End of rotation reflection- WD-OB/GYN
Jinjin Lin
During 5 weeks rotation at OB/GYN at Woodhall hospital, the most important thing I learned is to identify what screening and test should be done when patients comes in for prenatal care. Regular visits with healthcare provider throughout pregnancy are important to make sure the health of mother and the baby. In addition to medical care, we also provide prenatal care that include education on pregnancy and childbirth, plus counseling and support. The routine tests and screening are very important to remember like a blue print in the head, and when a patient comes in, we will know what tests to offer in different stages of pregnancy. For the 1st trimester, maternal blood screening tests include down syndrome screening, uterine size and gestation, blood type and Rh factor, hepatitis profile, syphilis, HIV, rubella and varicella immunity; ultrasound for fetal heart tones and fetal heart beat; chorionic villus sampling for chromosomal abnormality. For 2nd trimester, Quant screening with alpha-fetoprotein, beta-HCG, estradiol, and inhibin-A; ultrasound to check amniotic fluid level, fetal viability and growth for gestational age; gestational diabetes screening; and amniocentesis if required. For 3rd trimester, repeat antibody titers to see if patient needs RhoGAM; group B strep screening; biophysical profile for fetal breathing, fetal tones, amniotic fluid levels, nonstress test and fetal movements; nonstress test for baseline fetal heart rate; and contraction stress test for fetal response to stress.
For HPI, it is different from what I learned from ambulatory care rotation. In the ambulatory care rotation, I learned that HPI should be very concise, and only include pertinent negatives and positives. For obstetrics and gynecology H&P, I learned that they have special things need to addressed. For example, during the initial visit of pregnancy, a full medical history should be obtained, which includes previous and current disorders, drug use, risks factors for complications of pregnancy, and obstetric history, with the outcome of all previous pregnancies, including maternal and fetal complications, like gestational diabetes, preeclampsia, congenital malformations and stillbirth. And during the subsequent visits, questions will focus on interim developments, particularly vaginal bleedings or fluid discharge, headache, change in vision, edema of face or fingers, and changes in frequency or intensity of fetal movement.
Dealing with pregnant patients are not easy. Pregnancy brings a mix of feelings, and not all of them are good. Patients often come in labor and delivery floor with huge amount of anxiety. The patients, especially for the first pregnancy, anxiety is a feeling of unease, worry or fear of what are experiencing and what will happen to the baby. Some pregnant patients will raise all sorts of concerns and ask providers millions of questions, like why is baby kicking so much, how they bear the labor pain, which method is better to deliver the baby, vaginal or c-section, or if anything comes up like vaginal discharge or back pain, they are thinking they are in active labor, and they started to panic. This is very important for clinicians to understand that these emotions are normal and common to pregnant women. Trying to calm the mother down to their specific concerns. For example, some pregnant women are worried about they are not able to handle the pain. They just terrified. As a healthcare provider, I learned to calm them down by telling them the body was made to do this, pain and all. Explain to them that once labor is in full-swing, the endorphins will kick into high gear and for the most part, the body will take over like you have probably never seen before. Of course, in the event the pain does get to be too much and labor drags on for hours than expected, by all means scream for epidural. But even if the patient wants to skip them meds altogether and go natural, there are alternative pain management techniques to help make delivery more bearable like meditation and even hypnosis.
In this OB/GYN rotation, there is one case that I still remember. The patient is 32 years old, G1P0, at 35weeks 4days present to labor and delivery unit complaint of decreased fetal movement for 2 days. After brief assessment, nonstress test and ultrasound are done, which reveals deceleration and very weak fetal cardiac activity. Emergent c-section is done, and baby was delivered. The APGAR score 2, and baby was transferred to NICU right away. I also saw the patient in the postpartum mother baby unit, and the mother was tearing all the time, because she worried about her little daughter so much. I did not get assess to go to NICU and take a look at baby girl, but I heard from the nurse that the baby girl had seizure and was intubated. At this moment, I felt like any words are not able to calm the mother down, I did not interview her, and I left the room, and let her family and her some space to cry.
For my next long-term care rotation, I will try to practice on male and female catheterization, obtain a fecal occult blood sample, fecal disimpaction, and cerumen removal. If I have chance, I also want to do punch biopsy or excision of skin lesion. In the OBGYN rotation, I saw a lot of patients come for gynecology complaints, prenatal care, and assist in vaginal and c-section delivery. But I will learn more about geriatrics care and post-op care. For the following rotation, I will observe how clinicians interact with geriatrics population, how they deal with issues like polypharmacy, and how they do physical examination, then practice on these.
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