Site Visit Evaluation.

During my OBGYN rotation at Woodhull Hospital from May 20 to June 21, 2024, I underwent a comprehensive site visit evaluation conducted by PA Carlos Melendez. This evaluation included two key meetings: one midway through the rotation and a final assessment. During these sessions, I presented two complete History and Physical (H&P) reports, a pharmacological drug card, and one journal article. PA Melendez provided constructive feedback aimed at enhancing our clinical skills, particularly in patient assessment and medical documentation. He reinforced the critical elements of prenatal and postnatal care, including routine checkups, managing complications, and providing support for new mothers.

One of the cases I presented involved a patient experiencing left lower quadrant and suprapubic pain for one day. Through this case, I learned how to respond to obstetric emergencies such as ectopic pregnancy, preeclampsia, and postpartum hemorrhage. This experience enhanced my ability to act swiftly and effectively in critical situations using ultrasound imaging, Bhcg results, and blood work such as CBC and CMP. Additionally, we discussed the stages of labor and the various pharmacological agents used to induce labor, as well as the appropriate timing for their administration.

I also had the opportunity to discuss an article on the efficacy of medical management of leiomyoma-associated heavy menstrual bleeding (HMB). The article emphasized that medical management is typically the first-line approach for treating HMB associated with fibroids. Various options are available, including nonsteroidal anti-inflammatory drugs (NSAIDs), tranexamic acid (TXA), hormonal contraceptives (COCs), the levonorgestrel intrauterine system (LNG-IUS), and gonadotropin-releasing hormone (GnRH) agonists/antagonists. These treatments aim to alleviate symptoms by reducing menstrual bleeding and, in some cases, shrinking fibroid size.

In particular, I expanded on tranexamic acid (TXA), an antifibrinolytic agent. TXA is a synthetic lysine analogue that works by blocking the lysine binding sites on plasminogen molecules. Normally, plasminogen binds to fibrin clots and converts them into soluble fibrin degradation products through its activation to plasmin. By competitively inhibiting plasminogen activation, TXA prevents the breakdown of fibrin clots, thereby stabilizing clots and reducing bleeding. TXA is important in the treatment of heavy menstrual bleeding and the short-term prevention and control of bleeding in patients with hemophilia.

Overall, this rotation significantly enhanced my understanding and skills in OBGYN, particularly in managing obstetric emergencies and heavy menstrual bleeding. The constructive feedback from PA Melendez and the practical experiences at Woodhull Hospital have been invaluable in preparing me for a career in healthcare.