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SCENARIO
Module 12: Abnormal
Pregnancy
Current Assessment SCENARIO 1 Tracy, an 18 year old single woman presents to the delivery
suite with a two hour history of intermittent abdominal pains and vaginal bleeding.
The pains have been getting stronger and more frequent. She is 29 weeks into
her pregnancy and had one previous admission at 15 weeks with vaginal
bleeding. She lives with her mother and 3 younger brothers. She smokes 15
cigarettes per day but stopped drinking when she became pregnant. Vaginal
examination revealed the cervix to be 2cm dilated and fully effaced. SCENARIO 2 Deborah, a 25 year old married teacher is referred by her community
midwife at 34 weeks gestation after finding a blood pressure of 165/105.
Urine testing at the community clinic showed 1+ of protein in the urine. A
few days earlier, she had complained of swelling of her hands. Her blood
pressure had been 135/88 at that time. Clinical examination revealed a symphysis-fundal height of 30 cm. Blood pressure remained elevated over 24 hours. Ultrasound
examination demonstrated an estimated weight of 1.6kg with reduced liquor
volume. SCENARIO 3 Sue, a 28 year old woman in her second pregnancy was seen at the
clinic at 41 weeks. She requested induction of labour and was admitted 3 days
later. Her pregnancy had been uncomplicated (her previous baby weighed 4.2kg
and was delivered normally). The cervix had a modified Bishop score of 4 and
PGE2 2mg gel was inserted in the posterior fornix. Four hours later she was
contracting every 3 minutes and the cervix was 2cm dilated and effaced. Her
contractions eased, and so an amniotomy was
performed and an Oxytocin infusion commenced. Six
hours later the registrar told Sue that monitoring of her baby's heart was
showing fetal distress and that delivery by
Caesarean Section should be considered.
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