Obstetric learning issues - example

The essential part of obstetrics is learning to screen and monitor for possible problems that occur in the pregnant woman and know when to refer appropriately.

Case example

34 yo unemployed mother in defacto relationship presents with nausea. Transient episode of vomiting 2 weeks previously. Usually healthy. Has been amenorrheic past 8 weeks after ceasing pill. She complains of worse than usual breast tenderness. There is a family history of Type II diabetes. She has a two children with both children born in the > 90th percentile. The second one suffering mild neonatal hypoglycaemia.

On examination, she is significantly obese. Gyanecological examination reveals a modestly enlarged uterus and tender left adnexa.

A number of laboratory investigations performed are normal. An ultrasound confirms a pregnancy and shows no other abnormality. Later an oral glucose tolerance test demonstrates intolerance. Dietary modification is recommended and she is given a home gluocose machine but remains poorly compliant resulting in unstable glucose control. Diabetic nurse input is sought.

Physical examination at 34 weeks shows a large for dates baby and the head has yet to engage. The ultrasound confirms fetal macroscomia.

At 38 weeks the patient spontaneously enters labour and delivers a 4.2 kg male infant vaginally with moderately low APGARs. The infant requires IV glucose for 12 hours for low blood sugars but neither mother or child suffer further complications. Six weeks later repeat glucose tolerance test is normal.

Learning Issues