H&Ps:

Typhon Reports:

Site Visit Summary:

The site visits were an opportunity to learn about Obstetrics and Gynecology and how they are essential in optimal women’s health. I gained insight and knowledge from the conversations held with the site evaluator. The site evaluation ensured that I understood how different an Ob/Gyn history taking is from a regular H&P. For example, tocodynamometer findings and past history of sexually transmitted infections are essential parts of an OB/GYN H&P. The site evaluator also asked multiple questions that questioned and strengthened my knowledge of certain subjects. I enjoyed these sessions and look forward to future site evaluations.

Case and Journal Summary: 

Case: A  35 year old woman G5P4 with GA of 33 weeks and 5 days with past medical history of pre-eclampsia in first pregnancy and current pregnancy presents from the clinic with a blood pressure reading of 151/110. The patient states that she was at the clinic for her third trimester follow up when she was sent to triage for a blood pressure reading of 160/108. The patient states that she was experiencing a headache and dizziness for 2 days that has lessened now. The patient states that currently she does not have any symptoms but the headache. The patient rates the headache a 4 out of 10 and states that taking Tylenol helps for a few hours before the headache returns. The patient states that she was not prescribed anything for her high blood pressure and that she ensures to have a low sodium diet to help. The patient denies any history of seizures, dizziness and fatigue. The patient admits to headaches. 

Article: Garovic, V. D., Dechend, R., Easterling, T., Karumanchi, S. A., McMurtry Baird, S., Magee, L. A., Rana, S., Vermunt, J. V., August, P., & American Heart Association Council on Hypertension; Council on the Kidney in Cardiovascular Disease, Kidney in Heart Disease Science Committee; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Lifestyle and Cardiometabolic Health; Council on Peripheral Vascular Disease; and Stroke Council (2022). Hypertension in Pregnancy: Diagnosis, Blood Pressure Goals, and Pharmacotherapy: A Scientific Statement From the American Heart Association. Hypertension (Dallas, Tex. : 1979), 79(2), e21–e41. https://doi.org/10.1161/HYP.0000000000000208

Journal Summary: 

One of the major causes of maternal and fetal morbidity and mortality worldwide is hypertension-related pregnancies. Once a woman had a hypertensive disorder during pregnancy she is at an increased risk of cardiovascular disease later on in life despite not having traditional cardiovascular risk. Hypertensive disorders of pregnancy (HDP) is an umbrella term that includes chronic hypertension, preeclampsia, gestational hypertension, etc. Garovic et al focus on pathogenesis, diagnosing, and blood pressure (BP) goals. Prevention and treatment for hypertensive pregnancies. Garovic et al. summarized the new hypertensive disorders of pregnancy guidelines of 2019 and 2020 for diagnosing and what blood pressure readings diagnose the patient with the specific disorder. For example, if a patient is found to have hypertension (>140/>90 mmHg) after 20 weeks gestation and had a previous normal BP reading she is diagnosed with gestational hypertension. Another example would be preeclampsia where in addition to having hypertension after 20 weeks of gestation and a previous normal BP, the mother is found to have either proteinuria, renal insufficiency, new onset of headache or visual disturbances, etc. Garovic et al. also explained the difficulty in treating hypertensive patients as the benefit of treating hypertensive mothers and potential risk factors to the fetus remain elusive. 

Prevention of HDP is essential in protecting mothers and fetuses from morbidity and mortality. Most prevention focuses on lifestyle changes as diabetes, obesity, and chronic hypertension are risk factors for HDP. Garovic et al. found that exercise decreases the risk of gestational hypertension and preeclampsia by 30 to 40 percent. The use of low-dose aspirin between the 12th and 16th week of pregnancy was found to prevent the risk of preeclampsia and related adverse effects. Due to these positive effects, the American College of Obstetricians and Gynecology (ACOG) has recommended using low-dose aspirin in women with a history of early onset of preeclampsia, history of preterm delivery, and history of preeclampsia. 

According to the AHA task force, the BP goal for HDP is less than or equal to 130/80 mmHg for stage 1 hypertension and less than or equal to 140/90 for stage 2 hypertension. Universally, first-line monotherapy for hypertension during pregnancy is Labetalol or Methyldopa. Labetalol is a combined alpha and beta-adrenoceptor blocker, and should not be used in asthma and other lung obstruction diseases. Garovic et al. also explained that different antihypertensives are effective during each trimester.  

References: 

Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD and Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71:e13–e115

Rotation Reflection:

For my third rotation, I had the pleasure of going to Woodhull Hospital in Brooklyn. Woodhull Hospital serves a predominantly minority community of Hispanics. My third rotation was distinct from the others as it was my first rotation at a hospital. I had the privilege of rotating in different OB/GYN services such as Women’s Options/Clinic, Gynecology, and Labor and Delivery. I learned much from these different subgroups and enjoyed my time at Woodhull.

My perspective has vastly changed from my didactic year to rotating and working with midwives and clinicians in women’s health. During the didactic year, I was overwhelmed with Ob/Gyn and often thought of how much of a meticulous field it is. However, the moment I started my rotation I realized why it was meticulous and enjoyed the work that was given to me. I was allowed to perform transvaginal ultrasounds, and pap smears, assist in a Cesarean section, and was blessed to deliver a baby on my first day on the labor and delivery floor. It was truly an uplifting experience. Being exposed to these different techniques and skills made me more interested in the Ob/Gyn field and eager to learn more. One technique that I learned was the McRoberts maneuver which is performed when the mother is in labor to help widen the pelvis about 2 cm more. Performing the maneuver and visualizing the success of the technique was beyond words, it taught me that even the most basic techniques make a difference in treatment. The midwives and clinicians were kind and showed interest in teaching me techniques and strengthening my knowledge base.

During my rotation, I learned that clinicians, social workers, and many other healthcare workers play a role in women’s health. I discovered the importance of patient understanding. I found that without patient understanding there is a decrease in treatment adherence and possibly patient harm. This was crucial in Women’s Options for mothers getting medical abortions or in the clinic for injectable and medical implantation contraceptives. Explaining such critical discussion properly for the patient to understand is not easy and the clinicians at Woodhull taught me how much of an acquired skill it is. I enjoyed my time at Woodhull and I am excited for what comes next: Internal Medicine at Northwell Hospital.