Women's health · A-E assessment

Constant pain in labour

Hard

15 min station · 2 min reading · Curtin Year 5

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S S R X

2 min reading · 15 min station · reminders at 2 min

Instructions

You are an intern on the birth suite at Geraldton Regional Hospital. At 3 am the midwife asks you to see Tahnee Ryder, 32, who is in a trial of labour after a caesarean (second baby, 40+3 weeks). She has new, severe abdominal pain and the baby's heart rate has dropped. Her mother and aunty are with her.

  1. Perform an A to E assessment and treat as you go

  2. Outline to the examiner:

    • Your findings
    • Your most likely diagnosis and differentials
    • Next steps in management, including relevant investigations
  • A midwife will carry out your instructions
  • You do not need to take a full history
  • The obstetrician and anaesthetist are on call from home, 10 minutes away

Observations at 3 am

HR 128, BP 86/50, RR 24, SpO2 97% on air, T 36.6, alert; baby's heart rate 70 for the last 5 minutes

Labour record

Epidural at 11 pm, topped up at 2.40 am. At 2 am: cervix 7 cm, head at station 0, clear fluid. Booking weight 74 kg

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Investigations

Examination

After treatment