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Late pregnancy complications

Clinical Discipline(s)/Organ System(s)
Obstetrics & Gynaecology, Reproduction & Development, Paediatrics
Progress Test Topic(s)
Women's health
Description
A 34 year old Korean woman on the antenatal ward is 33 weeks pregnant, in her second pregnancy. The midwife calls you because she has developed abdominal pain and feels unwell.
Applied Science for Medicine 
   - Structure, development and function of the placenta
   - Pathophysiology and natural history of pre-eclampsia
   - Pathophysiology of preterm labour
   - Postnatal adaptation of babies; role of surfactant
   - Thermoregulation and nutrition in preterm and low birth weight babies
   - Pharmacology of nifedipine for tocolysis in threatened preterm labour; syntocinon to induce labour; antenatal steroids (betamethasone) in setting of suspected preterm birth
Clinical and Communication Skills 
   - Elicit a history from a woman with complications late in her pregnancy; assess risk factors for pre-eclampsia and preterm labour
   - Examination of a pregnant abdomen including palpation of uterine activity
   - Perform blood pressure measurement in a pregnant woman
   - Differential diagnosis of causes of abdominal pain in late pregnancy
   - Interpret relevant investigations: full blood count, blood group, electrolytes, renal and liver function tests, coagulation studies, glucose, urine culture, urine protein:creatinine ratio, ultrasound scan, cardiotocography (CTG), fetal fibronectin, Kleihauer test
   - Recognise symptoms and signs of pre-eclampsia and its complications, especially eclampsia and HELLP (haemolysis, elevated liver enzymes, low platelets) syndrome
   - Recognise symptoms and signs of preterm labour
   - Appropriate antenatal management of pre-eclampsia; use of magnesium sulphate to prevent and treat eclampsia
   - Maternal and fetal prognosis after pre-eclampsia
   - Appropriate antenatal management of preterm birth; role of tocolytics, steroids and magnesium sulphate, importance of transfer to hospital with appropriate level neonatal intensive care unit (NICU)
   - Management of babies born preterm: ventilation, surfactant, thermoregulation, nutrition, common problems
   - Outcome of babies born preterm
   - Understand the definition and common causes of stillbirth, and understand its impact on the woman and her family
Personal and Professional Skills 
   - Coping with stressful and emotional events in pregnancy
   - Appreciating the complexity of decision making when early delivery of a baby is indicated
   - Understanding that management needs to balance maternal risks with fetal risks
   - Communicating risks and treatments of prematurity
   - Understanding the role of the neonatology team
Hauora Māori 
   - Preterm birth in Māori patients
   - Consideration of inequities in access to health services for Māori, and in the treatment and management of medical conditions
   - Issues around post-mortem examination in Māori patients
Population Health 
   - Epidemiology of pre-eclampsia and its recurrence risk
   - Smoking as a risk factor for late pregnancy complications
   - Screening throughout pregnancy for early symptoms and signs of pre-eclampsia and preterm labour
   - Epidemiology of preterm birth
   - Long-term effects of prematurity
Conditions to be considered relating to this scenario
Common
pre-eclampsia, preterm labour, urinary tract infection, renal calculi, acute cholecystitis, gastro-oesophageal reflux disease, pregnancy induced hypertension, essential hypertension, constipation, Braxton-Hicks contractions, gastritis, preterm birth, apnoea of prematurity
Less common but 'important not to miss'
eclampsia, HELLP syndrome, placental abruption, haemolytic-uraemic syndrome (HUS)/thrombotic thrombocytopenic purpura (TTP), maternal sepsis
Uncommon
appendicitis, pancreatitis, acute liver disease of pregnancy