My OBGYN rotation at QHC was different than any other rotation that I have been on so far. On this rotation, I worked alongside the PAs and residents on labor and delivery, GYN, and clinic. I learned a lot from their expertise and took the opportunity to ask questions. I had the opportunity to attend many lectures by different attendings and learn about many things that I was not very familiar with relating to childbirth and prenatal care.
I spent the first two weeks of my rotation on the Labor and delivery floor. I learned how to take an effective history in triage including not forgetting important questions such as ones about contractions, leakage of fluid, bleeding, and fetal movement. I had the opportunity to assist in multiple vaginal deliveries and deliver placentas and obtain a cord blood specimen. I assisted in a few c-sections as well and learned about different possible complications during the procedure. As a mom, I found myself getting emotional each time a baby came out and let out the first cry. Other things that I learned during my time on Labor and Delivery was familiarity with many obstetric terms, and intrapartum management during inductions and spontaneous labor, interpreting fetal tracings, and performing physical exams to check for magnesium toxicity.
On the third week of my rotation, I rotated with the GYN residents rounding on patients in the morning, attending procedures, and assisting in GYN consults in the emergency room. One memorable patient experience was a 35-year-old female who was POD1 in the ICU. When we examined her, she was ventilated, unresponsive with a GCS of 3. She had been brought in by EMS 1 day prior with severe abdominal pain and unfortunately did not receive the timely diagnosis of a ruptured cornual ectopic pregnancy. She subsequently went into cardiac arrest and resuscitation and surgery was performed. Unfortunately, her death was declared 2 days later. Her case was discussed at the next grand rounds together with the ER team. Aside from learning that failing to make a timely diagnosis can lead to patient mortality, I realized the importance of debriefing a case since I found that I was having a hard time getting over it until after the grand rounds discussion. Another opportunity that I had on my GYN week was to observe multiple laparoscopic procedures which allowed me to learn anatomy in real time.
I spent the last two weeks of my rotation in outpatient clinic. I saw patients with many different obstetric complications on high-risk days including preeclampsia, hepatitis c, various fetal and placental anomalies, and history of preterm deliveries. I saw many patients with gestational diabetes and reviewed their fingerstick logs and management. I became proficient and measuring fundal heights and fetal heartbeats with a doppler. I also learned how to perform a prenatal ultrasound including dating the fetus by BPD, CRL, and measuring the AFI. While most of the clinic patients that I saw were OB patients, I also got to practices some GYN physical exam skills including pelvic exams, breast exams, pap smears and obtaining cultures.
In conclusion, I gained a lot from this rotation and learned many new skills. I now appreciate the many different aspects of OBGYN including management of various conditions. I will take this experience with me and continue to improve on the skills that I have acquired.
