| Scenario 1 | Scenario 2 | Scenario 3 |
---|---|---|---|
Clinical Picture | Postnatal mother with severe pre eclampsia at 30/40 gestation. Vaginal birth 90 min previously. Neonate transferred to neonatal unit | Postnatal mother who has recently had a primary PPH. On-going management in progress after the initial emergency treatment. Neonate with mother. | Woman 32/40 pregnant with comorbidities (type 2 diabetes and ventricular septal defect repaired in infancy). Raised BMI. Admitted with mild chest pain and low oxygen saturations (88–90%) in air. |
Intravenous magnesium sulphate / intravenous anti- hypertensives in progress | Blood transfusion in progress. | Continuous ECG in progress | |
Uncontrolled hypertension | CVP line in situ due to poor peripheral access | Requiring 4 L/min oxygen, via face mask to maintain oxygen saturations at 97% | |
Hyperreflexia, 4 beats of clonus | Hourly CVP readings requested to guide fluid replacement | Stable vital signs whilst patient has oxygen therapy in progress, (but at risk of deterioration) | |
Headache | Stable pulse and blood pressure. Lochia within normal limits. | Normal CTG, normal fetal movements. | |
Blood picture shows HELLP syndrome | Reduced urine output | Differential diagnosis of cardiac event or pulmonary embolism | |
Overall, presents with an unstable clinical picture in view of uncontrolled severe hypertension, blood picture and neurological examination findings. | Overall, relatively stable condition, but requiring CVP monitoring. | Currently stable with oxygen therapy in progress but potential for deterioration | |
Workload | Moderate. All women on the Delivery Suite are in labour – mainly low risk. | High. All but one of the Delivery Suite rooms are occupied however, anticipated that three women will be transferred home / to the post natal ward in the next hour. | Low to moderate. There are empty rooms, mainly low risk women in labour. |
Staffing | Correct number and grades of midwives on duty for the maternity unit in question | All band 6 midwives with one band 7 midwife coordinating. One band 6 midwife off sick. | All band 6 midwives (except one newly qualified midwife) on duty with one band 7 midwife coordinating. No staff off sick. |