Case scenario 1:
A 30-year-old woman has just delivered her third baby. The labour had been a long one but she has had a normal vaginal delivery. You are called by the midwife to attend to the patient who has collapsed in labour ward.
Outline the steps you would take in the immediate management for this woman.
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Discuss the possible causes for this mother’s collapse. (For each cause describe the main clinical features and justify the steps you will take to determine the cause of her collapse)
You find that she is bleeding vaginally. Looking around the room, you estimate the blood loss to be approximately 1 litre.
Discuss four (4) possible aetiology for her vaginal bleeding. For each cause define the typical examination findings and the intervention required to manage each cause. (your answer should include all the drugs, the clinical procedures & surgical procedures – if the initial measures were unable to control the vaginal bleeding)
You managed to control her vaginal bleeding. She has received 8 units of PRBC.
Justify the additional blood products you would transfuse.
Recommend strategies to prevent post-partum haemorrhage
Discuss the long-term complications for this patient.
Case scenario 2:
You are the medical officer working in a health centre. A woman who was on her way to the divisional hospital has just delivered in your health centre. She has a retained placenta. Discuss the principles of managing a retained placenta in this setting.
Case scenario 3: You are seeing a woman in the postnatal ward, she delivered yesterday.
Discuss how you would elicit points in the history which would be important for the following:
What you will ask her about breast feeding?
What would you ask her to ascertain or determine whether she has any perineal complications?
If her temperature is raised: What history would suggest a likely cause of infection?
What history may suggest postnatal depression?
What history would suggest puerperal psychosis?
What will you ask her about her contraceptive needs?
Should you ask her about screening for cervical cancer?
What advice would you give her about resumption of coitus?
Case scenario 4:
You see a 23-year-old in post-natal ward who has been diagnosed with lactational mastitis. Her breasts are engorged, painful, red and warm to touch.
Explain the pathogenesis of lactational mastitis.
Develop a management plan for this patient’s condition.
Recommend three (3) strategies to minimize the recurrence of lactational mastitis.
Family Planning: Compare and contrast the two (2) LARC form of family planning. For the following scenarios, determine the best family planning option for the patient. Your response should be justified. You may need to elaborate on the efficacy, effects, procedure & follow-up.
A 20-year-old university student who requests contraception, says she has dysmenorrhea and heavy menstrual loss on the first day of her menses. She has a regular monthly cycle and enjoys good general health.
A 23-year-old unmarried, unemployed woman from a squatter settlement has just given birth after an unplanned pregnancy. She plans to breast feed. A 30-year-old school teacher who has two (2) children, has just stopped breast feeding and was on a low dose progestogen only preparation. She is in good health and is undecided on a tubal ligation. She thinks she has completed her family.
A 38-year-old G5P5, had a normal delivery 24 hours ago. She is stable but having some trouble breastfeeding. She would like to breastfeed for as long as she can. She is undecided about which family planning method to use.
A 28-year-old woman has a 5-year-old child. She is not keen to have a pregnancy yet. She stopped the implant due to hormonal effects. A couple come to see you, they would like to consider vasectomy for the male partner. His wife is a known cardiac case who was admitted in ICU for pulmonary oedema.