TEALE FENNING

Nick Raine-Fenning

I have been thinking about this question for some time now.

"You are asked to consider the case of a pregnant woman who was found dead at home by her partner. What questions would you ask and what tests would you like to see?

That will keep you busy Wink

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"Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 915

hi, this is a cruel question Shocked

,

i have tried to bubble on it.

this is a high risk obstetrics question asking about logical approach to the cause of death

Intro
-Mat mortality - serious, affects family with life long consequences, most cases avoidable with good antenatal care but not all.
this is a case of sudden unexplained maternal death.
-could be due to obstetric causes - ecclampsia / Massive PE / Haemorrhage / amniotic fluid embolism
- or non obstetric causes - DM - hypoglycaemia or ketoacidosis / cardiac arrest , failure, arrythmia / cerebrovascular accident / asthama / suicide / domestic violence

history
- from partner / hand held notes / hospital records / GP files
- age , extremes of age, more medical problems, HT / Cardiac / CVA etc
- parity, higher the parity more the placental problems / haemorrhage / twins/ amniotic fluid embolism
- gestation - twins / polyhydramnios - amniotic fluid embolism
- antenatal care - if regular / high risk or low risk / if any DNAs
- recent symptoms / hospital admissions; SROM - infections
- any social problems/ depression etc noted by MW - domestic violence
- psychiatric illness - overdose of medication / suicide
- Previous obst history/ uterine surgery -- rupture of scar
- smoking / alcohol / recreational drug abuse/ high risk behaviour - abruption / infections /
- medical history - DM/cardiac disease/ HT/ previous DVT,PE
- family history of anyone else sudden collapse/ death - congenital cardiac / berry aneurysms/ heart blocks

Investigations- definate cause from autopsy
- blood - Hb/Platletts/Liver enzymes - ecclapmpsia; clotting DVT/PE/DIC; liverfunctions -drug overdose/ hepatitis; amylase surgical cause; serum infection screen
- placenta gross/ histology / swabs - infection /abruption/ malfornation / membrane tears--amniotic fluid embolism??
- baby - malformations
Xray - signs of PE

Social
- bereavement counselling
- debriefing for family and staff after results available
- social support groups / mat mortality support group

Risk management
- Red flag form
- coroner
- CEMD
- guidelines/protocols
-

that's it. can't think of anything else. took 8 mins to come up with the plan.

raj

Nick Raine-Fenning · Posted: Thu Jul 20, 2006 9:40 pm Post subject:

That is an absolutely wonderful 8 minutes of bubbling Cool

Not sure how much came from your knowledge and how helpful you found the bubbling but you have really hit the key areas.

It is basically a version of the classic question that gets asked after each Confidential Enquiry ... "What have we learnt"

You seem to have got all of the key areas and did not miss important areas like depression, suicide, domestic violence.

Other big movers in the Confidential Enquiries include indirect deaths from cardiac disease and early pregnancy complications especially ectopics. You need to stress these but not under-estimate the big players of hypertension and thromboembolism.

I you missed ectopic (not too mention miscarriage and sepsis) you should have asked yourself the question "what don't we know?". The answer ... gestational age!!!

I'll have a think about other options but that's a great start.
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"Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997

Xerxes I · Posted: Sat Apr 05, 2008 7:29 am Post subject:

Yep, very tricky one.
I would have missed quite a few of these.

It looks like a Memberhip examination for the Royal college of Forensic Medicine question though!

I would go on about involving every breathing creature in the vicinity in this. Copying the notes. very sensitive interview with the partner. qiet room, no bleep, time etc. don't ask: where were u between 7-8 last night? where u having an affair? was the baby yours? be sensible.