23 May 2016.
1
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How to
prepare
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2
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SBA. RCOG sample obstetric
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3
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SBA. RCOG sample gynaecological
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4
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Basic
communication skills
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5
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SBA. Placenta accreta,
increta & percreta
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6
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EMQ. Antenatal
steroids.
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1. How to prepare.
1st. time and
repeat candidates
Advice on website
“How to pass first time”
Section called “topics like "CNST" &
communication”
Study buddy
Going on a course
2. RCOG sample obstetric SBAs.
3. RCOG sample gynaecological SBAs.
4. Basic communication skills.
Things to start practising:
introducing
yourself & anyone else present
finding out
what a woman knows about a subject
encouraging
questions
5. SBA. Placental
accreta, increta and 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
A.
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Placenta which is difficult to remove, but can be
separated digitally
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B.
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Placental villi
invade the decidua, but not the myometrium
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C.
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Placental villi
invade the decidua and myometrium but not the serosa
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D.
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Placental villi
invade the decidua, myometrium and serosa
|
E.
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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
A.
|
Placenta is difficult to remove, but can be separated
digitally
|
B.
|
Placental villi
invade the decidua, but not the myometrium
|
C.
|
Placental villi
invade the decidua and myometrium but not the serosa
|
D.
|
Placental villi
invade the decidua, myometrium and serosa
|
E.
|
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
A.
|
Placenta is difficult to remove, but can be separated
digitally
|
B.
|
Placental villi
invade the decidua, but not the myometrium
|
C.
|
Placental villi
invade the decidua and myometrium but not the serosa
|
D.
|
Placental villi
invade the decidua, myometrium and serosa
|
E.
|
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
A.
|
1-2 per 1,000
deliveries
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B.
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1-2 per 1,000
maternities
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C.
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1-2 per 5,000
deliveries
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D.
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1-2 per 5,000 maternities
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E.
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1-2 per 10,000 deliveries
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F.
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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
A.
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Any pregnancy, including ectopic pregnancy
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B.
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Any pregnancy, excluding ectopic pregnancy
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C.
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Any pregnancy resulting in a live birth
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D.
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Any pregnancy resulting in live birth or stillbirth
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E.
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Any pregnancy ending from 24 completed weeks plus any
pregnancy resulting in a live birth.
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Question 6.
Lead-in
Why is the
term “maternity” important.
Option List
A.
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We should take best possible care of our pregnant
patients
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B.
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It is used as the denominator in calculations of the
maternal mortality rate
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C.
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It is used as the numerator in calculations of the
maternal mortality rate
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D.
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It is used as the denominator in calculations of the
maternal mortality ratio
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E.
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It is used as the numerator in calculations of the
maternal mortality ratio
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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
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BMI > 30
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Cigarette smoking in pregnancy
|
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Ethnic group non-white
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IVF pregnancy
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Maternal age > 35
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Parity ≥ 2
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PIH or PET
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Placenta previa diagnosed pre-delivery
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Previous Caesarean section > 1
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Previous Caesarean section x 1
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Previous uterine surgery – not C. section
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Option List
Adjusted odds ratio
|
0.53
|
0.57
|
0.66
|
0.9
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1.0
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2.0
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3.06
|
3.4
|
3.48
|
10
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14
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16.31
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32.13
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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
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No previous C section
|
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≥ 1 C section
|
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Placenta previa not diagnosed pre-delivery
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Placenta previa diagnosed pre-delivery
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Previous C section but placenta previa not
diagnosed pre-delivery
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Previous C section + placenta previa diagnosed
pre-delivery
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Option List
0.3
|
0.6
|
1
|
3
|
5
|
9
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108
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577
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1,000
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6. EMQ. Antenatal steroids.
Antenatal steroids
and the neonate.
Lead-in.
The
following scenarios relate to antenatal steroid use and the neonate.
Option list.
There is no option list.
I want you to come up with your answers.
Scenario 1.
What are the benefits to the neonate of appropriate administration of
antenatal steroids?
Scenario 2.
At what gestations should antenatal steroids be offered to women with
singleton pregnancies who are at risk of premature labour?
Scenario 3.
At what gestations should antenatal steroids be offered to women with
multiple pregnancies who are at risk of premature labour?
Scenario 4.
What advice is contained in the GTG in relation to very early
gestations, threatened premature labour and the use of antenatal steroids.
Scenario 5.
What
advice is contained in the GTG in relation to antenatal steroids and Caesarean
section?
Scenario 6.
What advice is given in the GTG about ANS in relation to the fetus with
FGR at risk of premature delivery?
Scenario 7
What advice is given in the GTG in relation to ANS for women with IDDM?
Scenario 8
What advice is in the GTG in relation to adverse effects of ANS on the
fetus?
Scenario 9
What advice is in the GTG in relation to short-term maternal adverse
effects?
Scenario 10
What
contraindications to ANS are cited in the GTG?
Scenario 11
What
is the recommended drug regime for ANS administration?
Scenario 12.
What is the time-scale for maximum effect of
ANS in reducing RDS?
Scenario 13.
When should repeat courses of ANS be given?
Scenario 14.
When may antenatal steroids be beneficial to
the fetus apart from accelerating lung maturation?
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