develop an understanding of the principles of accurate antenatal assessment and triage, examine the complexity of caring for women experiencing complex issues and preterm delivery, and examine the needs and management of complex neonates admitted to the neonatal intensive care unit (NICU).

Assessment Details

 

1.1.1          Critical Analysis of a Case Scenario. Students will be presented with a case scenario relating to complex childbirth.

 

 

Weight: 50%
Type of Collaboration: Individual
Due: Week 10, Wednesday 23rd September 2020 by 2400 hours
Submission: Refer to Section 2.5 of the LG -General Submission Requirements
Format: Essay
Length: 2,500 words
Curriculum Mode:  

 

Aim of assessment

This assessment enables you to explore the issues of a complex pregnancy case. You will develop an understanding of the principles of accurate antenatal assessment and triage, examine the complexity of caring for women experiencing complex issues and preterm delivery, and examine the needs and management of complex neonates admitted to the neonatal intensive care unit (NICU). Consideration and a description of the required postnatal care of the mother in this complex situation will also be explored.

Complex Case Details: Alison, Adam and Asher Background

Alison is a 37 y.o G5P1 (stillborn). Alison is married to Adam, and they are wheat farmers on a remote property west of Gilgandra. The drought for the last 5 years has been difficult and Alison has no real support except for Adam and their closest neighbours who have a young family and live 50km away, and Adam’s family who live on the adjoining property 100km away. In 2017 Alison birthed a stillborn baby boy, Archie at 34 weeks gestation. Alison was diagnosed and treated for pre-eclampsia and antiphospholipid (APS) syndrome during that pregnancy. The post mortem investigations did not reveal the true cause of Archie’s death though he was noted to be growth restricted and had evidence of a small, infarcted placenta. After Archie’s birth Alison had postnatal depression and has since struggled with her mental health. Following the death of her mother last year, Alison now has clinically diagnosed anxiety and panic attacks and is taking prescribed low dose fluoxetine. Alison and Adam both feel that she really just has to now get on with everything, and try and stay focused on this pregnancy.

 

Medical and current obstetric history

Alison is usually physically well but has a history of urinary tract infections since her early 20s. She had a BMI of 18.0kg/m² at booking-in and Alison also smokes 10-15 cigarettes a day and has been unable to quit this pregnancy. Alison had a spontaneous conception of this pregnancy and was commenced on low dose Aspirin and Fragmin due to her previous history of 3 miscarriages between 8-10 weeks gestation and the presence of elevated APS antibody titres in her first antenatal pregnancy screen in this pregnancy. In view of her complex obstetric and medical history Alison was then referred to the maternal-fetal medicine team at Northview, your tertiary hospital, for review and case management after her baby was diagnosed with a Tetralogy of Fallot at her 18 week anatomical scan in Dubbo Base Hospital. An amniocentesis and paediatric cardiology review were then attended a week later at Northview and this baby has a normal karyotype. Plans were made for Alison to return to Sydney around 36 weeks to be near the Children’s Hospital for ongoing pregnancy management and the birth of her baby. Alison and Adam were linked to the Northview maternity social worker during that 18 week visit. The medical team at Dubbo are also monitoring Alison for any signs of pre-eclampsia and APS changes during this pregnancy.

 

Recent events

Alison has been in Dubbo Base Hospital for observation since 31+3 weeks due to an episode of threatened premature labour. Swabs and blood tests at that time were negative for infection and Alison was given a course of prophylactic IV antibiotics and IMI steroids. Whilst at Dubbo Base Hospital Alison was seen by her psychologist and the hospital’s social worker after midwifery staff reported concerns that Alison is not sleeping, has ruminative worry and they also have concerns for her mental health when she returns to Gilgandra after this baby is born. Alison also stated she is feeling really overwhelmed with everything and does not want to go to Sydney to have the baby especially now in these Covid-19 times.

At 32 weeks at 1000hrs Alison reported a frontal headache and some irregular uterine contractions, a CTG was satisfactory and her B.P was 150/90mmHg. On a speculum examination Alison’s cervix was a multi os, a fetal fibronectin test was positive, she was re-commenced on oral nifedipine, given oral labetalol and a decision was made to transfer Alison to Northview. Alison was transferred via air ambulance and arrived at midnight, she was alone on transfer and visibly upset on arrival. After spending the night in the birth unit and being treated for an episode of threatened preterm labour and evolving pre-eclampsia, she was transferred to the antenatal ward where she remained for the next 4 days. Tocolytic and anti-hypertensive medications were continued. Follow-up social work and psychology review was also attended.

Birth details

At 32+4 weeks, Alison went in to spontaneous premature labour in the morning, her membranes ruptured, pink liquor was noted, and she was transferred back to the birth unit. Four hours later Alison had a normal vaginal birth of her baby girl Asher, who was born with Apgar scores of 2, 4 and 5. Asher was given active resuscitation and transferred to Northview’s NICU for immediate care and management before being transferred to the Children’s Hospital two hours after birth. Adam arrived in time to accompany Asher to the Children’s Hospital with the NICU team. Alison was transferred to the postnatal ward, and after a further satisfactory postnatal check and normal observations, she visited Asher at the Children’s Hospital later that afternoon.

 

  • From this case study identify four risk factors from Alison’s history that increase the risk of adverse maternal and fetal perinatal outcomes and describe how two of these risk factors may impact maternal and fetal perinatal health.
  • Using current evidence, analyse and discuss with rationales, the care and management that is required for ANY

premature neonate who requires active resuscitation and during the first 48 hours in the NICU.

  • Explain the specific and holistic postnatal cares and management that would be required for Alison following delivery, during her postnatal recovery and for her discharge

 

Resources:

 

There are a number of textbooks and resources available through the Library that may assist you. Please refer to the unit’s site for specific unit resources

 

Marking Criteria:

 

 

Conceptual Skills

 

Criteria Well above

expectations

Exceeds expectations Meets expectations Satisfactory but

needs improvement

Does not meet

expectations

Identifies four risk Four risk factors are Clear identification of Four risk factors for Four risk factors for Four risk factors for
factors from the case clearly identified and four risk factors for adverse perinatal adverse perinatal adverse perinatal
study and describes a comprehensive adverse perinatal outcomes are outcomes are outcomes may not be
how two of these risk description of two of outcomes are identified and a good provided, however identified and/or
factors may these are discussed. provided, and overall description of the two there is a more partial there is lack of
contribute to adverse How the two risk very good risk factors is explanation of the relevant explanation
perinatal outcomes. factors impact on commentary of the provided. Basic two identified risk of two of the risk
Demonstrates clear perinatal health is two risk factors is commentary is factors. Limited factors provided.
understanding of how clearly stated, and the described. provided about how commentary Identification and
the two identified writer demonstrates a Knowledgeable the two risk factors regarding how the investigation of how
factors impact upon clear understanding commentary is given impact upon two risk factors the identified risk
perinatal health. of these. about how the risk factors impact upon perinatal health. perinatal health. impact upon perinatal health. factors impact perinatal health is not discussed or not

covered in sufficient

          detail.
Subtotal (10) 8.5 – 10 7.5 – 8.0 6.5 – 7.0 5 – 6 <4.5
Allocated Mark          
Using current Critical analysis from Critical analysis from Critical analysis Critical analysis Critical analysis
evidence critically numerous and the relevant sources reflects a sound reflects a more basic reflects a partial
analyses, with most relevant sources reflects a detailed review of the current review of the current review or lack of
rationales, the care reflects a review of the current practices and practices and research of the
and management comprehensive and care practices and considerations considerations current practices and
that is required for contemporary review considerations of surrounding active surrounding active considerations of
ANY premature of current nursery active resuscitation resuscitation and resuscitation and active resuscitation
neonate who requires care practices and management and care management of a management of a management and care
active resuscitation management for any premature premature neonate up premature neonate up for a premature
up to the first 48 considerations of any neonate up to the to the first 48 hours to the first 48 hours neonate in in the first
hours in the NICU. premature neonate

who requires active

first 48 hours in the

NICU. Very good

in the NICU. The

text provides a more

in the NICU. The

text reflects a more

48 hours in the

NICU. Limited or no

  resuscitation up to explanations and general discussion limited discussion and discussion about the
  the first 48 hours in understanding of the and good demonstrates a basic required cares and
  the NICU. required cares is understanding of the understanding of the management and/or
  Demonstrates excellent discussion

and understanding of

provided. required cares and management. required cares and management. poor understanding is demonstrated.
  the required cares.        
Subtotal (15) 13 – 15 11.5 – 12.5 10 – 11 7.5 – 9.5 <7.0
Allocated Mark          
Provides holistic Critical analysis of Critical analysis of Critical analysis Critical analysis The critical analysis
analysis and specific postnatal care specific postnatal reflects a sound reflects a more basic did not provide
discussion of the and the management care and management review of specific review of the enough relevant
specific postnatal that Alison requires is for Alison is provided, postnatal care and postnatal care and discussion about
care and management explored and clearly and reflects a detailed management for management for postnatal care and/or
that Alison would articulated. review about cares for Alison. Some good Alison. Limited management for
require. Demonstrates very

good insight and

her at this time.

Some good insight

discussion, but

limited insight

discussion and insight

about any other

Alison. Holistic

midwifery

  further discussion and discussion regarding any other midwifery considerations were
  about other midwifery

considerations that

regarding other midwifery

considerations is also

midwifery considerations. considerations. not discussed.
  may assist Alison. covered.      
Subtotal (10) 8.5 – 10 7.5 – 8.0 6.5 – 7.0 5 – 6 <4.5
Allocated Mark          

 

Communication Skills: Structure and Style

 

Criteria Well above

expectations

Exceeds expectations Meets expectations Satisfactory but

needs improvement

Does not meet

expectations

Constructs an The introduction The introduction The introduction There is a distinct The essay does not
appropriate orientates the reader orientates the reader states your position, introduction, but it include a distinct
introduction. to the topic, states

your thesis position

to the topic, states

your thesis position

but may not also

orientate the reader

only orientates the

reader to the topic

introduction, or

includes one that

  clearly and concisely, clearly and outlines the topic or outline and/or outlines the does not align with
  defines the scope of the stages of the the stages of the stages of the essay: it the essay body and
  the discussion and outlines the stages of

the essay.

essay. essay. does not state your thesis position. conclusion, or that is otherwise

inappropriate.

 

Criteria Well above

expectations

Exceeds expectations Meets expectations Satisfactory but

needs improvement

Does not meet

expectations

Organises the essay body into a cohesive and logically sequenced series of paragraphs. The paragraphs are all well constructed and effectively linked; sequence of discussion matches introduction. The paragraphs are all well constructed and in most cases effectively linked; sequence of discussion matches introduction. The paragraphs are in most cases well constructed and in most cases effectively linked; sequence of discussion matches introduction. The paragraphs are in most cases well constructed but there are few effective links between paragraphs, or sequence of discussion does not match introduction. The essay contains many poorly constructed paragraphs and there are few effective links between paragraphs; sequence of discussion may not

match introduction.

Constructs an appropriate conclusion. The conclusion summarises key points from the essay body, restates the thesis position accurately and clearly, and makes an insightful final

comment.

The conclusion summarises key points from the essay body, restates the thesis position accurately and clearly and makes a final comment. The conclusion restates the thesis position accurately, but does not also summarise key points from the essay body and/or make a final comment. A distinct conclusion is stated, but it only summarises key points from the essay body and/or makes a final comment: it does not restate the thesis position. A distinct conclusion is not included, or includes one that does not follow from the essay body, or that is otherwise inappropriate.
Writes in a clear and Your writing is clear, Your writing is clear, Your writing is clear Your writing is Your writing is
succinct academic succinct and succinct and and succinct but you generally clear but verbose, convoluted
style. consistently formal

and objective in style;

consistently formal

and objective in style;

may sometimes revert

to an informal or

may not be succinct,

and/or you frequently

or otherwise difficult

to read, or you write

  you routinely use you often use relevant subjective style; you write in an informal primarily in an
  relevant technical technical language sometimes use or subjective style; informal or subjective
  language effectively effectively and qualify relevant technical you sometimes use style making little or
  and qualify all assertions. many assertions. language effectively and qualify some assertions. relevant technical language effectively and qualify some assertions. no effective use of relevant technical language and/or frequently making

unqualified assertions.

Subtotal (10) 8.5 – 10 7.5 – 8.0 6.5 – 7.0 5 – 6 <4.5
Allocated Mark          

 

Technical skills: Language and referencing

 

Criteria Well above

expectations

Exceeds expectations Meets expectations Satisfactory but

needs improvement

Does not meet

expectations

Uses correct grammar, spelling and punctuation. Your essay contains no errors in grammar, spelling and punctuation. Your essay contains one or two minor errors in grammar, spelling and/or punctuation, but these do not interfere with meaning. You have eliminated most errors in grammar, spelling and/or punctuation and the remaining errors do not interfere with meaning. You have eliminated most errors in grammar, spelling and/or punctuation; however some of the remaining errors interfere with

meaning.

Your essay contains many errors in grammar, spelling and/or punctuation that frequently interfere with meaning.
Correctly applies conventions of in-text citation for APA referencing style. You apply all conventions of APA correctly, use direct quotation sparingly and always paraphrase effectively. You apply all conventions of APA correctly, use direct quotation sparingly and paraphrase effectively in most cases. You apply most conventions of APA correctly; you use direct quotation sparingly but may paraphrase inconsistently. You do not use APA or you do not apply some conventions correctly; you rely too much on direct quotation and/or paraphrase

inconsistently.

You do not follow any conventions of APA correctly; you may rely too much on direct quotation and/or paraphrase poorly.
Includes a complete reference list correctly formatted according to APA referencing style. You use the correct bibliographical format for all sources and sequence them alphabetically. You use the correct bibliographical format for all but one or two sources and sequence them alphabetically. You use the correct bibliographical format for most sources and sequence them alphabetically. Your reference list is not formatted in APA or you do not use the correct bibliographical format for some sources; you may not sequence your sources

alphabetically.

Your essay has no reference list.
Subtotal (5) 4.5 – 5 4 3.5 2 – 2.5 <2
Allocated Mark          

 

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