of the uterus at 20 weeks at the umbilicus. If there's a discrepency between gestationtial age and the fundal height, be able to form a differential (most common is bad dates used in estimating GA, but also LGA, poly/oligohydramnios, etc.). Know about AFP. Think about the mom: gestational diabetes and hypertension are BIG.
Gyn triage is all about the things that make a vagina bleed. If you really look at it, there are 4-5 common diagnoses which are what you
really need to know. Virtually every woman needs a pregnancy test (unless they had a hysterectomy). If it's positive, it's time for vaginal U/S. Start thinking about spontaneous abortion, ectopic, moles, etc. If it the test is neg, then think STDs, bartholin cysts, cancer (endometrial biopsy in older women is mandatory), etc.
Gyn clinc is about chronic vaginal bleeding (e.g. fibroids), STDs, birth control, Pap smears for uterine cancer, and hormones. There's some urology as well, and Case Files has a good discussion of it. Know the indications for a hysterectomy. Know the different methods of birth control. Know about oral hormonal replacement therapy (and why it's so controversial).
Gyn-Onc is about 3 main things: endometrial, uterine, and ovarian cancer (a particularly horrible disease). Know them inside and out. Occassionally, vaginal cancer does happen, but those other 3 are huge.
Major gyn operations are mainly hysterectomies, which can be a vaginal or abdominal approach. Gyn Onc cases are usually advanced versions of those, depending on the stage (may have lymph node dissection, even intestinal resections). The minors are colposcopies, laser ablation, etc.
I think the first rotation sucks for everyone. No one knows what's going on. But just having the basics will allow you to have more fun, and if you can help out, you'll be more appreciated. Case Files is mandatory for the shelf. Blueprints (old or new) should fill in the gaps. Ob-Gyn Recall if you want to do a little more. The little red book
Obstetrics, Gynecology and Infertility: Handbook for Clinicians-Resident Survival Guide by John D. Gordon is good for clinic and those 10 minutes where you're doing nothing.
No matter what, be cool. Keep your mouth shut, but if nothing's happening, talk with the midwives, nurses, residents, etc. Some want medical questions, some like In Touch. Everyone needs a kind biographer, and everyone needs a counselor (confessor/psychiatrist). If you like gambling a little, express the unexpressed thought on everyone's mind. If you're the cool one, you'll cool everyone else off.
) would be appreciated. Thanks!!
