A third para with three normal deliveries is admitted with reduced fetal movements for 3 days at a POA of 35 weeks. Her antenatal period has been uncomplicated, and she has attended clinics regularly. The other children are healthy. Midwife has listened to the fetal heart sounds and as she did not hear she has asked you to do a scan. You have confirmed an IUD . You have called the couple to your room to break the news.
Role player
You are A thirdpara with three normal deliveries you have had reduced fetal movements for 3 days at a POA of 35 weeks. Your antenatal period has been uncomplicated, and you have attended clinics regularly. The other children are healthy. Midwife has listened to your baby’s heart and summoned a doctor. The doctor has performed a scan on you and he called you and your husband to his room.
Role player’s question
Doctor is there a problem with my scan?
Candidate’s answer
Candidate should develop a rapport.
Confirm the identity.
You had reduced fetal movements for 3 days. Midwife did not hear your baby’s heart beat and she asked me to do a scan. I am really sorry to say that your baby has died because I did not see the baby’s heart beat in the scan which I performed a few minutes ago.
Role player’s question
Doctor are you telling that my baby has died. It is your fault. I carried out all your instructions. It is the fault of the hospital and the medical team.
Role player should cry and be angry at the same time
Candidate’s answer
Allow the woman time to realize the diagnosis and express her feelings. It will help the couple to express their feelings of anger, guilt, blame, fear, anxiety, sorrow, grief, and failure.
I can see that you are sad and angry. I will also react in the same way if I faced a similar situation.
Role player’s question
Doctor can you tell me how my baby died?
I attended clinics regularly and performed all the tests and they were normal .
Candidate’s answer
Ask for the antenatal records. If the antenatal records are not available the candidate should inquire from the patient regarding BP, blood group, OGTT test, previous scans, bleeding, dribbling exposure to toxins and any other abnormalities. If the answers are negative the candidate should tell her that a cause is not obvious but there is always the possibility of cord complications.. We will perform a few investigations. We can examine the placenta, cord and the baby after birth. It will be very helpful if we can do a postmortem examination.
Role player’s question
Doctor you told me my baby is normal after performing an USS at 20 weeks.
Candidate’s answer
USS will show only major structural abnormalities but there can be small but serious problems which are not seen in the US. We do not routinely test for infections or genetic abnormalities which can also cause death in rare cases.
Role player’s question
Are you going to take out my baby immediately?
Candidate’s answer
We have two options
As you have no other problems It is better to wait for about 48 hours because you may go into labour. We will do a blood test as rarely you can get problems with blood failing to clot. We will induce you in about 2-3 days as the baby’s appearance can change and the PM can be difficult if we wait for too long.
Also we can induce labour immediately and deliver the baby if you feel anxious to wait.
You can choose either option
Role player’s question
Pl explain how you will take out my baby. Will it be painful?
Candidate’s answer
We will insert a tablet. Your husband can be with you. You will be in a separate cubicle. We will keep you free from pain. epidural would be the best option. There are injections and inhalation methods also but these are less effective. You can meet the anaesthetist if you wish.
Role player’s question
Can I see my baby.
Candidate’s answer
You can see, handle, take photographs and mementos. We can even arrange for religious rites.
Role player’s question
If you do a PM will you remove parts from my baby?
Candidate’s answer
There are Several types of postmortems- inspection only, Xray/MRI postmortems, obtaining scrapings from the mouth and the skin for genetic studies or a full postmortem where we cut open the baby and look at all the organs and remove small pieces of tissue for further studies. The latter will give the most information. It will be useful as we can do chromosomal tests since you are 35 years of age
We will only remove tiny parts and the appearance will be restored.
Role player’s question
Will my breasts be painful?
Candidate’s answer
May be painful for a short time but we will give you a drug to stop your milk you can take it twice a week for two weeks. It has no side effects and will not prevent lactation in the next pregnancy. You should wear a tight bra. Consult your doctor if the pain increases or if your breasts feel hard
Role player’s question
Will it recur?
Candidate’s answer
We cannot give a definite answer till we know the cause. Even if we do not find a cause there is a chance of recurrence . you will need very careful specialist follow up next time it is better to try to conceive after you mentally settle in 6 months since you are 35 years
Am I clear? Do you have any more questions ? Do you want me to repeat anything?
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