High Risk Pregnancy

Casebank History
1

Background

Who you are:
FY2 in antenatal clinic (O&G)

Who the patient is:
30 year old female referred by the GP. She is rubella non-immune and rhesus D negative. USS 12 weeks normal done by GP.

What you must do:
Talk to patient, take focused history and provide management

Telephonic

Data gathering

Lifestyle

  • Uses recreational drugs (heroin)
  • Lives in a social service house
  • Drinks alcohol
  • Smokes cannabis
  • She has multiple partners and not sure who is the father

Patient concerns

  • Are you going to do any tests?

Management

  • This is high risk pregnancy
  • New USS not required as has been done by GP
  • Advice to stop using restricted drugs
  • Advise the risk of Rubella infection in pregnancy, therefore avoid contact with young children having infection (rubella).
  • Explain the risk of fetal (baby) abnormality is high if you get infection before 16 weeks
  • Rubella vaccination can be taken during pregnancy, can be taken after delivery.
  • She has type of blood group called Rhesus D negative, if the baby has Rhesus D positive blood it may cause “Rhesus conflict”.
  • This is when the mother’s blood form antibodies that will fight the blood cells of the baby
  • This can cause poor growth of the baby during pregnancy
  • Explain she needs anti - D in 3rd trimester or if you develop any bleeding
  • Explain she will need additional antenatal to follow up
2

Rubella O- Blood

Station Details:

  • You are FY2 in antenatal care clinic.
  • Kelly, 30 years old.
  • She is 14 weeks pregnant and has come to the hospital for her results.
  • She came to the antenatal clinic when she was 12 weeks pregnant for a routine antenatal check-up.
  • Results:
    • Rubella = non-immune.
    • RH = -ve or OR, rhesus antibodies were negative.
    • Blood.
    • Urine = normal.
  • Task:
    • Talk to her, address her concerns and tell her the results.

Examination and Investigations: Check vitals.

Approach:

  • Greet, introduce yourself and confirm identity.
  • Ask pregnancy history.
  • Any bleeding, spotting or discharge from your front passage?
  • PMH + Recent health.
  • MAFTOSA.
  • DESA.
  • Sexual history.
  • Tell her the good news is that her blood tests are normal. However, her blood group is O negative, which means that we have to be a bit careful if the baby is O positive.
  • Explain to her that the blood test showed that she is not immune to rubella.
  • This means that she may have missed out on her MMR vaccination and she could spread rubella.
  • MMR vaccine cannot be given during pregnancy.
  • She should ask for the vaccine when she goes for her 6-week postnatal check after the birth. This will protect her in any future pregnancies.
  • Injection of immunoglobulin in the 3rd trimester of pregnancy.
  • Follow up.
  • Safety netting.