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RunningHead:PESI:HIGHRISKOBSTETRICSREFLECTIONPAPER

PESI:HighRiskObstetricsReflectionPaper
JodieKoide
KapiolaniCommunityCollege
October7,2016

PESI: HIGH RISK OBSTETRICS REFLECTION PAPER

PESI:HighRiskObstetricsReflectionPaper
ThePESI:HighriskobstetricsseminarwasheldonMondaySeptember26,2016atthe
HyattRegencyBallrooms.ItwasawonderfulopportunitytolistentotheexpertiseofJamie
Otremba,CNM,RN,MSNwhichalsosupplementedthematernitylecturetopicsheadinginto
myfinalexam.ThethreeSLOsIfocusedonwere#2Reflectonnursingpracticeinmanaging
careforgroupsofpatients,#3Seekinformationtodevelopplansofnursingcarethatare
familycentered,ageandculturallyappropriateusingevidencedbasedclinicalguidelines,and
#5Practiceasamemberofamultidisciplinaryhealthcareteam.AllthreeSLOswere
discussedthroughouttheentirepresentation,andthefollowingisamoredetaileddescriptionof
thespecificexamplesthatsupporteachSLO.
SLO#2wasreflectedinthediscussiononpreeclampsiaandhypertensioninpregnancy,I
wasparticularlyintriguedbytheinformationbeingpresentedonseverefeatureswhichare
categoriesthatdeterminewhethertodeliverpremature(insteadofcarryingthepregnancyto
term).TheevidencethatJamiepresenteddemonstratedthatdeliveryisthedefinitivetreatment
becauseitisalwaysbestformom,andareasontoprolongthepregnancyistoallowforfetal
maturation.OtherevidencethatJamiepresentedwasineffectivetreatmenttopreeclampsia
prevention,antihypertensivesdonotpreventtheprogressionofpreeclampsia,ratherlowdose
aspirinhasahigherefficacybecauseofitsantiinflammatoryandminimalantiplatelet
properties.AnothertopicthatdemonstratedSLO#2wasthrombophiliatesting.Jamie
discussedtheimportanceofreevaluatingpostpartumriskfactorsbecausetheycanchange
duringdeliveryandincreasethepatientsriskforclottingpostpartum.Furthermore,new

PESI:HIGHRISKOBSTETRICSREFLECTIONPAPER

evidencebasedresearchshowsthathyperhomocysteinemiaisnolongerconsideredanincreasing
factorforclotting,butratheranormalvariant.
SLO#3wasreflectedinthediscussiononecclampsiaandpostpartumpreeclampsia.In
thediscussiononecclampsia,IappreciatedhearingJamiestatethatsafetyisthenumberone
priorityandlistedfirstonthepowerpointslidewastostabilizemother.Otherindicationsof
providingfamilycenteredcareincludeddeliverafterstabilization,andtoconsiderthedelivery
route(whereonly20%delivervaginallyineclampsia).Thisdemonstratesfamilycenteredcare,
whileaddressingtherisksinvolvedtobothmotherandbaby.InthetopicofPPpreeclampsia,
JamiepresentednewevidencethatdexamethasonehasnobenefitinthetreatementofPP
preeclampsiabecausetheinitialrationalewastobenefitplateletproduction,howeverthe
productiontakestoolongandisnotafirstlinetreatment.AnotherkeypointthatJamie
mentionedrelatedtotesting,wastoweighthebenefitsandriskoftestingandperformthetests
thatwarrantresultsbecausetheideaoftestingoftenincreasesanxietyforthepatient.I
appreciatedthisstatementbecausesooftenavarietyoftestingisdonetoruleoutdiagnoses,
howeveritwasagoodreminderofprovidingpatientcenteredcareanddoingwhatisessential
fortreatment.
SLO#5wasdemonstratedinthediscussiononmanagementofshoulderdystocia.Oneof
thethingsIappreciatedJamiesayingwasthateveryoneneeds/shouldbe/isonthesamepage.
Inthisspecificexampleofteamcollaboration,callingforconsultants/supportisessentialinthe
managementoftheproblem.Jamiementionedthatatherfacility,theywouldpracticeanddrill
eachothersothateveryonewasfamiliarwiththeroutineandtoperformtheirfunctions
effectively.Jamiealsodiscussedtheimportanceofdocumentationasitrelatesto

PESI: HIGH RISK OBSTETRICS REFLECTION PAPER

communicationtotheteamandtothepatient.Iwasappreciativeofthedocumentationlistshe
providedtoguidewhattypeofhistorytoobtain,riskfactors,delivery,etc.Afteratraumalike
shoulderdystociaJamiealsoaddressedtheimportanceoffollowingupwiththefamilytodiscuss
whathappened.ShecallsittheIcarethisiswhyImfollowingupwithyouandalsoto
ensureeveryoneisonthesamepage.Thispresentedanewperspectivetoteamcollaboration,
becauseIalwaysvieweditasbeingthehospitalteam,butitalsoincludesthefamilyand
supportsystemforthemotherandbaby.
Overall,thisseminarsupplementedmyunderstandingofcertainhighriskcomplications
suchaspregnancyinducedhypertension,shoulderdystocia,preeclampsia,ecclampsia,andlabor
induction.Ifeelthatbyattendingthisseminar,itgavemeabetterunderstandingofthehighrisk
topicsonexamthree.Itwasencouragingtoseeotherscurrentlyinpracticeandthetypesof
questionstheyaskedbecauseitdemonstratedtheneedtobecontinuallylearningandawareof
newevidencebasedpractices.IwilldefinitelyapplywhatIhavelearnedfromthisseminarby
incorporatingteamwork,communication,andevidencebasedpracticetobettercareformy
patients.