1)H&P/Soap Note
2) Journal Article and Summary
The effect of coronavirus infection (SARS-CoV-2, MERS-CoV, and SARS-CoV)
during pregnancy and the possibility of vertical maternal–fetal transmission: a systematic review and meta-analysis
This article is a systematic review/meta-analysis, med-lined index study published September 4, 2020 in the European Journal of Medicine. The study discussed the effect of SARS-CoV-2, MERS-CoV, and SARS-COV infection on maternal and perinatal patients as well as the possibility of vertical transmission of the virus from pregnant mother to fetus. This is an important study because in the pregnant state, women experiences alterations in their hormones levels as well as a decreased lung volume due to a gravid uterus. This puts them at an overall slightly immunocompromised state. As a result, a mother and fetus are susceptible rapid deteriorating and greater risk of harm if they experience a respiratory infection like COVID.
This study included 39 out of 879 studies examined which involved 1316 pregnant women. The most common clinical features these patients had were viral pneumonia, fever, cough and myalgias. There were also gastrointestinal symptoms like diarrhea and abdominal pain observed in pregnant patients with COVID. The most common laboratory findings were lymphocytopenia and C-reactive protein. Pneumonia was the most diagnosed clinical symptom of COVID-19 and non-COVID 19 infection. Bilateral Pneumonia and ground-glass opacity were the most common CT imaging. The most common treatment options were hydroxychloroquine, ribavirin and oxygen therapy.
Regarding maternal outcomes, the rate of preterm birth birth under 37 weeks was 14.3%, preeclampsia 5.9%, miscarriage 14.5% preterm rupture of membranes 9.2% and fetal growth restriction 2.8%. I found it interesting that 56.9% of the coronavirus infected patients had a cesarean section, 31.3% were admitted to the ICU and 2.7% died.
Regarding transmission of Covid from Mother to fetus, sera immunoglobu-lin G was detected by using serological samples but CoV antibodies for IgG, IgM and IgA were detected in non of the newborn blood samples. The study concluded that there is no evidence of intrauterine transmission of SARS-CoV-2 and other CoV from mother to new-born infants.
3)Site Visit Evaluation: My Summary
For my site visit, I got to present a case of a 36-year-old female G4P1021 with PMH asthma c/o lower abdominal pain x 1 day described as sharp pressure, intermittent, radiating throughout the back and buttocks. Pt rated the pain 8/10, comparable to labor pain and worst with movement. PT also stated that she has been having intermittent vaginal spotting x 1 month and saw an OBGYN 1 week ago and had a B-hCG of 1400 on 1/11/21. On physical exam, she had abdominal tenderness in both the RLQ and LLQ and female exam was normal. Her bed side ultrasound showed a non gravid uterus but also a left adnexal mass with free pelvic fluid.
I was able to discuss with my preceptor that B-hcg values usually doubles every 48-72 hours. In the current visit, her B-hCG was 11095 on 1/22/2021 and therefore did not rise appropriately. The findings showed that the patient was having an ectopic pregnancy and was referred to the OR for exploratory laparotomy through a Pfannenstiel abdominal incision and left partial salpingectomy.
4)Typhon Report
5) Rotation Reflection: OBGYN
I had the opportunity to complete my OBGYN rotation at Woodhull Hospital in Brooklyn, NY and it was a great experience. I thought this was a good rotation for me because I was able to learn more about the obstetric and gynecological medical problems woman face. I also learned valuable important lessons about respecting women and understanding medical modesty for women during examinations and procedures as this is important for building a trusting relationship with the patient as a provider. This includes asking the patient for permission to conduct an examination, making sure the patient is comfortable and draped appropriately as well as only exposing areas that need to be examined.
Exposure to new techniques or treatment strategies – how did that go?
This rotation exposed me to new terminology, techniques and treatments that I was not familiar with. I was able to learn how to measure the fundal height (distance in centimeters from the pubic bone to the top of the uterus) which is done to determine if a baby is too small for its gestational age. I was also able to learn about fetal heart monitoring and visualize the tracings. I was able to understand more about some of the tests that are done in clinic which included collecting swabs for Papsmear, STD screening, Colposcopy, and measuring glucose for gestational diabetes.
I also was able to understand more about the labor and delivery process for women. Being on the L & D service, I was able to understand more about childbirth and that the process of bringing a child into this world takes time, patience and is an extremely difficult process for women to undergo. After observing this process, I can only say thank you and bow down with respect.
What was a memorable patient or experience that I’ll carry with me?
A memorable experience that I will carry with me was when I worked with PA Bartholomew as she assessed a patient who was suspected of having an ectopic pregnancy on night call. The patient had already been seen by an ER male physician and was going to be seen for an OBGYN consult. The patient expressed that she had a lot of abdominal pain as she appeared very uncomfortable. After conducting the examination an ultrasound confirmed that the patient did have an ectopic pregnancy.
After learning this, the PA explained to the patient the severity of the medical problem and advised her that surgery was needed to remove the ectopic pregnancy. The patient expressed that she wanted to leave but the PA was able to explain to the patient that regardless if she stays here or go to another hospital, she would need to have surgery. The PA also took additional steps to offer the patient an opportunity to have a second opinion from another physician. I thought these were great steps that the PA took in order to ensure the patient was well informed and comfortable with undergoing the surgery which I believed help to convince the patient to follow through with the procedure.
How your perspective may have changed as a result of this rotation?
Another memorable experience I had during a surgery was that a surgical tech in the operating room asked me if I was part of the surgery team and I said no I’m doing my OBGYN rotation. She said that she does not see many males in OBGYN often. Then I realized in this rotation that I was able to work with three males in OBGYN, PA Melendez as well as Dr. Daniel and Dr. Jones. This was good and important for me to see since I never really thought about males working in OBGYN. I also thought about the role of the OBGYN PA’s at the hospital and I thought it was cool that they were able to examine patients in the clinic, see patients in the emergency room for consults and first assist in surgeries in the OR.
What are some Interpersonal challenges and how you addressed them?
This rotation was also my last rotation in which I had interpersonal challenges that was important for me to revisit before entering the PA field.
- There are times on a shift where you may work with a provider who may seem intimidating especially if never had worked with the provider before. In this, it is important to not be discouraged in approaching the provider and make effort to work together to take care of patients. I was able to see a medical student do this well as he was persistent in being around a provider who did not appear to want to work with him as much. This showed that he was eager to learn and the provider respected his ambition pulled him into cases more.
- Being a good team player also involves motivating your teammates who may not be performing at their best. In my prior healthcare experiences, I was able to play this role, but I can admit that in this rotation I was experiencing some “senioritis” and as a result felt that I was losing some of my motivation and usual positive mindset that I have had. As I reflect on this, I realized the importance of having team members who are able to keep you motivated and push you in order to cross the finish line. I received pep talks that were very motivating from many of my classmates like Chris, Anthony, Raghda and Luke throughout PA school. In this rotation particularly, Farhana, Darielle and Darya were persistent in reminding me of the goal of finishing as well. I also have been able to see our class come together well under the leadership of our President Mariyanthe that has been nothing less than excellent. As I left the OBGYN rotation, I was able to really appreciate the women in our class and the women I worked with in rotations as they have exemplified great leadership.
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