HISTORY
N.C. a 26 year old woman para 4+3, gravida 8, at 26 weeks gestation with dichorionic dimniotic (DCDA) twins, presented to the Admissions department of Obstetrics and Gynaecology on 4th Septmember (Thursday) with a 24 hour history of crampy ‘tightening’ abdominal pain and decreased fetal movements. She had last noticed fetal movements on Wednesday morning. She said that the pain which was in the suprapubic region was more like a tightening and rated the severity as about 6/10 at worst. It had begun during Wednesday evening and she had taken no pain relief e.g. paracetemol. The pain was worse on micturition and had no relieving factors, it also did not radiate anywhere. There was no per vaginal bleeding at …show more content…
She has also had a previous placenta l abruption as well as the double placental abruption in this pregnancy. She also had all of her babies before term and one must wonder if some of these complications could have been avoided if N.C. had received more support and counselling in her attempt to quit smoking in each pregnancy. I know that during each pregnancy she tried to stop completely but ended up continuing to smoke a couple of cigarettes each day. She never tried any nicotine replacement therapy and I wonder if her G.P. should have done more to encourage this as this would be of great benefit in her attempt to quit completely.(3) This would have had a very positive impact on her pregnancies as well as her general health and her many complications would perhaps have been less likely if she had succeeded.