Hey guys, incoming intern here. Applied OB this year but had to SOAP into FM despite having 13 ranks (lol). I still am very very interested in reproductive health and obstetrics, and I was just wondering if any fellow FM residents here who are interested in it as well know much about OB fellowships after FM residency? I see the programs listed on the aafp website but most of them only take 1-2 people per year. I wasn’t sure if being able to do one is a bit of a pipe dream or if it’s possible. I really really want to be able to be trained to do both vaginal and cesarean deliveries, and this seems like the best route at this point besides trying to figure out a way into an OB residency (which seems unlikely at this point).
TW: Obstetrical rape
I was a victim of obstetrical rape during the birth of my first child. Additionally, I have never had an abnormal pap, I am vaccinated against HPV, I KNOW I'm in a monogamous marriage, and the CDC recommends women in my age bracket have an exam every 3 years.
My last pap was done during my first pregnancy, less than a year ago. I am primarily seeing a midwife (planning a homebirth), but I have a backup OB that I also see. I had a SCH earlier in the first trimester and because of this, didn't get the pap done at my initial appointment.
I have been a nervous wreck since then. I was dreading having my Ob all up in there. Well, I asked today if I could postpone until postpartum, and I expected her to fight me and drop me as a patient.... But she didn't! She looked at me and sweetly said, "Runnyeggyolks, you can deny any testing in my practice. I just want you to be comfortable and safe."
I am so happy. I am tearing up. I wish I had this last time.
Hi everyone! Would appreciate your take on obstetrics at Cedars-Sinai vs UCLA vs Providence Saint John's. Deciding on getting a new PCP and OBGYN. I'm currently with Providence, but would love to find the best option. Thanks in advance!
So I've been diagnosed with Asherman's (uterine adhesions post a D&C I had last year). The next step is a hysteroscopy to remove the adhesions. Pregnancy rates, if they're mild, are pretty good but go down with severity.
Anyways, I am an epidemiologist so my next step in preparing for this was to look up all the research and there are some decently sized studies that look at obstetric outcomes, including a meta-analysis which compared the complication rates to the general public. The percentage of women who were surgically treated for Asherman's seem to have morbidly adherent placenta/accreta 10-12% of the time (compared to 0.3% overall). Women who have had 5+ c-sections have accreta about 5% of the time, just as another comparison. Treatment for the accreta spectrum, even when they know about it, just seems so brutal and I'm struggling with being excited to try post surgery and I'm also pissed that this thing is rare so the research is sparse about if there is anything I can do post my surgery to reduce my chances of developing accreta if I do get pregnant. Part of me thinks I should focus on one step at a time but the other thinks I'd be a fool if I didn't consider the risks right now. I'm also in a US state with very high maternal mortality/morbitidy.
I was wondering if anyone else has found themselves in this space in their ttc journey either because of adhesions or some other treatment that restores fertility but raises obstetric risks? How are you coping?
So I was looking at the threads and couldn’t find specifics for what I was looking for in obs and gyn. Would really like if someone could help me out.
- If I don’t have a rotation in obs and gyn I feel like it puts me at a disadvantage. Is there a way I can compensate for this? Audits and research or getting papers published?
- I am not sure if there are any exams that I could do prior to finishing FY2 that could help me get into a obs and gyn programme, as most of them are run through
- How are the experiences of people going straight into the run through programme from FY2 or should I do a few years in core training before that?
Advance warning: Graphic description of assault. Reddit is being terrible and showing pictures, so I’m posting the link as a comment.
The article is from 2018 and the focus is the US. Abuse survivors have only started coming forward with their stories now, so who knows how widespread festering misogyny in healthcare even is worldwide. This article quote is the main takeaway:
“In standard OB-GYN care, Morrison says, women are barred from making choices in ways that would be unthinkable in other medical situations. She believes the root of this approach, and of obstetric violence, is the idea that a mother and baby are separate entities, that the baby has ‘rights’ that supersede his mother’s. ‘So all agency has been taken from women,’ Morrison says. ‘And the people who have done that are obstetrician-gynecologists. Obstetric violence has been visited upon pregnant women by the people that they look to for help and guidance.’”
Hi all,
There have been a few people interested in a detailed, high quality obstetrics management deck (as a supplement to the AAFP’s ALSO Course).
For this, a few goals:
- The curriculum is based off the AAFP’s ALSO Course, which is a certification course you can take for a fee. This would not replace that certification, just spread the info.
- I’m providing the PDFs, just need a team interested in OB!
- Anking card format
The course covers the following:
- safety in maternity care
- Intrapartum fetal surveillance
- Preterm labor / PPROM
- hypertensive disorders of pregnancy
- late pregnancy bleeding
- labor dystopia
- malpresentatjons, malpositions, and multiple gestation
- shoulder dystocia
- assisted vaginal delivery
- postpartum hemorrhage
- maternal resuscitation and trauma
- cardiac complications of pregnancy
- Venus thromboembolism in pregnancy
- maternal sepsis
- third and fourth-degree perineal lacerations
- diagnostic ultrasound in labor and delivery
- first trimester pregnancy complications
- cesarean delivery
- birth crisis
HMU if you’re interested! Im gonna ensure this one makes the sidebar
Hoop
Since I work from home, it would be best if we can visit someone nearby, that way I won’t have to take a long break from work and most Obgyns I saw don’t work on weekends.
Obstetrics and Gynecology should be separate specialties.
An OBGYN is a mix of two specialties which, in my opinion, should be separate. An OBGYN treats people with female reproductive organs. An obstetrician treats pregnant women, pre and postnatal care. They often assist people in getting pregnant, do IVF, monitor the health of the fetus and the woman. They also deliver babies. That is their job, create and deliver babies. A gynecologist treats disease and damage to a female's reproductive organs (uterus, ovaries, fallopian tubes cervix etc), and the pelvic floor They also do contraceptives (from pill to IUD to permanent sterilization) They treat diseases such as endometriosis, cancers, cysts, prolapse
Most OBGYNS practice both OB and GYN, some practice solely obstetrics and very, very few practice only gynecology. This is why it is so hard to get sterilized.
It is extremely hard to get permanently sterilized because most doctors, who possess male or female organs, from all cultures and places around the world, who can perform sterilizations, go into their specialty in order to create babies, care for babies in utero, driver babies and care for babies once they are out. They don't want to help women choose. They want to deliver babies.
There is a decent amount of overlap in the two specialties but separating them would be beneficial to everyone. If we had doctors who only treated living women we would have easier access to the care we need including sterilizations, contraceptives, investigations into pelvic and period pain, heavy bleeding, pain during intercourse, breast screenings, cancer treatment, and most important of all, abortions. It would also prevent the doctors from being a "jack of all trades but master of none." A jack of all trades is perfect for common, simple things but pretty much useless for that complex, specific, hard to treat issue. e.g Endometriosis
Separating the specialties will also make gynecologists available more as they are not called away as often as they are not doing deliveries. (A friend of mine had to wait ~ 6 hours for her twisted ovary to be untwisted as the only "ob-gyn" in a 500 km radius was too busy performing Elective C-sections. She lost the ovary due to the twist + wait. (she is childfree too, so not that big of a deal but still, an organ died due to wait times) That dude says he is a ob-gyn but, according to the people who went to him (there is no other option) he is 100% baby focused and is there
... keep reading on reddit ➡https://pubmed.ncbi.nlm.nih.gov/25483233/
Pavithra Ranganathan et al.
Introduction: Unintentional dural puncture (UDP) and postdural puncture headache (PDPH) occur during the course of epidural catheter placement for labor analgesia with a reported incidence of 1%-5%. After UDP with an epidural needle, 80%-86% of patients develop PDPH. Acute symptoms after UDP are well known. However, few studies have evaluated the long-term complications of UDP, which is important in assisting parturients in the decision-making informed consent process. We sought to elucidate the long-term (>6 weeks) sequelae of PDPH by examining parturients who had UDP (both recognized and unrecognized) associated with labor epidural analgesia.
Methods: Parturients with a documented UDP (n = 308) over a 5-year period were followed up for acute and long-term residual symptoms (lasting >6 weeks) and compared with a control group (no documented UDP, n = 50) in the same period. Specific symptoms included headache, backache, neck ache, auditory symptoms, and visual symptoms.
Results: In comparing parturients with a UDP with control group (no UDP), differences were noted in overall acute symptoms (75.9% vs 21.7%, P < .001), specifically headache (87.0% vs 8.7%, P < .001), backache (47.2% vs 19.6%, P = .002), neck ache (30.1% vs 2.2%, P < .001), auditory (13.8% vs 0%, P = .02), and visual symptoms (19.5% vs 0%, P = .002). Differences were also noted in comparing chronic symptoms (26.5% vs 10.9%, P = .04) and specifically with respect to chronic headache (34.9% vs 2.2%, P < .001), backache (58.1% vs 4.4%, P < .001), and neck ache (14.0% vs 0%, P = .02). No differences were noted between groups in comparing chronic auditory and visual symptoms.
Conclusion: Chronic headache and backache sequelae persist in the obstetrical population after UDP. When parturients are considering labor epidural analgesia, long-term sequelae should be discussed in the informed consent decision-making process.
Hi all,
I am currently a Foundation Year Doctor who is torn between Dermatology, O+G and Psych.
I have enjoyed all three specialties during medical school and feel each speciality has pros+ cons.
I have been able to complete audits and attend conferences in all 3 specialities. I have completed a Psych job and an elective + SHO job in O+G. I have also completed a taster week in Psych and Dermatology.
I have been trying to build all three CVs simultaneously and have good links to the respective teams in my Trust. I would say that my Psych CV is my strongest as I have a number of prizes and more oral poster presentations in comparison to the other 2 specialities but I am not sure if I would find Psychiatry enjoyable long term.
Just wanted some advice on how to decide which speciality to go for/ wanted to hear from any trainees.
Thank you :)
Does anyone work in this specific kind of unit? I have an interview coming up for this department as a new grad but I’m not entirely sure what all it would entail! I know it will probably be specific to the hospital but I would love to hear from any nurses in this speciality to get a better idea before my interview
Going through some of my old materials before I apply for a job and came across the uterine massage. I know it’s to prevent hemorrhaging and tightens the uterus if the fundus is soft, if it is firm, uterine massage is unnecessary and can potentially cause other issues. But for when it is bleeding and soft should I wait till after the placenta is delivered or do it before?
I feel like it’d be after the placenta is delivered to not cause the placenta to get stuck due to the uterine massage, but I’m not sure, though I imagine if she’s really bleeding heavily I’d probably place some dry sterile dressings over the vagina and would do the massage anyways and transport immediately.
It was so beautiful I cried. The mom didn't cry, the dad didn't cry, the nurse didn't cry, the resident didn't cry. But the random med student standing in the corner bawled their eyes out over a patient they met 2 minutes ago and that patient's newborn child. It was simultaneous the most beautiful and the most disgusting thing I'd ever witnessed.
