TEALE FENNING

Abik · Posted: Wed Apr 25, 2007 9:00 pm Post subject: Labour ward board!

Excellent teaching at the circuits course - thanks Julien!

It's 8am and you are taking over....

P2 40/40 clear liq, no synt, no epid, pushing for 90 mins.

P0 38/40 intact, no synt, epid, 3cm at 11pm and 3am

P0 42/40 mec liq, synt, epid, IOL. 8cm variable decelerations CTG

P0 18/40 - - - abdominal pain

P3 33/40 - 3 prev C.S. scar tenderness, PVB, tightening

HDU - P3 32/40 D&V - day 2. tightenings hourly U.O. iv abx

P0 39/40 clear liq, no synt, no epid, 3cm at 4am ?pushy. IUGR

P0 41/40 clear liq, synt, no epid ARM 3am, 3x prostin. synt from 4am

Some from my LW last night!!
Gradings?

cpeedahsa · Century Club Joined: 21 Apr 2007 Posts: 921

Gradings-
1)P3 33/40 - 3 prev C.S. scar tenderness, PVB, tightening
2)P0 42/40 mec liq, synt, epid, IOL. 8cm variable decelerations CTG
3)P2 40/40 clear liq, no synt, no epid, pushing for 90 mins.
4)P0 39/40 clear liq, no synt, no epid, 3cm at 4am ?pushy. IUGR
5)P0 38/40 intact, no synt, epid, 3cm at 11pm and 3am
6)HDU - P3 32/40 D&V - day 2. tightenings hourly U.O. iv abx
7)P0 18/40 - - - abdominal pain

wolverine · Century Club Joined: 16 Jan 2007 Posts: 394

That's like a walk in the park Abi! Come to Portsmouth to get some excitment! (only joking!)
Right! Do you mind if I take them in order and describe the tasks that need to be done in each room and then I will prioritize?
R1. She should have delivered by now. Ask midwife and review soon if delivery is not imminent.
R2. ARM to be done by M/W whenever possible
R3. Review CTG, possibly repeat V/E (when was that done? could she be fully now?) consider FBS/delivery depending on findings
R4. SHO to see (and prescribe antibiotics...)
R5. (is this Shaheen's lady?!) We need more infos. Is the placenta anterior low and is she a Jehovah's witness? (please say no!), is she bleeding heavily? how's the CTG? When did she have intercourse last time? Smear Hx? Rhesus +ve? (only joking!) etc..
HDU. We need more infos as well. What's wrong with her? Why is she in HDU and hourly UO? What's her bloods like? U+E's? LFTs? WCC? Plts? MSU? Stool culture? Speculums? HVSs?
R6 To be reassesed by M/W and ask if the CTG is fine (when always the answer is yes but there you go!)
R7 To be examined at some point (personally I'd examine 4 hours after proper contractions)

Therefore, summarising:
Reds: Not many. Potential reds are Room 1, 3 and 5 which I would like to see first. SHO to put a venflon in R5.
Amber: All the above if not red plus the HDU lady and then COFFEE!!!

Abik · Posted: Thu Apr 26, 2007 12:32 pm Post subject:

Not bad!

I actually only had two of these so did have coffee first!!!

Where are your greens?

R1 - amber, don't need to go in in 10mins ?imminent delivery ?FH
R2 - green. Won't make any difference if I don't see her in the first hour - technically she's not really in labour, what are they playing at getting her an epidural!!
R3 - Red. is baby about to drop off it's perch?
R4 - green/amber. I am going to make very little difference to this out come either way. Send SHO in later to assess.
R5 - Red ?abruption ?scar dehiscence ?CTG. needs iv
HDU - green. she's been here 2 days and can wait for an hour. want to know obs and CTG are stable.
R6 - Green. MW to assess and make sure paeds avail. CTG OK?
R7 - Green. Could wait an hour for assesment as long as CTG OK.

Abik · Posted: Sun Apr 29, 2007 10:59 am Post subject:

Nick help!

Wolverine and I were rapidly deteriorating into fisticuffs yesterday over a labour ward board!!
He was making every second person red saying that he would need some more vital information in the first ten mins and therefore would be red!
(sorry wolf-man!)

eg. Para 2 42/40 IOL for GDM, big baby, prostin - ARM 3cm, 6 hours to 7cm then synto, further 4 hours to 9cm now 2 hours later.

worries - shoulders! CPD, uterine rupture.
Needs reassment now and if not fully, low PP and looking reassuring needs LSCS. But in 10 mins???

The answers agreed urgent LSCS and first priority!

So my question - if we want a quick answer (is she fully) but a midwife can do, is it still red? I know this is picky but I wasn't that worried about her!!!!! Confused

wolverine · Century Club Joined: 16 Jan 2007 Posts: 394

She is para 2, with a possibly big baby, induction, very slow progress even on synto, 9 cms 2 hours ago still pregnant. I wouldn't let the midwife to assess her I think! And I would like to assess her soon although there is no immediate risk for maternal or fetal death

bronwyn · Posted: Sun Apr 29, 2007 10:06 pm Post subject:

I would agree needs delivery pretty soon (possibly 2 weeks ago at term Very Happy

), but in terms of prioritising I would make her amber and agree with ED that I would like to do it myself.
Can't blame the poor man for making everything red....it's the Pompey influence!
B
_________________
Bronwyn Bell
SpR
Portsmouth

wolverine · Century Club Joined: 16 Jan 2007 Posts: 394

Nick Raine-Fenning · Posted: Mon Apr 30, 2007 7:49 am Post subject:

wolverine · Century Club Joined: 16 Jan 2007 Posts: 394

And it aleays depends on the rest of the board! When there is no catastrophe going on (somebody fitting or bleeding like a tap or a bradycardia for 9 minutes) they are all amber then! The thing with this woman is that she is multip, 6 hours on synto with a massive baby and she is due for another V/E NOW! Would you let her M/W or SHO to do it? I would definetely go myself at least in the room and if I can see the head I would stay untill the shoulders come out, If I can't see the head I'll proceed with the V/E myself, stop the synto, prepare her for C/S (theatres, anaest., consultant) Done! 2 minutes.

Abik · Posted: Mon Apr 30, 2007 10:20 am Post subject:

2 minutes!!

You obviously don't bother with gloves! or consent!! Laughing

Nick (or Julien or Geeta) - the royal free material says to the examiners to mark down if the candidate wants to go room by room rather than start with the first priority. What are your thoughts?