This was now my fifth rotation and it was spent at Woodhull hospital in Brooklyn. This rotation was specifically on women’s health and was split into two departments. This involved spending time in the women’s health clinic, GYN call and labor/delivery floors. Each day was able to provide me with a new and different preceptor and I was able to work with a variety of different professionals ranging from attending OBGYN physicians, Midwifes, PAs and nurses.

I felt that this was a very unique rotation in the sense that you do a bit of everything in OBGYN. When we had our women’s health class during the didactic year, our professor would tell us that he loved this specific field because you are able to do so much as a PA. This meant following up on women’s health physicals, performing various procedures and scrubbing into surgeries. Being able to attend surgical procedures like cesarean sections and first assist on a cervical cerclage was one of my first exposures to surgery. It was an incredible learning opportunity to be able to scrub in, assist the surgeon and learn as much as I could have.

During this time, I was also able to perform various procedures that consisted of pelvic exams, breast exams, bimanual exams and assisted the provider in procedures like Nexplanon implants, IUD insertions/removals and colonoscopies. I will mention that in this hospital, many of these patients that I would see were primarily Spanish speaking. This is where I was able to help bridge the gaps in communication. I felt that I was able to instill trust into these patients as they were able to fully understand the situation they were in and the treatment plans. I thoroughly enjoyed this experience at Woodhull hospital and felt that I was able to refine my skills/knowledge of women’s health that will help become a better PA in the future.

In this rotation, I had rotated through Woodhull’s OBGYN department and my primary preceptor was Professor Carlos Melendez. My interactions with professor Melendez were great and he was able to provide me feedback during my mid site evaluation. It was important for me to take into consideration what was mentioned in the midsite evaluation, which proposed a short and straight to the point assessment that made it easy to read for any clinician. I took this feedback and was able to work on my presentation for the final site visit. This was reflected in my last H&P that was presented and I feel that it made it flow better.

During this time, Carlos would also ask me important OBGYN questions that I must know for the boards (stages of labor, postpartum hemorrhaging and treating STI’s) and was always available in person or by phone if I had any general questions or patients I wanted to discuss with him. I look forward to these next site visits with future preceptors as it is a great learning experience that will help me become a great PA in the end.

The article that I chose was based on my last H&P that I had presented. This was a systematic review with meta-analysis that focused on the topic of headaches and its association with pregnancy. The top differential diagnosis that I believed my patient had in my third H&P was a migraine. It was learned that migraines are the second most common primary headache disorder after tension-type headache and it’s estimated to affect about one in seven people worldwide.

Migraines are two to three times more prevalent in women of childbearing age, with almost 30% experiencing migraine by the age of 45 years. Patients that have migraines are more likely to report a negative impact on their education, employment, family relationships and leisure activities. If there is a presence of aura (focal neurological symptoms), which occurs 30% of the time, there is an increased risk of ischemic heart disease and stroke than migraine alone. Recommended treatment options during pregnancy include Acetaminophen (first line), non-steroidal anti-inflammatory drugs (NSAIDs – prior to 20 weeks) or triptans (third line) for symptom relief. However, there is little evidence regarding their safety in pregnancy, which means that it is advised they are used with caution with acetaminophen being the safest option for the mother and fetus.

It was concluded that women with migraine had a higher odds of preeclampsia, low birth weight and peripartum mental illness. It was also shown that women exposed to triptans had higher odds of miscarriage compared to healthy controls, which is why it’s used as a third line agent in severe cases.