History & Physicals:
Journal Article Summary:
Much controversy has circulated in the general public as to whether or not the Covid-19 vaccination is safe in pregnancy and data on infection rates and outcomes is lacking in this patient population being that pregnant women were excluded from pre-marketing clinical trials studying the vaccine. Although pregnant women are not at a higher risk of catching COVID-19 but they are at a higher risk of having a severe infection.
Results showed that 77.4% of COVID-19 infections in pregnancy occurred in unvaccinated women, 11.5% in partially vaccinated women, and 11.1% in fully vaccinated women. Of the COVID-19 infections in unvaccinated pregnancies, 19.5% were associated with hospital admission compared to 8.3% of those partially vaccinated, and 5.1% in those fully vaccinated. 2.7% of unvaccinated COVID-19 infections in pregnancy were associated with critical care admission compared to 0.2% of those partially vaccinated and 0.2% in those fully vaccinated. Statistically, this means that unvaccinated pregnancies accounted for 77.4% of the total COVID-19 infections in pregnancy, 90.9% of infections associated with hospital admission, and 98.1% of infections associated with critical care admission.
This population-based study of 18,000 pregnant patients in Scotland provides the first evidence of more favorable pregnancy outcomes among those who have received the Covid-19 vaccination. The study found that unvaccinated individuals represented a significantly higher proportion of COVID-19-associated hospital and critical care admissions (90% & 98% respectively) as well as perinatal deaths. Thus, the findings of this study support the clinical recommendation that all pregnant people should have an updated COVID-19 vaccination.
Site Visit Summary:
During my first site evaluation I presented two articles. The first case was about hidradenitis suppurativa on the vulva and the second case a pre-surgical note on my first cesarean delivery. In the case of hidradenitis suppurativa there was confusion over whether the abscess was truly that or a Bartholin gland cyst that had extended. The assessment and plan were not completely clear on which one it was or the thought process behind it. Based on feedback, I learned how to better depict this differential in my note. The patient was also given additional pain management and anxiolytics for her anxiety around the medical procedure and the reasoning for this could have been better depicted as well. I picked the cesarean section because this was my first opportunity to write a pre-surgical note for my H&Ps. I also presented five drug cards of medications commonly prescribed in this specialty.
For my second site evaluation I presented a case of a threatened abortion that we were consulted for. The biggest feedback for this is that I did not mention in the assessment and plan that this was a threatened abortion and instead labeled it as vaginal bleeding in pregnancy. In the future, I will focus more on crafting my assessment and plan section especially in naming the diagnosis. I also presented a journal article which the summary is listed separately on this page and discussed 5 more pharmacology cards relating to this specialty. Overall, I received positive feedback on my presented cases and plan to make the aforementioned changes in future H&Ps.
Typhon Case Logs:
As in all my rotations, this one was full of many “firsts” for me. I was able to assist in my first case of a missed abortion for a woman desiring pregnancy. This case was a good example of the many aspects of medicine. Aside from ordering the abortifactant to help facilitate the passage of contents, I provided many clean sheets, sanitary napkins, and most importantly, empathy & compassion for the patient. I also participated in my first cesarean section. During my last rotation in pediatrics, I enthusiastically watched cesareans from the pediatric side of the operating room, so I was very excited to have the opportunity to participate in this procedure. As the surgeon talked me through the procedure, I assisted via retracting, suctioning, and cutting the sutures. This was my first time scrubbing in and participating in a surgery and I learned that I really enjoy participating in this type of medicine.
During my last week in the outpatient OB/GYN clinic I had the opportunity to work with the fertility specialist. This was a great learning experience for me to learn how to manage different types of infertility beyond the basics. I was surprised to learn that many of the patients I saw had not just one medical diagnosis causing infertility but often multiple which required management from different angles. The fertility provider shared resources new to me such as patient education PDFs from reproductivefacts.org which I found very helpful and hope to use in my future practice when applicable.
This rotation also reinforced the importance of proper technique during medical examinations and procedures. I had already performed pelvic examinations in prior rotations but my preceptor and other medical providers during this rotation guided me on minor altercations to make in my technique which in turn made the exam more comfortable for the patient which is my top priority. I walked away from this rotation feeling much more confident in my ability to perform a pelvic examination.
One of the key take aways from this rotation is that women’s health is not limited to OB/GYN. Gynecologic and reproductive concerns show up in many specialties such as emergency medicine, family medicine, internal medicine & more. Thus, it is important to be competent and well trained in this discipline in a variety of specialties.
Obstetrics and gynecology have always been a special interest of mine and something I concerned going into in the back of my head. When asked what area of medicine I want to practice, I have always refrained from saying “OB/GYN” since I had not yet rotated in the discipline to definitively decide if it was the right fit for me. Although I have enjoyed all my rotations thus far, on this rotation I learned that OB/GYN is the specialty I would like to enter upon graduation!
OSCE Case Scenario: