Thursday 28 May 2015

Tutorial 28 May 2015

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28 May 2015.

1
How to prepare
2
SBA. RCOG sample obstetric.
3
SBA.  RCOG sample gynaecological
4
Basic communication skills.
5
SBA. Placenta accrete, increta & percreta
6
EMQ. MBRRACE.

2 & 3  - the RCOG's sample questions can be downloaded from the website.
              go to the tab "courses, exams and events" then select "about the part 2
              exam".
                                  
5. Placenta “creta”: accreta increta & percreta

This topic has been chosen to remind you of the existence of UKOSS and the various Reports it has produced as they would make perfect EMQs or SBAs.

Abbreviations.
Creta:      term to describe accreta, increta or percreta.
PET:         pre-eclampsia
PIH:          pregnancy-induced hypertension

Question 1.
Lead-in
Choose the best option from the option list for the definition of placenta accreta.

Option List


  1.  
Placenta which is difficult to remove, but can be separated digitally

  1.  
Placental villi  invade the decidua, but not the myometrium

  1.  
Placental villi  invade the decidua and myometrium but not the serosa

  1.  
Placental villi  invade the decidua, myometrium and serosa

  1.  
Placental villi  invade adjacent organs, e.g. the bladder

Question 2.

Lead-in
Choose the best option from the option list for the definition of placenta increta.

Option List


  1.  
Placenta is difficult to remove, but can be separated digitally

  1.  
Placental villi  invade the decidua, but not the myometrium

  1.  
Placental villi  invade the decidua and myometrium but not the serosa

  1.  
Placental villi  invade the decidua, myometrium and serosa

  1.  
Placental villi  invade adjacent organs, e.g. the bladder

Question 3.

Lead-in
Choose the best option from the option list for the definition of placenta percreta.

Option List


  1.  
Placenta is difficult to remove, but can be separated digitally

  1.  
Placental villi  invade the decidua, but not the myometrium

  1.  
Placental villi  invade the decidua and myometrium but not the serosa

  1.  
Placental villi  invade the decidua, myometrium and serosa

  1.  
Placental villi  invade adjacent organs, e.g. the bladder

Question 4.

Lead-in
What is the approximate incidence of placenta creta in the UK?

Option List


  1.  
1-2 per   1,000 deliveries

  1.  
1-2 per   1,000 maternities

  1.  
1-2 per   5,000 deliveries

  1.  
1-2 per   5,000 maternities

  1.  
1-2 per 10,000 deliveries

  1.  
1-2 per 10,000 maternities

Question 5.
You need to be able to define “maternity” and know why it is important.

Lead-in
What is a “maternity”?

Option List


  1.  
Any pregnancy, including ectopic pregnancy

  1.  
Any pregnancy, excluding ectopic pregnancy

  1.  
Any pregnancy resulting in a live birth

  1.  
Any pregnancy resulting in live birth or stillbirth

  1.  
Any pregnancy ending from 24 completed weeks plus any pregnancy resulting in a live birth.


Question 6.

Lead-in
Why is the term “maternity” important.

Option List


  1.  
We should take best possible care of our pregnant patients

  1.  
It is used as the denominator in calculations of the maternal mortality rate

  1.  
It is used as the numerator in calculations of the maternal mortality rate

  1.  
It is used as the denominator in calculations of the maternal mortality ratio

  1.  
It is used as the numerator in calculations of the maternal mortality ratio

Question 7.
This question relates to risk factors for placenta accreta

Lead-in
Match each of the risk factors  listed below with an adjusted odds ratio from the Option List. Each option can be used once, more than once or not at all.
Note that some of the adjusted odds ratios show a reduced risk.

Risk factors and adjusted odds ratio.
Risk factor
Adjusted odds ratio
BMI > 30

Cigarette smoking in pregnancy

Ethnic group non-white

IVF pregnancy

Maternal age > 35

Parity ≥ 2

PIH or PET

Placenta previa diagnosed pre-delivery

Previous Caesarean section > 1

Previous Caesarean section x 1

Previous uterine surgery – not C. section















Option List

Adjusted odds ratio
0.53
0.57
0.66
0.9
1.0
2.0
3.06
3.4
3.48
10
14
16.31
32.13
65.02
102

Question 8.

Lead-in
This question relates to estimated incidence of placenta creta for various risk factors.
Match the risk factors with the estimated incidence in the option list. Each option can be used once, more than once or not at all.

Risk factors and estimated incidence per 10,000 maternities.
Risk factor
Estimated incidence
No previous C section

≥ 1 C section

Placenta previa not diagnosed pre-delivery

Placenta previa diagnosed pre-delivery

Previous C section but placenta previa not diagnosed pre-delivery

Previous C section + placenta previa diagnosed pre-delivery










Option List

0.3
0.6
1
3
5
9
108
577
1,000


6. EMQ. MBRRACE.

Lead-in.
The following scenarios relate to MBRRACE.
Pick one option from the option list.
Each option can be used once, more than once or not at all.

Abbreviations.
CMACE:        Centre for Maternal and Child Enquiries (now deceased).
MMR:           Maternal mortality rate.
             
Option list.

Scenario 1.          What is the meaning of the acronym MBRRACE-UK”?
Scenario 2.          Which organisation does it replace?
Scenario 3.          How does it differ structurally from its predecessor?
Scenario 4.          How will its reports differ from those of its predecessor?
Scenario 5.          When was its first Report published?
Scenario 6.          What geographical innovation was included in its first Report?
Scenario 7.          What was the latest MMR reported in its first Report?
Scenario 8.          How did this compare with the final MMR reported by CMACE?
Scenario 9.          Which topics were reviewed in detail in the first Report?
Scenario 10.      What was the leading direct cause of death in the first Report?
Scenario 11.      What was the leading indirect cause of death in the first Report?
Scenario 12.      What is the definition of a maternal death?
Scenario 13.      What is the definition of a direct maternal death?
Scenario 14.      What is the definition on indirect maternal death?
Scenario 15.      What observation was made in the first Report about deaths due to hypertensive diseases.
Scenario 16.      Which condition was linked to 1 in 11 maternal deaths?
Scenario 17.      What were the 5 top causes of direct maternal death in the years 2009 – 2011?
Scenario 18.      What key messages were singled out in the first Report?


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