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Maternal and Neonatal Health Complications exam 2013...

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SUMMER EXAMINATIONS 2013 MID201413NB

MODULE TITLE

Maternal and Neonatal Health Complications

LEVEL

Five

TIME ALLOWED

Two hours

Instructions to students: •

Enter your student number not your name on all answer booklets.

•

Read the questions carefully

•

Candidates must answer ONE question in each section

•

All questions have equal weighting

•

Neither books nor notes may be taken into the examination

No. of Pages

5

No. of Questions

8

Page 1 of 5

MID201413NB Section A: Antenatal – answer ONE question from this section. 1. Tracy is 24 weeks gestation and booked for midwife led care. During a tour of the maternity unit she complains of feeling generally unwell and of having pain in her lower abdomen and in her left leg. She also complains of feeling breathless. Tracey is sent to labour ward: on examination her temperature is 37.5°C; blood pressure is 115/65; pulse 96; respiratory rate 23; Hb 10.0gm/dl. At booking her body mass index was 28kg/m². a) With reference to anatomy and physiology, discuss the possible reasons for Tracy’s symptoms. b) Discuss the midwife’s role and responsibilities in the care of Tracy.

2. Sharon is 20 years old, pregnant for the first time and 24 weeks gestation. She lives in a refuge as she has been subjected to severe emotional and physical abuse from her partner. Sharon and her partner are both Heroin users but Sharon is now on a Methadone programme. At 16 weeks gestation when Sharon booked with her midwife; her body mass index was 19kg/m²; blood pressure 100/40; Haemoglobin 10g/dl. a) With reference to anatomy and physiology; discuss the significance of the observation results. b) Discuss the midwife’s role and responsibilities in the future management and care of Sharon.

_____________________________________________________________ END OF SECTION A SECTION B FOLLOWS OVERLEAF _____________________________________________________________

Page 2 of 5

MID201413NB Section B: Intrapartum – answer ONE question from this section. 3. Molly is 38 years old, gravida 3 para 1+1. She is 32 weeks pregnant and presents on labour ward complaining of contractions every 10 minutes which are moderately strong and she is requesting something for the pain. Molly also reports that her membranes have ruptured. The maternal observations are within normal limits and a cardiotocograph is commenced. On palpation the lie is longitudinal with a cephalic presentation, left occipito-anterior position. a) Discuss the midwife’s priorities in the immediate care of Molly. b) Discuss the midwife’s role and responsibilities in the management and care of Molly if she is in active labour.

4. Stacey is an 18 year old primigravida at 41+5 weeks gestation. She commenced spontaneous labour 8 hours ago. On palpation the lie was longitudinal, with a cephalic presentation and the position was right occipito-lateral. Four hours ago her membranes ruptured and the cervix was effaced and 7cm dilated, with clear liquor draining; the head was asynclitic, at the level of the ischial spines in a right occipito-lateral position. The uterine contractions have been incoordinate, 2 to 4 in 10 minutes. On vaginal examination the cervix is now 7cm dilated. The fetal heart trace is reassuring. a) With reference to anatomy and physiology, discuss the implications of the fetal position and station and the labour dystocia. b) Discuss the options for management for Stacey responsibilities of the midwife in her continued care.

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_____________________________________________________________ END OF SECTION B SECTION C FOLLOWS OVERLEAF _____________________________________________________________

Page 3 of 5

MID201413NB Section: C Postnatal – answer ONE question from this section. 5. Tracy has been receiving therapeutic low molecular weight Heparin (LMWH) antenatally for a deep vein thrombosis diagnosed at 28 weeks gestation. Following a forceps delivery at 38 weeks gestation she was transferred to community care on day 3 postpartum with prophylactic LMWH and compression stockings. Tracy is breast feeding baby Jessica. On postnatal day 14, Tracy is referred back to labour ward by her general practitioner complaining of feeling very unwell with ‘flu’ like symptoms. On examination: temperature is 36°C, pulse 122 beats per minute, respiratory rate 21 and blood pressure 90/40. a) With reference to anatomy and physiology, discuss the possible reasons for Tracy’s symptoms. b) Discuss the midwife’s role and responsibilities in the care of Tracy.

6. Dominique has had a vaginal breech birth at 38 weeks gestation for her second baby; with an epidural for pain management and active management of the third stage of labour. At 8 hours post partum, Dominique complains of severe ‘after pains’ and that she has not been able to pass urine. She feels hot and her lochia is heavy with some clots; she is changing her pads very frequently. a) Discuss the observations and investigations the midwife needs to undertake. b) With reference to anatomy and physiology; discuss the midwife’s role and responsibilities in the immediate care of Dominique.

_____________________________________________________________ END OF SECTION C SECTION D FOLLOWS OVERLEAF _____________________________________________________________

Page 4 of 5

MID201413NB Section D: Neonatal – answer ONE question from this section. 7. Elaine, an insulin dependent diabetic, has had a normal vaginal birth at 39 weeks gestation. She wishes to breast feed baby Noah who weighs 4.585kg with an Apgar score of 4 at 1 minute and 8 at 5 minutes. Noah only required stimulation to establish normal respirations. a) With reference to pathophysiology discuss the immediate care and management of Noah. b) Discuss the midwife’s role and responsibilities in the continuing care of Noah on the postnatal ward.

8. Caroline is an 18 year old primigravida at 41+5 weeks gestation. She has had a Ventouse delivery for delay in the second stage of labour. Baby Edward is born with an Apgar score of 5 at one minute and 9 at 5 minutes. He weighs 3.9kg. a) Discuss the role and responsibilities of the midwife in the immediate postnatal care of Edward. b) Edward has a large ‘chignon’ on his head with some broken skin and bruising on his face. On postnatal day three he looks Jaundiced, is sleepy and reluctant to feed. Discuss the role and responsibilities of the midwife in the further care of Edward.

END OF SECTION D END OF PAPER

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