Maternity Assessment Q&A (February 2011)

You are working as a student midwife on the Maternity Day Assessment Unit and you have just started your shift so check the diary to see what experience you are likely to gain today.

1)09.00 – Anna (31)arrives with a letter outlining her appointment for a 12/40 week ultrasound scan, she decided to decline screening for Downs Syndrome in this pregnancy.

What is the purpose of this scan and will Anna have been given any instructions to follow prior her ultrasound scan appointment?


To date the pregnancy
To check there is a heartbeat and that it's in the uterus
To see the number of fetuses
She will be asked to have a full bladder and to bring a urine sample

2)09.40 – You answer the telephone to an extremely anxious woman. Kelly (19) is pregnant with her first baby at 10/40 and in general good health. Throughout the night she has been experiencing period-like cramps and slight staining of toilet paper upon wiping. This morning the pain has increased and Kelly is reporting fresh red loss PV with some small clotting. Kelly is anxious that she is having a miscarriage.

How would you advise Kelly on the telephone? Would you offer any reassurance?
Ask how much blood there is
Ask Kelly to come in for an ultrasound scan to see if it is miscarriage
Reassure her that it isn’t definitely a miscarriage but she needs to be checked to be sure. Do not tell her it’ll be ok

3)10.15 – Kelly arrives at the MDAU with her partner, Jonathan. They are both visibly upset.

How would you treat Kelly and which investigations would you undertake and why?
Take a full history from Kelly regarding what happened prior to the bleed and how many weeks she thinks she is.
Calm them down, offer drinks etc.
Arrange ultrasound scan
beta Hcg bloods to see hormone levels
Arrange repeat appointment depending on results

4)11.30 – Jennifer (25) has been referred to the MDAU via her Community Midwife as her blood pressure readings at her antenatal appointment was 150/95, 155/100 and 155/105 and there is ++protein in her urine. This is her 3rd pregnancy with a new partner.

What could these symptoms indicate? What questions would you ask Jennifer regarding other symptoms? What would the next line of investigation be?
Could be pre-eclampsia
Ask re epigastric pain, headaches, odema (swelling), visual disturbances
Repeat her observations for yourself
Take bloods (LFTs, U&Es, FBC, Coag)
Arrange for 24hour urine collection to start
Review by doctor to potentially start medication immediately
5) 13.00 – Belinda (33) self refers from home stating she “doesn’t feel right”. She gives a history of feeling sick, difficulty opening bowels without discomfort, dizziness, intermittent left hand abdominal pain and a funny feeling at the shoulders. She is approx. 8 weeks pregnant and this is her 4th pregnancy.

What could this be and what are the possible long-term effects on fertility?
Could be ectopic pregnancy
Can reduce fertility as can cause scarring in the fallopian tube or tube may be removed

6)14.00 – Gemma (26) arrives for an ultrasound scan to confirm fetal position. She is 37 weeks pregnant with her second baby.

If the fetus is found to be breech – What are the options available to Gemma?
ECV
Elective section
Vaginal breech birth

7) 14.45 – Stacey (16) arrives at the MDAU unannounced with her 2 year old daughter in tow. She is 30/40 pregnant with her second baby with a new partner. She smells strongly of cigarettes and gives a history of very reduced fetal movements over the last 2 days. You see from her notes that she did not attend her antenatal appointment at 28/40.

What would you do for Stacey upon arrival? What advice would you give her whilst she was there?
Full antenatal check (BP, urine etc)
CTG
Advice on the importance of attending appointments, of monitoring fetal movements and on stopping smoking

8) 15.30 – Fay (29) arrives for her pre-operative assessment. This is her third pregnancy and she is having her third elective caesarean following her first baby being breech. She is 38 weeks pregnant and her caesarean section is planned for the following week. During her assessment, Fay discloses that she had a bit of “snotty bloody goo” in her knickers a couple of days beforehand and her back has been aching all night. She has had a dull ache in her lower abdomen with occasional sharp pains, approx. 3-4 times an hour. This has been going on for about 4 hours and she is irritable and fed up with pregnancy now.

What could be the cause of Fay’s symptoms? What investigations might the midwife wish to do?
She may be going into labour
On top of the investigations for the section (ie MRSA swabs and bloods) midwife may want to do CTG and vaginal examination

9) 16.00 – You take a call from Alana (30) who is complaining for extreme morning sickness. This is her first pregnancy and she is 11/40. She has been unable to stomach any food for a couple of days and is now finding it difficult to keep down water. She is feeling very weak and dizzy and does not know what to do. You ask her to come in.

What do you think Alana is suffering from? What do you expect to do for her when she arrives at the unit?
Hyperemesis gravitarum
Set of obs (BP, pulse)
Put up fluids to hydrate her
Get reviewed re medication and vitamins

10) 16.55 – Just before the end of your shift you check the computer system for the results of the HVS sent to the lab earlier. The results show that there is a heavy growth of yeast and BV has been detected.

What is the common name for a yeast infection and what does BV stand for? What treatment would the woman be offered for these conditions?
Yeast – Thrush
BV – Bacterial Vaginosis
treatment for thrush – canesten
treatment for BV – antibiotics


BONUS – Some women receive an anti-D injection at the MDAU. At what point in pregnancy would these be offered, why and to whom?
Offered to rhesus negative women to prevent problems if the fetal blood mixes with the mothers blood
28, 34 weeks and after sensitizing event (ie ECV, bleed, fall)

Re: Maternity Assessment Q&A (February 2010)

Ah I don't think I did too badly! Might have waffled some absolute rubbish as well though!

Learnt loads thankyou all.

Great questions this month.