Tutorial 2 August 2012

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Tonight we had an EMQ and 4 essay topics and still managed to finish early.
 

 PPH.

Lead-in.

The following scenarios relate to post-partum haemorrhage.

For each, select the appropriate answer.

Pick one option from the option list.

Each option can be used once, more than once or not at all.

Abbreviations.

APH:   antepartum haemorrhage.

GTG:   Green-top Guideline No 52. “Prevention and Management of PPH.”

i.m.      intramuscularly.

PPH:   postpartum haemorrhage.

s.c.      subcutaneously.

Scenario 1.

A 34 year-old, para 4 delivers the first twin and bleeds loses 250 ml. of fresh blood. A further 300 ml. is lost after the delivery of the second baby. What is the classification of the bleeding?

Scenario 2.

A 25 year-old nulliparous woman delivers a stillborn baby at 22 weeks. 1,000 ml. of fresh bleeding occurs in the next 2 hours. What is the classification of the bleeding?

Scenario 3.

A 45 year-old primigravid woman is readmitted at 10 weeks post-delivery as she has bled continuously for 3 weeks. What is the classification of the bleeding?

Scenario 4.

A 34 year-old woman passes placental tissue and 500 ml. of fresh blood 14 weeks after delivery of her second child. What is the classification of the bleeding?

Scenario 5.

Which drug is recommended by the GTG for routine use in the active management of the 3^rd. stage?

Scenario 6.

By what amount does active management using syntometrine reduce the risk of 1ry. PPH?

Scenario 7.

What is the definition of primary PPH?

Scenario 8.

What is the definition of secondary PPH?

Option list.

Bleeding from the birth canal ≥ 500 ml.

Bleeding from the birth canal ≥ 500 ml. up to 24 hours after delivery of the placenta.

Bleeding from the birth canal ≥ 500 ml. from 24 hours after delivery of the placenta until 6 weeks later.

Bleeding from the birth canal ≥ 1,000 ml. from 24 hours after delivery of the placenta until 6 weeks later.

Bleeding from the birth canal ≥ 500 ml. from 24 hours after delivery of the baby until 12 weeks later.

Bleeding from the birth canal ≥ 1,000 ml. from 24 hours after delivery of the baby until 12 weeks later.

Abnormal bleeding from the birth canal from 24 hours after delivery of the baby until 12 weeks later.

APH.

1ry. PPH.

Major primary PPH.

2ry. PPH.

Syntocinon 5 i.u. i.m.

Syntometrine 5 mg. i.m.

Misoprostol 10 mg. orally.

Gemeprost 40 mg. rectally.

Vasopressin 5 i.u. s.c.

20%

40%

60%

80%

None of the above.

 

Essays 2 August 2012

1.      Critically evaluate the management options for uterine fibroids.

2.      Critically evaluate the non-contraceptive benefits of the combined oral contraceptive.

3.      A 32 year-old woman attends the clinic with her partner. A recent laparoscopy for pelvic pain and dyspareunia revealed endometriosis. They have not used contraception for 12 months but have not conceived. Neither has had a child before.

1.   Outline the history you will take.                                                               6 marks

2.   Outline the investigations you will arrange.                                           6 marks

3.   Outline the information you will wish to discuss with the couple.   8 marks

4.      A 32 year-old woman with learning difficulty attends the gynaecology clinic with her mother. The referral is because of severe dysmenorrhoea and menorrhagia. The mother is keen for her to have hysterectomy and is prepared to give her consent.

1.  What factors will you take into consideration before offering treatment?                 8 marks.

2.  Outline the treatment options, not including hysterectomy, that you will discuss.   6 marks.

3.  If it is concluded that hysterectomy is the best option, justify the steps you will take to

arrange this.                                                                                                                                          6 marks.