Helen is a 32-year-old P1 who was driven to your maternity unit by her partner Sam. She is semiconscious and has had a notable diuresis. She is 36/40 and has been a type 1 diabetic form the age of 12. Sam informs you that Helen has been nauseated and vomiting for two days and hasn’t checked her blood sugar since yesterday morning when it was 9.5mmols/l.
Case Study 2: Helen is a 32-year-old P1 who was driven to your maternity unit by her partner Sam. She is semiconscious and has had a notable diuresis. She is 36/40 and has been a type 1 diabetic form the age of 12. Sam informs you that Helen has been nauseated and vomiting for two days and hasn’t checked her blood sugar since yesterday morning when it was 9.5mmols/l. Critically discuss Hope’s case with reference to the guidelines above.
Requirements: everything is in the first uploaded documents
Assessment of knowledge related to module learning outcomes 3 and 4 (below) will be appraised by a continuous assessment that will take the form of a Critical Analysis of a Case Study. This assessment must be passed independently of other assessment elements within the module.
Module Learning Outcomes related to this assessment element:
Learning Outcome 3: Demonstrate competence and critical thinking related to the enhanced assessment, planning, delivery and evaluation of midwifery care for women experiencing acute/deteriorating pregnancy/perinatal conditions.
Learning Outcome 4: Critically evaluate and implement strategies to ensure consistent high-quality interdisciplinary collaboration and communication
Critical Analysis of a Case Study Guideline
Word Limit: 2,500
Marks Weighting 100%
Submission Date: TBC
Submission Requirements: One electronic copy submitted to turnitin via Moodle
Each student is required to choose one of the case studies below and undertake a critical discussion / analysis using the following headings:
Clinical reasoning and clinical judgement – identifying and prioritising the woman’s condition; risk factors, signs and symptoms (subjective and objective measurements)
Consideration of a diagnosis / differential diagnosis
Critical discussion of underlying pathophysiology of the condition that is presenting and how this relates to signs/symptoms and signs of clinical deterioration
Clinical Assessment: diagnostic tests / assessment of fetal wellbeing where appropriate
Collaborative interventions: obstetric / medical / surgical / mental health
Clinical interventions and care plan
Evaluation of Care Plan / Interventions – expected outcomes
Psycho-socio-cultural Considerations
Reference to evidenced based literature must inform the analysis throughout the case study.
A SAMPLE CASE STUDY ON POSTPARTUM HAEMORRHAGE
Word Count: 2,749
Introduction
In this case study the subject I intend to explore is Postpartum haemorrhage (PPH) and its impact on maternal wellbeing. I will examine the clinical presentation, management, treatment, and outcome of a postnatal woman presenting with a PPH. Obstetric haemorrhage remains one of the leading causes of maternal morbidity and mortality worldwide. It was the second leading cause of direct maternal death in the United Kingdom from 2013 to 2015 (Knight et al. 2017). Primary PPH is a prominent cause of a major obstetric haemorrhage (Mavrides et al. 2016) In fact one of Ireland’s maternity units seen an increase in the incidence of Primary PPH of 11.3% in 2008-2014 (Sheehan et al.2014)
The case I have chosen involves both Primary and Secondary PPH which resulted in re-admission to hospital requiring surgical intervention and level 2 Critical Care. Due to the complications surrounding the case and word limitations I will only discuss Secondary PPH. The primary aim of this case study is to demonstrate an understanding of the pathophysiology of PPH with accurate and reliable diagnostic skills and emphasising the importance of early clinical intervention. A high proportion of morbidity can be prevented through early recognition with adequate intervention and proper choices of therapies (Woiski et al. 2016). The woman involved in this case study will be known as Mary to protect her identity. Mary’s past medical and surgical history along with a summary of her labour and delivery are included in Appendix 1.
There are many definitions to describe PPH. Kasap et al. (2016) defines it as bleeding of 500ml or more following a vaginal birth,1000 ml or more after a caesarean section, classifying it as primary if occurring within 24 hours and secondary from 24hours to 12 weeks. While Mavrides et al. (2016) further divides primary into two categories minor 500-1000ml in the absence of adverse effects and major more than 1000ml, but does not state a blood volume for Secondary PPH. PRactical Obstetric Multi-Professional Training (PROMPT) defines secondary PPH as a blood loss of 500ml or more occurring from 24 hours to 12 weeks postpartum (Winter et al. 2017). While Carroll et al. (2016) suggests a definition for Secondary PPH “any blood loss from the genital tract in excess of normal lochia at any time period after 24 h post birth to 6 weeks postpartum” (Carroll et al. 2016, p10). Although Secondary PPH may occur anytime between 24hours and 12 weeks
following the birth, it is most commonly between day 7 and day 14 (Chandraharan et al. 2017)
There are many risk factors associated with PPH both antenatal and intrapartum, though it can occur without any risk factors. Nevertheless a history of severe PPH increases the risks by nine-fold in future pregnancies (Nyfløt et al., 2017)
Pathophysiology
In pregnancy blood volume, coagulation, and clotting factors are increased as a normal physiological process which allows the body to compensate well in the early stages of haemorrhage. The blood volume in pregnancy is increased by as much as 30ml/kg giving a total volume of 6-7litres at term (Winter et al. 2017). Mousa et al. (2014) states a blood loss of up to 500ml at delivery is physiological which brings the blood parameters to their normal non pregnant level. Yet the signs of hypovolaemic shock can be masked because of the increased circulating volume (Mavrides et al. 2016). Hypovolaemia will lead to insufficient blood to the heart for normal function, affecting oxygen transportation which will result in hypoperfusion of vital organs. If not corrected hypoperfusion can cause the release of endothelial tissue factor and activation of coagulation cascade resulting in disseminated intravascular coagulation (Hossain et al. 2013)
Following delivery, the uterus contracts and this causes the placenta to separate from the uterine wall, exposing blood vessels that were in contact with the placenta surface. Haemostasis is achieved when the uterus contracts compressing the blood vessels and by transient activation of the coagulation system (Chireau et al. 2015). If the uterus fails to contract then PPH will occur. The most common cause of primary PPH is atonic uterus. PROMPT defines the causes of PPH by using 4 T’s, Tone, (uterine tone) Tissue, (retained products) Trauma (genital tract tears) and Thrombin (coagulopathy) (Winter et al. 2017). However Secondary PPH can be caused by retained products of conception, endometritis and subinvolution of the placenta site. (Mavrides at al. 2016)
Postpartum Haemorrhage- Case Study
Mary presented on day 11 postnatal, complaining of feeling unwell and giving a history of passing clots at home and having intermittent lower abdominal crampy pains. She felt faint and dizzy and appeared pale and anxious. Having a low Haemoglobin (HB) further bleeding regardless of blood volume could have an adverse effect on her wellbeing (WHO 2012)
I immediately put Mary lying flat on the bed with her legs elevated and administered high flow oxygen 15litres per minute via a facial oxygen mask (Winter et al. 2017). The RCOG also recommends giving a high concentration of oxygen regardless of maternal oxygen concentration (Mavrides et al. 2016). I checked and recorded Mary’s vital signs on the Irish Maternity Early Warning System (Appendix 2). The IMEWS is a bedside tool designed to give an early warning score when the vital signs deviate from the normal parameters thus prompting early recognition and intervention. The aim is to improve the management of a deteriorating woman, during pregnancy and up to 42 days postnatal (HSE 2014a) I found Mary’s temperature to be 37.0C, her Pulse 100 beats per minute (BPM) and Respirations 20, Blood pressure 60/30 and oxygen Sp02 97%. These findings gave an early warning score of 2 yellow and 2 pink triggers on the IMEWS chart therefore alerting a prompt intervention and the need to continuously monitor the vital signs. Indeed changes in respiratory rate can be an early indicator of deterioration in wellbeing (HSE 2014a). If the Systolic blood pressure falls below 100mmHg the blood loss could be as much as 25% of the maternal blood volume (Winter et al. 2017). As a result hypotension is a late sign of deterioration and indicates decompensation (HSE 2014a). Although Mary’s temperature was within normal limits (36-37.4 degree centigrade) I used a Mistral –air blanket to keep her warm. According to the Mavrides et al. (2016) hypothermia could exacerbate acidosis.
I called for assistance requesting the appropriate obstetric staff including the Obstetrician for an instant review. The management of PPH contains four components which must be undertaken simultaneously, Communication, Resuscitation, Monitoring and Investigation (HSE 2012). In order that clear concise information was given I used the Identification-situation-background-assessment-recommendation (ISBAR) tool. This structured communication tool was developed to enhance communication within the team to benefit patient care management (HSE
2014a).However the management of a major PPH can be frightening for the woman and her partner as the room quickly becomes crowded and numerous simultaneous activities are taking place. Therefore it was important that Mary and her partner were kept informed on events from the onset. (Mavrides et al. 2016)
As part of my extended role as a midwife and being aware of the need for urgent fluid replacement, I inserted a size 16 gauge intravenous cannula in Mary’s left hand. An Intravenous infusion (IV) of Hartmann solution which is a crystalloid solution was commenced to help restore fluid volume so to improve cardiac output and perfusion. PROMPT recommends an IV infusion of warmed crystalloid fluids as cold fluids can cause cardiac arrhythmias and the fluids should be infused rapidly until the systolic blood pressure is restored within normal limits (Winter et al. 2017). Therefore I applied a pressure bag to aid the infusion rate. In the same way the WHO (2012) recommends isotonic crystalloid fluids in preference to colloids fluids. According to Mauvrides et al. (2016) the bases of resuscitation in a PPH is to restore the blood volume and the oxygen capacity. Likewise the Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (Knight et al. 2017) states that the key management of Obstetric haemorrhage is to assess the blood loss and identify the need and replace the fluids and blood products.
In the meantime the Senior House Officer (SHO) inserted a second 16 -gauge intravenous cannula in Mary’s right arm and obtained blood samples for, Full blood Count, coagulation screen, Urea and electrolytes, Liver function test , C-Reactive protein and group and cross- match of 6 units. I contacted the Laboratory Specialists to inform them, that urgent bloods for Mary were being sent and required urgent processing. The HSE (2012) clearly state that involving the Laboratory specialists in the early stages is crucial in the management of PPH. Mary received 2 litres of intravenous Hartmann Solution prior to commencement of a blood transfusion (1 unit of Red Blood Cells) It is essential to commence a blood transfusion of Red Blood Cell as soon as possible on the basis of clinical signs and symptoms rather than waiting on blood reports (Mavrides et al. 2016)
In accordance with the WHO (2012) uterine massage was commenced by the obstetric register as the first line management of PPH. While Mary’s abdomen was very tender to touch the uterus was palpated at the level of the umbilicus, a large volume of blood clots approximately 400mls were expelled vaginally. Blood clots
retained in the uterus can prevent effective uterine contractions (Winter et al. 2017). In addition a further 300mls of blood was noted on the sheets. To obtain a more accurate amount of the total blood loss, the sheets, swabs and pads were weighed. A literature review revealed estimating blood loss as a volume was highly inaccurate (Hancock et al. 2015).Though measuring the exact blood loss can prove difficult resulting in inaccurate measurements (Mousa et al. 2017). In the assessment of PPH it is vital to include all clinical signs and symptoms of hypovolaemia as blood loss is often under estimated (Mavrides et al. 2016). I chaperoned the consultant while he carried out a speculum examination, it was difficult to visualise the cervix because of the active bleeding, though on vaginal examination the cervix was opened. A high vaginal swab was taken for culture and sensitivity. Co-Amoxiclav 1.2grams IV 8 hourly and Flagyl 500mgs IV 8hourly was commenced. The RCOG recommends that all women presenting with a secondary PPH should have a high vaginal and endocervical swabs taken for bacteriological testing for endometritis and commenced on appropriate antimicrobial (Mavrides et al. 2016).
Being aware a full urinary bladder can prevent the uterus from contracting and it is also essential to monitor the urinary output as it reflects the fluid volume and the renal function. Following informed consent and under aseptic technique I inserted a size 12 Foleys catheter and attached an urometer for monitoring hourly urinary output. An intake and output fluid chart was commenced so to keep an accurate record of all fluid intake and output in a 24 hour period. A positive balance indicates fluids received are greater than fluid loss, although fluid is also lost through perspiring and respiration, a negative balance is a result of more fluids being lost than received which could lead to renal failure if not corrected (Winter et al. 2012). The aim is to achieve a urinary output of greater or equal to 0.5ml/kg/hr (HSE 2014c)
In order to effectively and appropriately manage the PPH, the first drug to be given was an uterontonic agent Syntometrine I ml intramuscular (IM). However Syntometrine is contraindicated if there is a history of hypertension, heart disease, pre-eclampsia or eclampsia (Mousa et al. 2014). According to the WHO (2012) Oxytocin alone should be the uterontonic first drug of choice. The National Institute for Health and Care Excellence (NICE 2014) identifies that there is uncertainty regarding the most effective drug treatments and dosage regimes. Oxytocin 40iunits was prescribed and was added to 1litre of compound sodium lactate solution, the
Intravenous infusion (IV) was commenced at 250mls/hour as per local hospital policy. PROMPT recommends that 40units of Oxytocin should be diluted in 500mls of 0.9% sodium chloride and infused over 4 hours at 125mls/hour. According to Pantoja et al. (2016), Oxytocin has an antidiuretic effect and can cause water intoxication if given in repeated doses in large volumes of electrolyte-free solutions.
The bleeding failed to stop Tranexamic Acid 1gram was administered IV. It can be repeated after 30 minutes (winter et al. 2017). It prevents fibrinolysis by inhibiting the interaction of plasmin and fibrin (Glymph et al. 2016).The WHO (2017) recommended Tranexamic acid for the treatment of PPH. Misoprostol (Cytotec) 1gram was administered per rectum by the Obstetric Registrar. It is a synthetic form of prostaglandin E1 and aids uterine contractions. Has Mary continued to bleed Carboprost (Haemobate) 250micrograms was given IM. It is a synthetic analogue of prostaglandin F2a, if deemed necessary can be repeated every 15minutes to a maximum of eight doses (Winter et al. 2012).It is contraindicated with a history of cardiac or pulmonary disease as it can cause bronchospasm, hypotension and intrapulmonary shunting with arterial oxygen desaturation (Van de Velde et al. 2013).
In the meantime the Consultant preformed an ultrasound scan which confirmed retained products of conception. In a study Nyfløt et al. (2017) found that retained placenta tissue caused a high incidence of severe PPH. Mary continued to pass clots with a total blood volume of 1500ml though it was reassuring her blood clotting factors were all within normal limits. Her HB was 9.2g/dl and her IMEWS continued to trigger all of which showed evidence of haemostatic compromise. Based in all findings the decision was made to go to theatre for examination under anaesthesia (EUA) and evacuation of retained products of conception (ERPC). Informed consent was obtained and I prepared Mary for theatre. Has ERPC can result in uterine perforation, the consultant obstetrician performed the procedure as recommended by the RCOG (Mavrides et al. 2016)
Following Examination under General Anaesthesia and ERPC, Mary returned to the labour Ward to receive Level 2 critical care. To insure individual needs are met critical care is divided into 4 levels of care. The level required depends on the number of organs requiring support and the type of support required (HSE 2014b). In Mary’s case following a major PPH and receiving a blood transfusion she required on-going monitoring and close observation. The RCOG (2016) acknowledges the
need to continuous monitoring the physiological condition even when the bleeding appears to have stopped and the importance in recognising on-going bleeding. Mary’s condition remained stable during my shift and she received a further unit of overnight. I continued to record all vital signs on the IMEWS which remained within normal parameters and I had kept contemporaneous notes throughout my shift. Mary’s urinary output was recorded hourly which showed adequate urine volume. I removed the urinary catheter before Mary left the Labour ward. The Oxytocin infusion had remained in progress for 6 hours following ERPC. The uterus remained contracted at the level of the Symphysis pubis and the vaginal loss was minimal. However Mary’s HB dropped to 7g/dl the following day and therefore a further 2 units of was transfused. Mary remained very anxious and voiced a lot of concerns surrounding her PPH although she had been kept fully informed of all events as they unfolded, she constantly needed reassurance. On transferring care I emphasised the need for a full debriefing for Mary and her partner and the importance of an early follow up care by the Public Health Nurse in the community following discharge. The RCOG also acknowledges the importance of a debriefing session with the woman and her partner following events (Mavrides et al. 2016).
Conclusion
PPH is a major and challenging Obstetric emergency, which requires early detection escalation of care with prompt intervention and treatment in order to prevent morbidity and mortality. The IMEWS is a fundamental tool, making prompt awareness by highlighting abnormal parameters of vital signs. Therefore it is vital that all relevant obstetric staff is familiar with the IMEWS and receive the recommended educational training for its use. It is imperative the staff have continuous education relating to PPH and is aware of local guidelines and protocols which will ensure delivery of safe and efficient high quality care within our Maternity Services. It is paramount that the woman and her partner are debriefed in the early days following the event. PPH impacts on the physical and psychological wellbeing of the mother, as midwives we have an important role in the management of PPH to help reduce morbidity and mortality.
References
Carroll, M., Daly, D., and Begley, CM. (2016) The prevalence of women’s emotional and physical health problems following a postpartum haemorrhage: a systematic review. BMC Pregnancy and Childbirth, 16, p.261.
Chandraharan, E. and Krishna, A. (2017) Diagnosis and management of postpartum haemorrhage. British Medical Journal, 358(3875), pp.494-497.
Chireau, MV., M.D., MPH, FACOG and FAHA. (2015). Is Misoprostol Equivalent to Oxytocin for Postpartum Hemorrhage? Issues in Law & Medicine, 30(2), pp.217-275.
Glymph, DC., Tubog, TD. and Vedenikina, M. Use of Tranexamic Acid in Preventing Postpartum Hemorrhage. (2016) AANA Journal Course, 84(6), pp.427-437.
Hancock, A., Weeks, AD., and Lavender DT. (2015) Is accurate and reliable blood loss estimation the ‘crucial step’ in early detection of postpartum haemorrhage: an integrative review of the literature. BMC Pregnancy and Childbirth. 15(1), p.230.
Health Service Executive and Royal College of Physicians of Ireland (2012). Clinical Practice Guideline – Prevention and Management of Primary Postpartum Haemorrhage. Version 1.1, Guideline No. 17[online].. Available from:
[accessed 5 February 2018]
Health Service Executive and Royal College of Physicians of Ireland (2014a). Clinical Practice Guideline – The Irish Maternity Early Warning System (IMEWS). Version 1.1, Guideline No. 25 [online]. Available from:
https://www.hse.ie/eng/services/publications/clinical-strategy-and-programmes/imews-guidelines.pdf
[accessed 16 February 2018]
Health Service Executive (2014b). Guidelines for the Critically Ill Woman in Obstetrics. Version 1.1. [online]. Available from:
[accessed 28 February 2018]
Health Service Executive (2014c). Clinical Practice Guideline – The Diagnosis and Management of Sepsis in Pregnancy, Intrapartum & in the Puerperium. Our Lady of Lourdes Hospital, Drogheda[online]. Available from:
[accessed 1 March 2018]
Hossain, N., MBBS, MCPS, FCPS and Paidas, MJ. (2013) Disseminated intravascular coagulation. Seminars in Perinatology, 37(4), pp.257-266.
Kasap, B., Akbaba, E., Öner, G., Küçük, M., Nur-Akın, M., Turhan-Öztürk, N., Deveer, R. (2016). Evaluation of Patients with Postpartum Hemorrhage Patients in a University-Affiliated Tertiary Care Hospital. Haseki Tıp Bülteni, 54, pp.13-18.
Knight, M., Nair, M., Tuffnell, D., Shakespeare, J., Kenyon, S. and Kurinczuk, JJ (Eds.) on behalf of MBRRACE-UK (2017). Saving Lives, Improving Mothers’ Care – Lessons learned to inform maternity care from the UK and Ireland Confidential Enquires into Maternal Deaths and Morbidity 2013-15. Oxford: National Perinatal Epidemiology Unit, University of Oxford.
Mavrides, E., Allard, S., Chandraharan, E., Collins, P., Green, L., Hunt, BJ., Riris, S. and Thomson, AJ. (2016) on behalf of the Royal College of Obstetricians and Gynaecologists, Prevention and management of postpartum haemorrhage. British Journal of Obstetrics and Gynaecology [online], 124, pp.106-149. Available from:
https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg52/
[accessed 17 February 2018]
Mousa, HA., Blum, J., Abou El Senoun, G., Shakur, H. and Alfirevic, Z (2014). Treatment for primary postpartum haemorrhage. Cochrane Database of Systematic Reviews [online], Issue 2. Art. No.: CD003249. DOI: 10.1002/14651858. CD003249.pub3. [accessed 22 February 2018]
National Institute for Health and Care Excellence (2014). Clinical Guideline – Intrapartum care for healthy women and babies [online]. Available from:
nice.orkg.uk/guidance/cg190 [accessed 22 February 2018]
Nyfløt, LT., Sandven, I., Stray-Pedersen, B., Pettersen, S., Al-Zirqi, I., Rosenberg, M, Jacobsen, AF. and Vangen, S. (2017) Risk factors for severe postpartum hemorrhage: A case-control study. BMC Pregnancy and Childbirth [online]. DOI 10.1186/s12884-016-1217-0
[accessed 17 February 2018]
Pantoja, T., Abalos, E., Chapman, E., Vera, C. and Serrano, VP (2016). Oxytocin for preventing postpartum haemorrhage (PPH) in non-facility birth settings. Cochrane Database of Systematic Reviews [online], Issue 4. Art. No.: CD011491. DOI: 10.1002/14651858.CD011491.pub2. [accessed 6 March 2018]
Sheehan, S., Hughes, P., Miletin, J., D’Arcy, T., Carey, M., O’Leary, J., Donohue, P. (2014) Annual Clinical Report 2014. Coombe Women and Infants University Hospital. Ospidéal Ollscoile Ban agus Naíonán an Chúim
Van de Velde, M., Scholefield, H. and Plante, LA. (2013) Maternal Critical Care: A Multidisciplinary Approach. Cambridge University Press: New York
WHO (2012) WHO recommendations for the prevention and treatment of postpartum haemorrhage. World Health Organisation. Geneva 27, Switzerland [online]. Available from: http://apps.who.int/iris/bitstream/handle/10665/75411/9789241548502_eng.pdf?sequence=1 [accessed 3 March 2018]
WHO (2017) WHO recommendations on tranexamic acid for the treatment of postpartum haemorrhage. World Health Organisation. Geneva 27, Switzerland [online]. Available from: http://apps.who.int/iris/bitstream/handle/10665/259374/9789241550154-eng.pdf;jsessionid=8E03E8FDAA1024012DCE2B66D8D8A765?sequence=1
[accessed 3 March 2018]
Winter, C., Crofts, J., Draycott, T. and Muchatuta, N. (2017) PROMPT course manual. Third Edition. Cambridge University Press.
Woiski, MD., van Vugt, HC., Dijkman, A., Grol, RP., Marcus, A., Middeldorp, JM., Mol, BW., Mols, F., Oudijk, MA, Porath, M., Scheepers, HJ. and Hermens, RP. (2016). From Postpartum Haemorrhage Guideline to Local Protocol: A Study of Protocol Quality. Maternal and Child Health Journal, 20(10), pp. 2160–2168.
Appendix 1
Background
Mary was a 30 year old Para 2 who had a previous normal delivery in 2016, followed by a primary postpartum haemorrhage caused by an atonic uterus. She is now 11 days postnatal, following a normal delivery, and a primary postpartum haemorrhage of 1300mls.
Social History
Mary and her partner are both Irish. Their religion is Roman Catholic. Mary is a full time home carer and her partner is a carpenter.
Past Medical History
No previous medical history noted.
Surgical History
Had a cyst removed from her back in 2013.
Labour and Delivery Summery
Mary presented in labour at 40 weeks gestation. Her Labour progressed well, having had an epidural for pain relief. After a 4 hour labour she had a normal delivery of a healthy baby girl weighing 3490grams. She had active management of the 3rd stage of labour and following delivery of the placenta and membranes had a PPH of 1300 mls. The placenta appeared complete but the membranes were ragged. Mary was given Uterotonic drugs which controlled the bleeding, she also received fluid resuscitation, but did not require a blood transfusion. On day 2 postnatal Mary’s Haemoglobin was 10.1g/dl and she went home on Iron Supplements.
Appendix 2
Appendix 2
Assessment of knowledge related to module learning outcomes 3 and 4 (below) will be appraised by a continuous assessment that will take the form of a Critical Analysis of a Case Study. This assessment must be passed independently of other assessment elements within the module.
Module Learning Outcomes related to this assessment element:
Learning Outcome 3: Demonstrate competence and critical thinking related to the enhanced assessment, planning, delivery and evaluation of midwifery care for women experiencing acute/deteriorating pregnancy/perinatal conditions.
Learning Outcome 4: Critically evaluate and implement strategies to ensure consistent high-quality interdisciplinary collaboration and communication
Critical Analysis of a Case Study Guideline
Word Limit: 2,500
Marks Weighting 100%
Submission Date: TBC
Submission Requirements: One electronic copy submitted to turnitin via Moodle
Each student is required to choose one of the case studies below and undertake a critical discussion / analysis using the following headings:
Clinical reasoning and clinical judgement – identifying and prioritising the woman’s condition; risk factors, signs and symptoms (subjective and objective measurements)
Consideration of a diagnosis / differential diagnosis
Critical discussion of underlying pathophysiology of the condition that is presenting and how this relates to signs/symptoms and signs of clinical deterioration
Clinical Assessment: diagnostic tests / assessment of fetal wellbeing where appropriate
Collaborative interventions: obstetric / medical / surgical / mental health
Clinical interventions and care plan%3
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