Term
| Q: How do you introduce yourself to Mrs. X at 34 weeks gestation? |
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Definition
| A: "Good morning, I'm Dr [Name], a junior doctor here. I understand the midwife noted concerns about baby's position during your routine check-up. May I ask questions and examine you?" |
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Term
| Q: What 4 key questions assess pregnancy status? |
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Definition
A:
1. "How many weeks pregnant are you?" (Confirm 34w)
2. "Is this your first pregnancy?"
3. "Had any recent scans?"
4. "Has pregnancy been smooth?" |
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Term
| Q: List 6 red-flag symptoms to screen for. |
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Definition
A:
1. Vaginal bleeding/spotting
2. Persistent abdominal pain
3. Hand/ankle swelling
4. Blurred vision/headache/epigastric pain
5. Abnormal discharge/itching
6. Reduced fetal movements |
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Term
| Q: What 5 elements cover medical/psychosocial history? |
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Definition
A:
1. Past obstetric history
2. Medical problems (e.g., HTN, diabetes)
3. Current medications/allergies
4. Smoking/alcohol/drug use
5. Home support system |
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Term
| Q: How do you explore ICE (Ideas, Concerns, Expectations)? |
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Definition
A:
1. "Do you understand what might be happening with baby's position?"
2. "Is anything specifically worrying you?"
3. "What were you hoping to achieve today?" |
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Term
| Q: How do you introduce abdominal examination? |
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Definition
| A: "I'll gently feel your tummy, measure the bump, and listen to baby's heartbeat. It might be uncomfortable but not painful. Please empty your bladder first. May you lie flat with tummy exposed from below breasts to mid-thighs? A chaperone will be present. Do I have your consent?" |
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Term
| Q: List abdominal exam steps in order. |
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Definition
A:
1. Inspection (size, shape, scars)
2. Superficial palpation (temperature/tenderness)
3. Leopold's manoeuvres (fundal/lateral/pelvic grips)
4. Fundal height measurement (cm ≈ weeks ±2cm)
5. Fetal heart auscultation (110-160bpm) |
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Term
| Q: What palpation findings suggest breech? |
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Definition
A:
- Fundal grip: Hard ballotable head
- Pelvic grip: Soft irregular mass (buttocks)
- Lateral grip: Fetal back not in expected position |
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Term
| Q: How do you explain breech diagnosis at 34 weeks? |
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Definition
| A: "Your baby's head is pointing upwards instead of downwards - called breech presentation. At 34 weeks, this is common and many babies turn naturally, but we'll plan next steps." |
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Term
| Q: What is initial management at 34 weeks? |
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Definition
A:
1. Confirm with ultrasound
2. Reassess at 36w (first pregnancy) or 37w (previous births)
3. If persistent: Offer ECV at 37+ weeks
4. If ECV fails/declined: Plan cesarean section |
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Term
| Q: How do you explain ECV? |
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Definition
| A: "A senior doctor uses gentle pressure on your tummy to turn baby head-down under continuous monitoring. Success rate ~50%. Rare risks include temporary fetal heart changes or need for emergency delivery." |
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Term
| Q: What safety netting advice do you give? |
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Definition
A: Contact immediately if:
- Vaginal bleeding
- Painful contractions
- Blurred vision/swelling/headaches
- Reduced fetal movements
- Fluid leakage |
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Term
| Q: How does management differ at 36 weeks? |
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Definition
A:
- Confirm breech with ultrasound immediately
- Offer ECV from 36+0w (first baby) or 37+0w (previous births)
- If ECV unsuccessful: Recommend planned cesarean
- Vaginal breech delivery possible only with specialist team |
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Term
| Q: How do you address patient concerns? |
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Definition
A:
"Why breech?" → "Often no clear cause. Uterine shape or fibroids might contribute."
"Is it my fault?" → "Absolutely not. Nothing you did caused this."
"Will I need cesarean?" → "If ECV works, vaginal delivery is possible. If not, planned cesarean is safest." |
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Term
| Q: Summarize breech management by gestation. |
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Definition
A:
- <36w: Monitor only
- 36-36+6w: Confirm with US, discuss ECV
- 37+w: Offer ECV → if unsuccessful → caesarean |
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