Substance use in pregnancy — booking-visit communication and management station

Communication and management station: a late-booking woman with concealed polysubstance use and a child-protection history. Tests trauma-informed universal screening with AUDIT-C and 4Ps, the principle of opioid agonist therapy over detox, FASD counselling, neonatal abstinence syndrome planning, and the scored rapport, respect and communication domains. Includes assessor key and marking domains.

Prompt

You are the registrar in the booking clinic. A 23-year-old G3P2 books at 18 weeks. She smells of stale tobacco, has taken no folic acid, is unsure of her dates, and averts her gaze when you ask about her partner. A routine, non-judgemental screen reveals daily tobacco and cannabis use, weekly alcohol binges, and intermittent heroin. Her previous child is in care. The assessor will run the clock and score your stance, your screening, your management, and your communication with her.

Station brief

Format. Communication and management station, approximately 12 minutes. You are the obstetric registrar in the booking clinic with a midwife and a named addiction-liaison worker available. The assessor plays the woman and runs the clock, feeding you her responses and her reactions. [1][15]

Candidate instruction. Establish rapport, take a trauma-informed substance-use history with validated screening tools, agree a management plan covering alcohol, tobacco, cannabis and opioids, and outline the plan for the neonate and the postpartum period. Verbalise your stance and your communication as deliberately as your clinical decisions. [1][15]

Obstetrics & Gynaecology Pro

You have read the opening of this case. The complete unit — every section and its primary-source references — is part of the Obstetrics & Gynaecology fellowship atlas.

References6Show ledger

[1]ACOG Committee on Health Care for Underserved Women, American Society of Addiction Medicine ACOG Committee Opinion No. 524: Opioid abuse, dependence, and addiction in pregnancy Obstet Gynecol, 2012.PMID 22525931
[2]Jones HE, Kaltenbach K, Heil SH, et al. Neonatal abstinence syndrome after methadone or buprenorphine exposure N Engl J Med, 2010.PMID 21142534
[13]Lange S, Shield K, Rehm J, et al. Fetal alcohol spectrum disorder: neurodevelopmentally and behaviorally indistinguishable from other neurodevelopmental disorders BMC Psychiatry, 2019.PMID 31660907
[14]Bush K, Kivlahan DR, McDonell MB, et al. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test Arch Intern Med, 1998.PMID 9738608
[15]American College of Obstetricians and Gynecologists Committee on Health Care for Underserved Women ACOG Committee Opinion No. 343: psychosocial risk factors: perinatal screening and intervention Obstet Gynecol, 2006.PMID 16880322
[16]McQueen K, Taylor C, Murphy-Oikonen J Systematic Review of Newborn Feeding Method and Outcomes Related to Neonatal Abstinence Syndrome J Obstet Gynecol Neonatal Nurs, 2019.PMID 31034790

Substance use in pregnancy — booking-visit communication and management station

Station brief

Obstetrics & Gynaecology Pro

You have read the opening of this case. The complete unit — every section and its primary-source references — is part of the Obstetrics & Gynaecology fellowship atlas.

References6Show ledger

[1]ACOG Committee on Health Care for Underserved Women, American Society of Addiction Medicine ACOG Committee Opinion No. 524: Opioid abuse, dependence, and addiction in pregnancy Obstet Gynecol, 2012.PMID 22525931
[2]Jones HE, Kaltenbach K, Heil SH, et al. Neonatal abstinence syndrome after methadone or buprenorphine exposure N Engl J Med, 2010.PMID 21142534
[13]Lange S, Shield K, Rehm J, et al. Fetal alcohol spectrum disorder: neurodevelopmentally and behaviorally indistinguishable from other neurodevelopmental disorders BMC Psychiatry, 2019.PMID 31660907
[14]Bush K, Kivlahan DR, McDonell MB, et al. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test Arch Intern Med, 1998.PMID 9738608
[15]American College of Obstetricians and Gynecologists Committee on Health Care for Underserved Women ACOG Committee Opinion No. 343: psychosocial risk factors: perinatal screening and intervention Obstet Gynecol, 2006.PMID 16880322
[16]McQueen K, Taylor C, Murphy-Oikonen J Systematic Review of Newborn Feeding Method and Outcomes Related to Neonatal Abstinence Syndrome J Obstet Gynecol Neonatal Nurs, 2019.PMID 31034790