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Abrupt Onset of Severe Pain at Term: A Case Report

Authors

  • Rebecca L. Skovgaard CNM, MS,

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    • Rebecca L. Skovgaard received a master of science degree in nurse-midwifery from Georgetown University in 1988 and, subsequently, was on the faculty of the Georgetown University Nurse-Midwifery Program.

    • Currently, all of the coauthors hold dual faculty appointments in both the Department of Obstetrics and Gynecology and the School of Nursing at the University of Rochester and are members of the Strong Midwifery Group.

  • Carolyn S. Christenson CNM, MS,

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    • Carolyn S. Christenson received a master of science degree in nurse-midwifery from the University of Minnesota in 1993.

    • Currently, all of the coauthors hold dual faculty appointments in both the Department of Obstetrics and Gynecology and the School of Nursing at the University of Rochester and are members of the Strong Midwifery Group.

  • Mary M. McClard CNM, MSN,

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    • Mary M. McClard received a master of nursing degree in nurse-midwifery from the University of Texas at El Paso in 1994.

    • Currently, all of the coauthors hold dual faculty appointments in both the Department of Obstetrics and Gynecology and the School of Nursing at the University of Rochester and are members of the Strong Midwifery Group.

  • Carol D. Spoor-Sandefur CNM, MN, MPH,

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    • Carol D. Spoor-Sandefur received a master of nursing degree in nurse-midwifery, as well as a master of public health degree, from Emory University in 1992.

    • Currently, all of the coauthors hold dual faculty appointments in both the Department of Obstetrics and Gynecology and the School of Nursing at the University of Rochester and are members of the Strong Midwifery Group.

  • Karen E. Kedley CNM, MS

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    • Karen E. Kedley received a master of science degree in nurse-midwifery from the University of Illinois in 1976.

    • Currently, all of the coauthors hold dual faculty appointments in both the Department of Obstetrics and Gynecology and the School of Nursing at the University of Rochester and are members of the Strong Midwifery Group.


Department of Obstetrics and Gynecology, University of Rochester, Box 668, 601 Elmwood Avenue, Rochester, NY 14642.

ABSTRACT

This case report involves an adolescent primigravida at term who was admitted with urinary complaints to the labor and delivery unit of a medical center. Within an hour, she suddenly began screaming and complaining of severe pain running from her anterior pelvis through her vagina and up her spine. Three days of very challenging comanagement of the patient, with several recurrences of acute pain, followed. Differential diagnoses that could explain this patient's symptoms are reviewed and discussed. Difficult management issues, including the stress of clinical management in the face of unidentified disease processes, are addressed. Lacking a certain diagnosis even retrospectively, the authors request comments from readers.

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