Midwifery

How to use the case scenario

There are various ways you may use the case stories, from individual self-directed learning to support continuous professional development to using them in a team environment. The idea is that by learning from the experience of others, maternity unit staff will be able to change their approach to care.

The following case study is an example scenario based on people’s real experiences for the purpose of learning. All names are fictional. We thank NHS Resolution for the use of use their case story about recognising and avoiding significant maternal and neonatal hyponatraemia.

Consider the following:

  •  Could this happen where I work?
  • What changes within my organisation or team might I consider after reading the material, including individual practice?
  • What information should I share with the team?
  • How can I share the learning from this case story?
  • Who else needs to know?

 

Practical applications

  1. Consider the key elements of the case story and through reflection apply the learning to influence your practice in the future.
  2. Use this case study as a point of discussion at appropriate multi-disciplinary team meetings, safety huddles, and/or human factor’s training.
  3. Use this case study to create a multi-disciplinary simulation in the clinical area or on mandatory training.


Topic: recognising and avoiding significant maternal and neonatal hyponatraemia.

Key points:

  • All women in labour are at increased risk of hyponatraemia (defined as blood serum sodium < 130 mmol/l), especially dilutional hyponatraemia which is sometimes referred to as water intoxication.
  • This is a result of lower baseline serum sodium in pregnancy, impaired ability to excrete water in the third trimester and exposure to the anti-diuretic effect of oxytocin (synthetic and/or endogenous). Excessive oral or intravenous fluid intake exacerbates this, with potentially serious complications for mother and baby.
  • Complications of hyponatraemia include headache, agitation, confusion, seizures and death. Vigilance, diagnosis and active management is therefore imperative.
  • Water freely crosses the placenta, lowering the infant’s blood sodium concentration in tandem with its mothers. Seizures secondary to hyponatraemia in the newborn infant are like those caused by hypoxic ischaemic encephalopathy (HIE) and they are likely to receive therapeutic cooling as a result.
  • In a study, 26% of low-risk mothers who received or ingested more than 2500 millilitres of fluid during labour were hyponatraemic1.
  • Significant hyponatraemia can be avoided by giving women evidence-based advice on oral fluid intake, careful monitoring of fluid input and output and responding to positive fluid balance.