Website.
Tonight we discussed plans for 3 essays.
Question 1.
A woman attends the antenatal clinic at 10 weeks. Her son developed chickenpox two days ago. Her sister is 38 weeks pregnant. Critically evaluate the management.
Question 2.
A woman books at 6 weeks in her first pregnancy. She smokes 20 cigarettes daily.
1. Detail the key aspects of the history you will take. 6 marks.
2. Outline the risks to the mother. 4 marks.
3. Outline the risks to the fetus / baby. 6 marks.
4. Justify the steps you will take to reduce the risks. 4 marks.
Question 3.
A 25-year-old primigravida attends the antenatal clinic at 36 weeks. She has read a magazine article about delayed cord clamping (DCC)
1. Outline the factors that make DCC unwise. 6 marks.
2. Justify the advice you will give about the benefits and risks of DCC. 8 marks.
3. Outline the arrangements necessary for DCC. 6 marks.
We also managed an EMQ.
If you e-mail your answers, I'll send what I have written.
Early pregnancy complications.
Lead-in.
The following scenarios relate to early pregnancy. For each, select the most appropriate answer from the option list.
Each option can be used once, more than once or not at all.
Abbreviations.
AFC. antral follicle count.
AMH. anti-Mullerian hormone.
CRL. crown-rump length.
EPU. early pregnancy unit.
FSH. follicle stimulating hormone.
GTD. gestational trophoblastic disease.
GTG 17. RCOG Green-top Guideline 17. ”Recurrent Miscarriage.” 2003.
GTG 25. RCOG Green-top Guideline 25. ”The Management of Early Pregnancy Loss.“ 2006.
hCG. human chorionic gonadotrophin
MEUC. medical evacuation of uterine contents.
PUL. pregnancy of unknown location.
PUV. pregnancy of uncertain viability.
RM. recurrent miscarriage.
SEUC. surgical evacuation of uterine contents.
TVS. trans-vaginal scan
USS. ultrasound scan
Scenario 1.
A nulliparous woman attends the booking clinic at 8 weeks’ gestation. An ultrasound scan shows a missed miscarriage of a size commensurate with the gestation. What will be your management?
Scenario 2.
A nulliparous woman attends the booking clinic at 8 weeks’ gestation. An ultrasound scan shows a missed miscarriage of a size commensurate with the gestation. She has had two previous pregnancies; both resulted in 1st. trimester miscarriage. What will be your management?
Scenario 3.
A primigravid woman attends the A&E department with abdominal pain and vaginal bleeding. A home pregnancy test was +ve 1 week ago; the date of the LMP is uncertain. What will be your management?
Scenario 4.
A 40-year old woman is pregnant for the first time. Her periods have been erratic for 12 months and she has occasional hot flushes. She attends the A&E department with abdominal pain and vaginal bleeding. The bleeding is slight and her condition is good. An hCG is +ve and a TVS shows an incomplete miscarriage. What will be your management?
Scenario 5.
A 35-year-old woman has had two normal pregnancies. She attends the booking clinic after an unplanned conception. Her hCG is +ve. A TVS shows endometrial thickening but no evidence of intra-uterine pregnancy. No pelvic abnormality is seen. What will be your management?
Scenario 6.
A 35-year-old woman has had two normal pregnancies. She attends the booking clinic after an unplanned conception. Her hCG is +ve. A TVS shows a 15 mm. intra-uterine sac, but no fetus or yolk sac. What will be your management?
Scenario 7.
A 35-year-old woman has had two normal pregnancies. She attends the booking clinic after an unplanned conception. Her hCG is +ve. A TVS shows a 30 mm. intra-uterine sac, but no fetus. What will be your management?
Scenario 8.
A 35-year-old woman has had two normal pregnancies. She attends the booking clinic after an unplanned conception. Her hCG is +ve. A TVS shows an intra-uterine fetus with crown rump length of 5 mm., but no evidence of fetal heart activity. What will be your management?
Scenario 9.
A 35-year-old woman has had two normal pregnancies. She attends the booking clinic after an unplanned conception. Her hCG is +ve. A TVS shows an intra-uterine fetus with crown rump length of 6 mm. Fetal heart activity is seen. What will be your management?
Scenario 10.
A 35-year-old woman attends the A&E department at 6 weeks’ gestation with pain and bleeding. She became pregnant after IVF. An ultrasound scan shows a viable intrauterine pregnancy of a size compatible with the gestation. What will be your management?
Option List.
A. Admit as an emergency case.
B. Counsel and arrange TVS in 1 week.
C. Counsel and arrange TV colour Doppler scan.
D. Counsel re expectant management.
E. Explain diagnosis and counsel re MEUC and SEUC.
F. Explain diagnosis and counsel re expectant management and MEUC and SEUC.
G. Explain diagnosis and counsel re expectant management, MEUC and SEUC and refer to the EPU.
H. Explain diagnosis and counsel re treatment options with accent on the relative merits of SEUC and refer to the EPU.
I. Explain diagnosis and counsel re treatment options with accent on the relative merits of MEUC and refer to the EPU.
J. Counsel re missed miscarriage and refer to the EPU.
K. Explain diagnosis and refer to the EPU for PUL protocol.
L. Explain diagnosis and refer to the EPU for PUV protocol.
M. Manage as ectopic pregnancy until proven otherwise.
N. Arrange progesterone assay.
O. Arrange AFC.
P. Arrange AMH assay.
Q. Arrange serial hCG monitoring for 48 hours.
R. Administer anti-D immunoglobulin.
S. Administer ergometrine 0.5 mg i.m.
T. Prescribe mifepristone.
U. Prescribe misoprostol for vaginal use.
V. Continue with routine booking.
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