In the mid-rotation evaluation site visit, I present a patient with complains of vaginal bleeding. This is the first patient I interviewed during my GYN call shift. The patient is 37 years old, and she EGA 7wks5d with PMH ectopic pregnancy last year presents to ER complains of vaginal bleeding for 3 days. She has vaginal spotting initially and then became heavier this morning. The pelvic exam shows closed cervical os, blood noted in vaginal vault without signs of blood clot. The bedside ultrasound releases positive IUP with not FHT noted. This case allows me to explore all signs and presentations a patient with missed abortion may have, like abnormal vaginal bleeding, closed cervical os, positive IUP without fetal heart tone. PA Melendez agreed with my thought process and most of the management, however, for vaginal bleeding, he points out that I should put give patient iron supplement instead of IV normal saline. We discussed the differences between these two treatments and when patient has to use them. Finally, the five pharm cards also been tested.

For my final site evaluation, I presented on a initial OB visit case of a 32-year-old boy who is G2P1001. Her family and she are happy with the pregnancy. Patient only complains mild fatigue, weakness, norming nausea and few vomiting. The management plan was discussed during this meeting and explained to patient whether the c-section is not a good choice for her at this time. While I was presenting my case, PA Melendez brought up some points that I did not focus on. And I also got the test of five pharm cards.