|
107 |
Role-play.
Androgen
insensitivity syndrome. |
|
108 |
Role-play.
Fetal
death in utero. FDIU. |
107. Androgen insensitivity syndrome.
The patient is
Anastasia Johnstone. She is 17 years old. She attended the gynaecology clinic 1
month ago with primary amenorrhoea. Clinical examination showed an apparently
normal young woman with normal breast development but absent pubic and axillary
hair. The external genitalia appeared normal. Vaginal examination was not
attempted.
She has come
today for the results of an ultrasound scan and blood tests. The scan shows
absence of the uterus. There are no ovaries in the pelvis. There are bilateral
groin masses. The karyotype is 46XY.
Your tasks are to
explain the results and their implications and to answer her questions.
108. Role-play. Fetal death in utero. FDIU.
Candidate’s instructions.
You are an SpR and were successful in a consultant
interview last week. You are now working your notice period before taking up
your new post, which has a particular component in labour ward management.
Anne West is a 25-year-old primigravida who delivered a
stillborn baby in the night. Her husband works in Saudi Arabia and won’t be
able to get home until tomorrow. She has opted to stay in hospital until then.
The pregnancy was normal. She noted reduced fetal movements the day before
yesterday. There were no movements when she awoke, so she phoned the labour
ward and was advised to attend. Fetal heart activity could not be detected and
an ultrasound scan confirmed fetal death in utero. A detailed scan was not done
because of her distress, but no gross abnormality was seen and the liquor
volume looked reduced but in the normal range. The cervix was noted to be
effaced and 2 cm. dilated. She opted to have labour induced immediately and
arranged for her sister to be with her as her husband works overseas. The
labour was normal, as was the delivery.
Your consultant has said that it will be good experience
to take responsibility for talking to her about bereavement and permission for
post-mortem examination.
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