Obstetrics and Gynecology: Clinical Experience
The Overall Experience
Albeit having faced a few challenges, such as the introduction of new complex discussion topics in obstetrics, it would be appropriate to term the entire experience as successful. There was a lot to learn, and the tutors were very accommodating and helpful. All the questions asked were answered well with accompanying relevant and relatable examples. Additionally, reading and reference material was provided generously and on time. Teamwork and group work were also encouraged.
Patient Assessment
The patient in the discussion is a 38-year-old para 2+1 gravida four at 34 weeks gestation with a singleton fetus. She presented to the OBGYN department with a two-day history of severe temporal-frontal headaches and worsening blurring of vision. She reported having been on antenatal follow up at a peripheral health facility and had experienced similar symptoms during her second and third pregnancy. She, however, reported perceiving normal fetal movements.
On examination, her blood pressure was 172/110, with a pulse rate of 22 breaths per minute. The fetal presentation was cephalic with a longitudinal lie and a baseline fetal heart rate of 143 beats in a minute. The patient generally appeared restless, with remarkable bilateral pitting edema of the lower limbs.
Hospitalization of the patient was necessary, with concerns of immediate stabilization of her vital signs. Oxygen therapy was prescribed at 8 liters/minute flow rate using a facemask and blood drawn for laboratory tests that included a complete blood count, liver function tests, and serum electrolytes. Instructions for the assessment of proteinuria by a daily urinalysis were given. Further, as lowering the blood pressure was considered the most important intervention, oral methyldopa was prescribed. Magnesium sulfate was administered intravenously and a maintenance dose prescribed for seizure prophylaxis. Assessment of fetal wellbeing every 30 minutes and strict monitoring for magnesium sulfate toxicities was emphasized (Armaly et al.,2018).
The mother was counselled on the need to have the baby delivered, as the symptoms are known to worsen with the progression of the pregnancy with possible morbidity and mortality (Hu et al.,2016). Dexamethasone was prescribed for 48 hours to be administered intramuscularly before the induction of labor. Psychological support was necessary for the patient, as a preterm baby would be delivered and admitted to the newborn unit until they attained a particular weight. This decision would translate into an elongated hospital stay for the mother with definite social and emotional impacts.
The working diagnosis for the above patient was preeclampsia with associated severe features. The differential diagnoses included gestational hypertension, HELLP syndrome, hemolytic uremic syndrome, and chronic renal disease.
Learning Points for Future Reference in Clinical Practice.
The different complications that occur in pregnancy and labor were discussed and demonstrated extensively. Emphasis was put on the early recognition of maternal-fetal complications, the construction of a correct diagnosis and subsequent appropriate, timely interventions to prevent morbidities and mortalities
Conclusion
The OBGYN clinical experience was very engaging and helpful. Various topics were adequately covered and will be very helpful in future clinical practices.
References.
Armaly, Z., Jadaon, J. E., Jabbour, A., & Abassi, Z. A. (2018). Preeclampsia: novel mechanisms and potential therapeutic approaches. Frontiers in physiology, 9, 973.
Hu, W. S., Feng, Y., Dong, M. Y., & He, J. (2016). Comparing maternal and perinatal outcomes in pregnancies complicated by preeclampsia superimposed chronic hypertension and preeclampsia alone. Clin Exp Obstet Gynecol, 43(2), 212-215.