FORMAT Essay:2500 words.
Aim of assessment This assessment enables you to explore the issues of a complex pregnancy case. You will develop an understanding of the principles of accurate antenatal assessment and triage, examine the complexity of caring for women experiencing complex issues and preterm delivery, and examine the needs and management of complex neonates admitted to the neonatal intensive care unit (NICU). Consideration and a description of the required postnatal care of the mother in this complex situation will also be explored.
Complex Case Details: Alison, Adam and Asher
Alison is a 37 y.o G5P1 (stillborn). Alison is married to Adam, and they are wheat farmers on a remote property west of Gilgandra. The drought for the last 5 years has been difficult and Alison has no real support except for Adam and their closest neighbours who have a young family and live 50km away, and Adam’s family who live on the adjoining property 100km away. In 2017 Alison birthed a stillborn baby boy, Archie at 34 weeks gestation. Alison was diagnosed and treated for pre-eclampsia and antiphospholipid (APS) syndrome during that pregnancy. The post mortem investigations did not reveal the true cause of Archie’s death though he was noted to be growth restricted and had evidence of a small, infarcted placenta. After Archie’s birth Alison had postnatal depression and has since struggled with her mental health. Following the death of her mother last year, Alison now has clinically diagnosed anxiety and panic attacks and is taking prescribed low dose fluoxetine. Alison and Adam both feel that she really just has to now get on with everything, and try and stay focused on this pregnancy.
Medical and current obstetric history
Alison is usually physically well but has a history of urinary tract infections since her early 20s. She had a BMI of 18.0kg/m² at booking-in and Alison also smokes 10-15 cigarettes a day and has been unable to quit this pregnancy. Alison had a spontaneous conception of this pregnancy and was commenced on low dose Aspirin and Fragmin due to her previous history of 3 miscarriages between 8-10 weeks gestation and the presence of elevated APS antibody titres in her first antenatal pregnancy screen in this pregnancy. In view of her complex obstetric and medical history Alison was then referred to the maternal-fetal medicine team at Northview, your tertiary hospital, for review and case management after her baby was diagnosed with a Tetralogy of Fallot at her 18 week anatomical scan in Dubbo Base Hospital. An amniocentesis and paediatric cardiology review were then attended a week later at Northview and this baby has a normal karyotype. Plans were made for Alison to return to Sydney around 36 weeks to be near the Children’s Hospital for ongoing pregnancy management and the birth of her baby. Alison and Adam were linked to the Northview maternity social worker during that 18 week visit. The medical team at Dubbo are also monitoring Alison for any signs of pre-eclampsia and APS changes during this pregnancy
Alison has been in Dubbo Base Hospital for observation since 31+3 weeks due to an episode of threatened premature labour. Swabs and blood tests at that time were negative for infection and Alison was given a course of prophylactic IV antibiotics and IMI steroids. Whilst at Dubbo Base Hospital Alison was seen by her psychologist and the hospital’s social worker after midwifery staff reported concerns that Alison is not sleeping, has ruminative worry and they also have concerns for her mental health when she returns to Gilgandra after this baby is born. Alison also stated she is feeling really overwhelmed with everything and does not want to go to Sydney to have the baby especially now in these Covid-19 times.
At 32 weeks at 1000hrs Alison reported a frontal headache and some irregular uterine contractions, a CTG was satisfactory and her B.P was 150/90mmHg. On a speculum examination Alison’s cervix was a multi os, a fetal fibronectin test was positive, she was re-commenced on oral nifedipine, given oral labetalol and a decision was made to transfer Alison to Northview. Alison was transferred via air ambulance and arrived at midnight, she was alone on transfer and visibly upset on arrival. After spending the night in the birth unit and being treated for an episode of threatened preterm labour and evolving pre-eclampsia, she was transferred to the antenatal ward where she remained for the next 4 days. Tocolytic and anti-hypertensive medications were continued. Follow-up social work and psychology review was also attended.
At 32+4 weeks, Alison went in to spontaneous premature labour in the morning, her membranes ruptured, pink liquor was noted, and she was transferred back to the birth unit. Four hours later Alison had a normal vaginal birth of her baby girl Asher, who was born with Apgar scores of 2, 4 and 5. Asher was given active resuscitation and transferred to Northview’s NICU for immediate care and management before being transferred to the Children’s Hospital two hours after birth. Adam arrived in time to accompany Asher to the Children’s Hospital with the NICU team. Alison was transferred to the postnatal ward, and after a further satisfactory postnatal check and normal observations, she visited Asher at the Children’s Hospital later that afternoon.
– From this case study identify four risk factors from Alison’s history that increase the risk of adverse maternal and fetal perinatal outcomes and describe how two of these risk factors may impact maternal and fetal perinatal health.
– Using current evidence, analyse and discuss with rationales, the care and management that is required for ANY premature neonate who requires active resuscitation and during the first 48 hours in the NICU.
– Explain the specific and holistic postnatal cares and management that would be required for Alison following delivery, during her postnatal recovery and for her discharge home.
1) Identifies four risk factors from the case study and describes how two of these risk factors may contribute to adverse perinatal outcomes. Demonstrates clear understanding of how the two identified factors impact upon perinatal health. Four risk factors are clearly identified and a comprehensive description of two of these are discussed. How the two risk factors impact on perinatal health is clearly stated, and the writer demonstrates a clear understanding of these
2) Using current evidence critically analyses, with rationales, the care and management that is required for ANY premature neonate who requires active resuscitation up to the first 48 hours in the NICU.Critical analysis from numerous and the most relevant sources reflects a comprehensive and contemporary review of current nursery care practices and management considerations of any premature neonate who requires active resuscitation up to the first 48 hours in the NICU. Demonstrates excellent discussion and understanding of the required cares.
3Provides holistic analysis and discussion of the specific postnatal care and management that Alison would require.Critical analysis of specific postnatal care and the management that Alison requires is explored and clearly articulated. Demonstrates very good insight and further discussion about other midwifery considerations that may assist Alison.
4) Constructs an appropriate introduction. The introduction orientates the reader to the topic, states your thesis position clearly and concisely, defines the scope of the discussion and outlines the stages of the essay.
5) Organises the essay body into a cohesive and logically sequenced series of paragraphs. The paragraphs are all well constructed and effectively linked; sequence of discussion matches introduction.
6) Constructs an appropriate conclusion.The conclusion summarises key points from the essay body, restates the thesis position accurately and clearly, and makes an insightful final comment
7) Writes in a clear and succinct academic style.Your writing is clear, succinct and consistently formal and objective in style; you routinely use relevant technical language effectively and qualify all assertions.
8) Your essay contains no errors in grammar, spelling and punctuation.
9) Correctly applies conventions of in-text citation for APA referencing style. You apply all conventions of APA correctly, use direct quotation sparingly and always paraphrase effectively
10) Includes a complete reference list correctly formatted according to APA referencing style. You use the correct bibliographical format for all sources and sequence them alphabetically.