Last updated on 27 Aug 2014 at 2:37 PM (Preg01)

Risk assessment in early pregnancy
A 38 year old NZ European woman presents to her GP as she has not had a period for 7 weeks. She has a positive pregnancy test at the clinic. When you examine her, you note a blood pressure of 135/85 mmHg and a body mass index (BMI) of 34.

 

Applied Science for Medicine
Physiology of pregnancy, hormonal and other physiological changes during the different stages of normal pregnancy
Pathophysiology of obesity
Pathology of metabolic syndrome
Outline the normal embryonic and fetal development from implantation to birth and trophoblast
Pathogenesis of hypertension in pregnancy
Medication use in early pregnancy; reliable sources of drug information

Clinical and Communication Skills
Elicit a history from a woman with a high risk pregnancy; complete a risk assessment for the pregnancy
Calculate the estimated delivery date
Examination of a patient who is pregnant including blood pressure measurement, weight and height
Identify risk factors present at the start of this pregnancy, and list complications that may arise as a result of these risk factors
Interpret routine and relevant additional antenatal investigations, such as ultrasound and early diabetes testing
Management of high risk pregnancy based on the risk assessment and knowledge of complications that may arise as a result of the risks identified, both maternal and fetal: pharmacological (e.g. low dose aspirin, calcium, methyldopa) and non-pharmacological (lifestyle, diet and exercise,optimal gestational weight gain)
Management of pre-existing and gestational hypertension in pregnancy
Prescribing for pregnant women and women of child-bearing potential
Optimising maternal health pre-pregnancy
Role of periconceptual folic acid in preventing neural tube defect

Personal and Professional Skills
Lifestyle changes
Ascertaining woman's feelings towards pregnancy
Counselling on high risk factors in pregnancy, prenatal screening, appropriate lead maternity carer (LMC) according to pregnancy risk
Ethical aspects of prescribing; recognise limits of competence and ask for help when needed; responsibility to update knowledge
Understanding the role of the midwife and obstetrician in a high risk pregnancy
Supporting normality during pregnancy

Hauora Māori
Health literacy needs of patient and whānau

Population Health
Models of antenatal care in New Zealand
Epidemiology of hypertension and pre-eclampsia/eclampsia in pregnancy
The role of pre-conceptual counselling in all women of reproductive age; folic acid, weight loss, smoke-free counselling, avoiding alcohol and drugs, early booking with lead maternity carer (LMC)
The role of high risk pregnancy clinics
Epidemiology of obesity; how to modify the risk of adverse outcomes

 

Conditions to be considered relating to this scenario

Common

essential hypertension, pregnancy induced hypertension, gestational diabetes mellitus, diabetes mellitus, metabolic syndrome, preeclampsia, fetal growth restriction

Less common but 'important not to miss'

eclampsia, renal disease, HELLP (haemolysis, elevated liver enzymes, low platelets)

Uncommon

secondary causes of hypertension