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COTW SMNET Catch of the week 5/12/11

Discussion in 'Catch Of The Day' started by iolaus, Dec 5, 2011.

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  1. iolaus Education Moderator

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    SMNET Staff Past Quiz Winner
    For anyone who's not sure - these are real situations designed to help you get an idea of what other people would do in this situation, to help you evaluate the care you'd provide, to get other ideas if you are in the situation in the future - and to make you realise just how much there is to learn in midwifery and just when you think you have it sussed something will happen to make you realise that nature has ways of taking us all by surprise, no matter how experienced you are. The women and their families have very kindly agreed for their experiences to be shared online and in accordance with the NMC all are completely anonymous.

    Some of these situations will be lovely normal births, others will end up in theatre or have a nice birth with complications afterwards, as in real life not all pregnancies will have a happy ending. There are various settings so don’t forget where you are (can’t transfer to theatre from a homebirth without ringing an ambulance etc). Intermixed with the intrapartum cases there will be antenatal or postnatal scenarios thrown in as midwifery is not all about the birth.

    Each event will last for 1 week, with me setting the scenario on the Monday and unfolding a bit more each day until Sunday when I conclude it, ready for the next. However if I am around and basic questions are asked (such as why I did something or what something means) then I’ll answer them earlier.

    Join in, make comments - be they practical suggestions of what could have been done, a 'OMG I'd never have done that', a 'why did that happen?', 'similar thing happened to me', or a 'I haven't got a clue - hope mum and baby were ok'. The more people and comments who are part of this the more fun and interactive



    You come onto an early shift on the alongside midwifery led unit.

    You are allocated to take care of Kat, a primigravid woman at 40 weeks and 1 day gestation into an uncomplicated pregnancy. She was admitted in spontaneous labour at 1.30 this morning, when she was found to be 4cm dilated.
    At 1.45 she asked for, and was given 100mg of pethidine IM
    At 5.30 she was reexamined and was 8cm dilated
    At 6.00 she SROMed and blood stained liquor has been draining and she has been involuntarily pushing.    The FH has been between 130 and 140bpm, with Kat’s pulse around 70bpm

    The midwife handing over tells you the last two FHs have been creeping up (160bpm and 158bpm respectively)
    iolaus, Dec 5, 2011
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  2. Sapphire Member

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    Introduce yourself, make sure all obs are up to date. I assume there's nil visible, look for external signs of fully. Get Kat to eat and drink something if she can. Make sure she's in a comfortable, preferably upright position, listen in for one minute every 5 minutes following a contraction and see what develops.
    Sapphire, Dec 5, 2011
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  3. Penguin Moderatorgator

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    No idea... Subbing to read when people come along with better answers :)
    Penguin, Dec 5, 2011
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  4. dawni3 Active Member

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    As Sapphire said. Is there any maternal tachycardia to along with the creeping FH? Recheck maternal obs, encourage plenty of fluids - any pyrexia? Very intrigued to see where this goes!

    eta; just reread the info, can see maternal pulse is 70bpm! Is it still that now? Is she flushed/warm, recheck temp and keep an eye on it.
    dawni3, Dec 5, 2011
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  5. chubbylove Member

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    just commenting to subscribe :)
    chubbylove, Dec 5, 2011
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  6. River Song Well-Known Member

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    Watching with interest :)
    River Song, Dec 5, 2011
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  7. Sunny Well-Known Member

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    I guess (and it is just a guess) that 2 higher FH alone could be ok if it comes back down. So continue to listen. No idea if it continues. How is maternal tachycardia treated? I was tachy during a c-sec and they increased my fluids.
    Sunny, Dec 5, 2011
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  8. elfprincess Member

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    watching as usual, nothing to add though!
    elfprincess, Dec 5, 2011
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  9. muffinbuns Member

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    Is blood stained liquor still draining or is it becoming more diluted and more clear as it drains?

    Monitor FHR and maternal obs, check temp and blood pressure as well depending how long it has been since last check. Speak to Kat about how she feels, does she notice she is pushing or does she feel pushy? Does she have any support with her?

    What was the FHR earlier and how much has it increased?

    Also check chart and confirm their plans for the birth and third stage. I would probably also prepare delivery pack in case things happen quickly now and keep some gloves in my pocket.
    muffinbuns, Dec 5, 2011
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  10. Auntie Patches Active Member

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    70bpm is quite nice and low,(one lady last week was at 140bpm! Madness making sure the ctg wasn't picking up maternal. Straight onto IV ABx naturally) but perhaps a wee temp check wouldn't do any harm, just in case infection is spotted.

    FH still just within normal though. Continue listening in and see how that goes.
    Auntie Patches, Dec 5, 2011
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