CASE STUDY

Case Study

Case Study

Introduction

Sue's indication for visiting the antenatal clinic was with referral from her General practitioner after a positive pregnancy test. Sue had no serious medical history except a appendicectomy when she was 9 years old and she was diagnosed with PCOS (Polycystic Ovarian Syndrome), Metformin; treatment for PCOS. She is much exited about this pregnancy as she thought she would never be able to fell pregnant, due to PCOS. She has a body mass of >34. Accurate history taking provides the midwife with information necessary to determine the existence of risk factors that may affect the course of her pregnancy.

Prior to Sue's interview with the midwife, she checks the availability of scales for height and weight, obtains a sphygmomanometer, stethoscope, educational materials and clinical notes. Automated devices and ambulatory BP monitoring should not yet be used in routine practice why? Assessment of Sue's handheld record, prior the interview will give the midwife an indication what her pregnancy and health status may predict. By being prepared the midwife exhibits a competent and confident image that may reassures Sue (Lowdermilk & Perry 2004). The midwife introduces herself to Sue and invites her in an area that is screened from the public, preferably a private room with a door.

The midwives explanations to Sue about her health history will be conducted extensively. The midwife will make sure to include biographic data, information on her nutritional status, medical history, a family history, a gynaecology and obstetric history.

Thorough explanation will allay fears and encourage open and honest discussion. The interview should take place in a relaxed manner, avoiding an intervening desk. “The midwife needs to keep in mind to inform Sue about assessment findings throughout the examination” (The Eclampsia Trial Collaborative Group 1995 2561). Sharing this information with her may help her to comply with health care recommendations and encourage her to seek additional information about problems or questions that she has in the pregnancy.

Biographic Data

When obtaining this data from Sue assure her that the information will remain confidential. The midwife will discuss her age; cultural considerations, such as race and religion; marital status; occupation and education.

EDC (Estimated Date of Delivery)

Accurate estimation of EDC is crucial for managing the pregnancy, especially with regard to timing interventions and monitoring foetal growth. Sonography estimation of the EDD is mandatory when menses are irregular as in Sue's case due to PCOS, the LMP is unknown, or in women conceiving while taking oral contraceptive pills. Sonography estimation of EDC is also useful when there is a history of irregular menstrual cycles or when the uterine size estimated on physical examination differs from that predicted by menstrual dating. “Some causes of discrepancy between the actual uterine size and that expected by LMP include uterine fibroid, uterine malposition (e.g. extroverted uterus) and multiple gestations” (Faulding 2001 321).

Social History

It is important to assess the response of the whole family to the pregnancy and to aim to improve health and reduce health inequalities, in her ...