Sunday, 15 February 2015

Tutorial 12 February 2015

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There was no tutorial tonight as only one person could attend.
The topics I planned to discuss were:

52.
EMQ. Labour ward 1.
53.
EMQ. Labour ward 2.
54.
SBA. Operative vaginal delivery.
55.
EMQ. DSDs: AIS, MRKH and Swyer’s syndrome
56.
EMQ. Haemophilia 1.
57.
EMQ. Haemophilia 2.


Send your answers and I'll send mine.

52. Labour Ward 1. 
Lead in.
Read each of the following clinical scenarios and choose the best management from the list of options. Each option may be used once, more than once or not at all.
Option list.
A.      anticipate spontaneous vaginal delivery
B.      perform biophysical profile.
C.      perform fetal scalp pH sampling
D.      perform fetal buttock pH sampling
E.       arrange flow cytometry to assess for feto-maternal haemorrhage
F.       correct maternal diabetic keto-acidosis and re-assess
G.      exclude cephalo-pelvic disproportion
H.      check for descent with contraction / maternal pushing
I.        give steroids to promote fetal lung maturation.
J.        deploy the APH protocol
K.       start syntocinon
L.       use the Kiwi
M.    use the silastic ventouse
N.      use Kiel land forceps
O.     use Neville-Barnes forceps
P.       use Spencer Wells forceps
Q.     breech extraction
R.      internal podalic version and breech extraction
S.       elective Caesarean section
T.       emergency Caesarean section
U.      Caesarean hysterectomy
V.      resign your post and become a Cistercian monk / nun
W.    None of the above.

1.     A primigravida with a 10 year history of IDDM is admitted at 30 weeks with diabetic ketoacidosis. The fetal heart rate is noted to 160 b.p.m. with loss of beat-to-beat variability and variable, late decelerations. What action will you take in relation to the fetal condition.
2.     A primigravida with a 10 year history of IDDM with good glycaemic control has been actively pushing in the second stage of labour for 2 hours and is exhausted. The first stage of labour lasted 8 hours. She has an effective epidural in place. The baby feels of average size and the scan estimate was of a birthweight of 7 – 8lbs. 1/5 of the fetal head is palpable abdominally. The position is OA with the head at the spines and a moderate degree of caput and moulding. What action, if any, will you take to expedite the delivery?
3.     A 35-year-old woman has had two normal deliveries of babies weighing 7 and 8 lb. ten years before. Diabetes has been diagnosed in this pregnancy and has been well-controlled with diet. She is admitted at 39 weeks in spontaneous labour. The cervix is fully dilated and a flexed breech presentation is noted. The fetal heart rate is 100 beats per minute with poor variability and late decelerations. There is thick, fresh meconium. What action, if any, will you take to expedite the delivery?
4.     A 35-year-old primigravida is admitted at 34 weeks with SROM and obvious liquor draining. Abdominal examination shown breech presentation. Her temperature is normal and her condition is good. A CTG shows a normal pattern. What will be your first action?
5.     A 40-year-old woman has had two normal deliveries of babies weighing 7 and 8 lb. ten years before. After a first stage lasting 5 hours she has sudden pain and fresh bleeding. The fetal heart rate drops to 90 beats per minute with no recovery over a period of 5 minutes. The cervix is noted to be almost fully dilated with only a thin rim of cervix anteriorly. The position is OA with the head 2 cm. below the spines. There is minimal caput and moulding. What action will you take to expedite the delivery after sending a midwife to call for help?
6.     A primigravida has spontaneous onset of labour at 40 weeks. The first stage last for 15 hours. After active pushing in the second stage for 2 hours, she is becoming tired. The CTG is normal and the liquor is clear. Abdominal examination shows 1/5 of the fetal head to be palpable. The presenting part is at the ischial spines. The position is occipito-transverse with moderate caput and moulding. There is no descent of the presenting part with contractions and pushing. What action, if any, will you take to expedite the delivery?
7.     A primigravida has spontaneous onset of labour at 40 weeks. The first stage last for 15 hours. After active pushing in the second stage for 2 hours, she is becoming tired. The CTG is normal and the liquor is clear. Abdominal examination shows 0/5 of the fetal head to be palpable. The presenting part is at the ischial spines. The position is occipito-transverse with moderate caput and moulding. There is some descent of the presenting part with contractions and pushing. What action, if any, will you take to expedite the delivery?
8.     A primigravida at 32 weeks has been pushing in the second stage for 90 minutes. The first stage lasted for 6 hours and was of spontaneous onset. Maternal condition is good. You have been summoned as the CTG shows bradycardia, loss of variability and late decelerations. The head is not palpable abdominally and the position is occipito-anterior and the station 1 cm. below the ischial spines. What action, if any, will you take to expedite the delivery?
9.     A woman of 45 years from an Irish traveller family has had 5 normal deliveries of babies weighing from 4 to 4.5kg. The youngest child is 10 years old. She is admitted in advanced labour having had no antenatal care. Examination shows the cervix to be fully dilated with the head presenting 1 cm above the spines in an occipito-anterior position. There is moderate caput and moulding. She is obese, but the fetal head is thought to be 1/5 palpable. There is evidence of fetal compromise with loss of variability and late decelerations. What action, if any, will you take to expedite the delivery?
10.   A woman of 30 years with a history of elective Caesarean section for breech presentation in her only previous pregnancy is in labour after a consultant decision that her wish for VBAC is appropriate. After 6 hours in labour she complains of sudden lower abdominal pain. A small amount of fresh blood is noted. The CTG shows sudden onset of compromise with a rate of 80 beats per minute, loss of variability and variability. What action, if any, will you take to expedite the delivery?
53. Labour Ward 2.
Lead in.
For each scenario below, choose the most appropriate answer from the option list.
Each option may be used once, more than once or not at all.
Abbreviations.
CTG.     cardio-tocograph.
FBS.      fetal scalp-blood sample.
FHR.     fetal heart rate.

Option List.
  1. start protocol for severe hypertension
  2. allow labour to progress and re-assess in 30 minutes
  3. increase syntocinon infusion rate.
  4. increase syntocinon infusion rate and encourage effective pushing.
  5. give misoprostol.
  6. stop syntocinon, give O2,perform left-lateral tilt and re-assess in 30 minutes
  7. start intra-uterine pressure monitoring
  8. start STAN monitoring
  9. perform fetal blood sampling
  10. arrange category 1 Caesarean section
  11. arrange category 2 Caesarean section
  12. arrange category 3 Caesarean section
  13. arrange category 4 Caesarean section
  14. perform ventouse delivery
  15. perform forceps delivery
  16. perform breech extraction
  17. perform external cephalic version
  18. perform internal podalic version
  19. none of the above

Scenario 1.
A 30-year-old primigravida has labour induced at 39 weeks because of pre-eclampsia.
Her blood pressure had been moderately raised since 36 weeks and a 24-hour urine collection showed 4 gm. protein. (Do you know the cut-offs for mild/moderate/sever hypertension? Answer below.)
ARM was done when the cervix was 4 cm. dilated and an oxytocin infusion was started 2 hours later as the contractions were infrequent.
She reached the 2nd. stage 6 hours after the ARM. You are called to see her 30 minutes later as the CTG shows variable decelerations and loss of baseline variability.
The fetal head is not palpable abdominally and vaginal examination shows a cephalic presentation 1 cm. below the spines and the position DOA.
What will be your management?
Scenario 2.
A 40-year-old grande-multip with BMI 35 goes into labour at 38 weeks. She decides to have an epidural as she has not had one before and would like the experience. An effective block has been sited. She reaches the second stage 4 hours after admission. The epidural is not topped up and active pushing starts 30 minutes later. After 1 hour a FHR deceleration to 60 b.p.m. with slow recovery and loss of variability is noted. On abdominal examination, the head is < 1/5 palpable. Vaginal examination shows the head to be just above the ischial spines with moderate caput and moulding. What will be your management?
Scenario 3.
A 29-yr-old woman with IDDM is admitted at 36 weeks’ gestation with ketoacidosis and a blood sugar of 15 mmol/l. A CTG is done and the FHR is 180 b.p.m. with loss of variability and variable decelerations. What will be your management?
Scenario 4.
A 30-year-old woman with a previous normal delivery is admitted in labour for a planned vaginal breech delivery. On admission the cervix is 6 cm. dilated and a flexed breech presents 2 cm. below the spines. Two hours later the fetal heart rate rises to 160 b.p.m. with loss of variability and variable decelerations. Fresh meconium is passed. What will be your management.
Scenario 5.
A 35-year-old woman with a previous normal delivery is admitted in labour for a planned vaginal delivery. On admission the cervix is 6 cm. dilated and a cephalic presentation is confirmed with the presenting part 2 cm. below the spines. Two hours later the cervix is 9 cm. dilated and the presenting part is on the perineum. The fetal heart rate has risen to 150 b.p.m. with loss of variability and variable decelerations. Fresh meconium is passed. A FBS shows a pH of 7.3. What will be your management?
Scenario 6.
A 35-year-old woman with a previous normal delivery is admitted in labour. On admission the cervix is 6 cm. dilated and a cephalic presentation is confirmed with the presenting part 2 cm. below the spines. Two hours later the cervix is fully dilated and the presenting part is on the perineum. The fetal heart rate has risen to 150 b.p.m. with loss of variability and variable decelerations. Fresh meconium is passed. A FBS shows a pH of 7.2. What will be your management?
Scenario 7.
A 20 year-old nulliparous woman is admitted in labour at 33+5 weeks’ gestation. She reaches the 2nd. stage after 12 hours with the head in an OA position and 2 cm. below the spines. She becomes exhausted after 2 hours of active pushing. The FHR shows variable decelerations + loss of variability. A FBS shows a pH of 7.22. What will be your management?
Scenario 8.
A 20 year-old nulliparous woman is admitted in labour at 39+5 weeks’ gestation. An epidural is sited at her request when her cervix is 4 cm. dilated but a dural tap occurs. She complains of headache. What will be your management?
54. SBA. Operative vaginal delivery.
Operative vaginal delivery.  Based on work done by Aqeela Ayaz.

Abbreviations.
BHIVAG     BHIVA guideline:  “BHIVA guidelines for the management of HIV infection in pregnant women.” Updated May 2014
CA11:         RCOG’s Consent Advice 11: “Operative vaginal delivery.” July 2010
CPD:           cephalo-pelvic disproportion
Cs:              Caesarean section.
DVT:           deep vein thrombosis
GTG26:      RCOG’s Green-top Guideline No. 26: “Operative vaginal delivery.” January 2011
MCID:        mid-cavity instrumental delivery
NYHA:        New York Heart Association which has a functional capacity classification system 
OA:             occipito-anterior position
OP:             occipito-posterior position
OT:             occipito-transverse position
OVD:          operative vaginal delivery
PTSS:          post-traumatic stress syndrome
SS:               sagittal suture
SUI:             sequential use of instruments
VTE:            venous thromboembolism
                   
Question 1.
Lead-in. The use of which of the following is categorised as instrumental delivery?


  1.  
forceps delivery

  1.  
vacuum delivery

  1.  
manual rotation

  1.  
delivery with the Odent device

  1.  
delivery with Credé’s manoeuvre
Option List

  1.  
A + B

  1.  
A + B + D

  1.  
A + B + C + D

  1.  
A + B + D + E

  1.  
A + B + C + D + E

Question 2.
Lead-in. The following are included in the recommended classification of instrumental delivery in GTG26 with which exception?
Option List

  1.  
outlet

  1.  
low

  1.  
mid with sagittal suture ≤ 450 from the OA position

  1.  
mid with sagittal suture > 450 from the OA position

  1.  
high

Question 3.
Lead-in
What is the incidence of OVD in the UK?
Option List

  1.  
≤ 5%

  1.  
>5 % but <10%

  1.  
≥10 % but <15%

  1.  
≥15 % but <20%

  1.  
≥20%

Question 4.
Lead-in. What has been the trend in the incidence of OVD in the UK in recent years?
Option List

  1.  
the incidence has not changed significantly

  1.  
the incidence has increased by 25%

  1.  
the incidence has increased by 50%

  1.  
the incidence has decreased by 25%

  1.  
the incidence has decreased by 50%

Question 5.
Lead-in. Which, if any, of the following features would be grounds for considering OVD?

  1.  
suspected fetal compromise

  1.  
meconium staining of the liquor

  1.  
maternal pyrexia

  1.  
maternal myotonic dystrophy

  1.  
paternal myotonic dystrophy

  1.  
nullipara who has been “pushing” for 2 hours without evidence of continuing progress

  1.  
multipara who has been “pushing” for 2 hours without evidence of continuing progress
Option List

  1.  
all of the above

  1.  
all of the above except B + C

  1.  
all of the above except B + C + E

  1.  
all of the above except B + C + D + E

  1.  
none of the above

Question 6.
Lead-in. In relation to consent for OVD with the woman remaining in the delivery room, which, if any of the following statements are true.
Option List

  1.  
It can safely be assumed that all women capable of giving consent will have heard of OVD and no information on the subject needs to be given during antenatal care.

  1.  
It cannot safely be assumed that all women capable of giving consent will have heard of OVD.

  1.  
All women should be informed during antenatal care about the possibility of OVD being required.

  1.  
All women should be given enough information orally and in written form during antenatal care to ensure that they can give informed consent for OVD if required.

  1.  
All women should be given enough information orally and in written form during antenatal care to ensure that they can give informed consent for OVD and be asked to sign a consent form for OVD to ensure that there is valid consent if OVD is required.

Question 7.
Lead-in. In relation to consent for OVD with the woman transferred to theatre, which, if any of the following statements are true.
Option List
A.
It can safely be assumed that all women capable of giving consent will have heard of OVD and no information on the subject needs to be given during antenatal care.
B.
It cannot safely be assumed that all women capable of giving consent will have heard of OVD.
C.
Verbal consent suffices.
D.
Written consent should be obtained.
E.
Written consent should be obtained before attempting OVD for both OVD and Caesarean section in case OVD fails.

Question 8.
Lead-in. Which, if any, of the following measures can reduce the need for OVD?

  1.  
continuous support in labour, particularly by a supporter who is not a member of the labour ward team

  1.  
consumption of raspberry tea in labour

  1.  
use of erect or lateral position in labour

  1.  
delaying pushing in primiparae

  1.  
use of a personalised partogram taking account of height, BMI, ethnicity
Option List

  1.  
A + B

  1.  
A + B + D

  1.  
A + C + D

  1.  
A + C + D + E

  1.  
A + B + C + D + E

Question 9.
Lead-in. Which, if any, of the following are not contra-indications to the use of the vacuum extractor?
Option List

  1.  
blood-borne viral infection of mother

  1.  
gestational age less than 34 weeks

  1.  
asynclitism

  1.  
mento-anterior face presentation

  1.  
mento-posterior face presentation

  1.  
breech presentation

Question 10.
Lead-in. What are the pre-requisites for OVD?
There is no option list – just jot down as many as you can think of.

Question 11.
Lead-in. Which, if any, of the following statements are true when vacuum extraction (VE) is compared with forceps delivery?
Option List

  1.  
VE has a higher risk of failed delivery

  1.  
VE has an increased risk of cephalo-haematoma

  1.  
VE has an increased risk of risk of maternal retinal haemorrhage

  1.  
VE has an increased risk of neonatal retinal haemorrhage

  1.  
VE has an increased risk of maternal worry about the baby

  1.  
VE has an increased risk of perineal trauma

  1.  
VE has an increased risk of vaginal trauma

  1.  
VE has an increased risk of Caesarean section

  1.  
VE has a decreased risk of low Apgar score at 5 minutes

  1.  
VE has a decreased risk of the baby needing phototherapy

Question 12.
Lead-in. How do forceps and the different types of vacuum extractor rank in the likelihood of achieving vaginal delivery?
Option List

  1.  
forceps, hand-held vacuum extractor, metal cup vacuum extractor, soft cup vacuum extractor

  1.  
forceps, hand-held vacuum extractor, soft cup vacuum extractor, metal cup vacuum extractor

  1.  
forceps, metal cup vacuum extractor, hand-held vacuum extractor, soft cup vacuum extractor

  1.  
forceps,  metal cup vacuum extractor,  soft cup vacuum extractor hand-held vacuum extractor

  1.  
forceps, soft cup vacuum extractor, metal cup vacuum extractor, hand-held vacuum extractor

Question 13.
Lead-in. What is the role of episiotomy in OVD? Which, if any, of the following statements are true?
Option List

  1.  
episiotomy should be done in all primiparous women and all multiparous women who have had episiotomy before

  1.  
episiotomy should not be done unless 3rd. of 4th. degree tears are anticipated

  1.  
a policy of liberal use dependent on the operator’s judgement is advocated in GTG26

  1.  
a policy of restrictive use dependent on the operator’s judgement is advocated in GTG26

  1.  
GTG26 does not advise

Question 14.
Lead-in. When should attempted OVD be abandoned?
Option List

  1.  
after 3 pulls

  1.  
when there is no progressive descent

  1.  
when, using moderate traction,  there is no progressive descent or delivery is not imminent after 3 pulls

  1.  
when there is no progressive descent or delivery is not imminent after 3 pulls

  1.  
when the operator needs a rest

Question 15.
Lead-in
When should a clinical incident form be submitted after OVD?
Option List

  1.  
all OVDs

  1.  
all OVDs that fail to deliver the baby

  1.  
all OVDs with an adverse outcome

  1.  
all OVDs with an adverse outcome excluding failure to deliver the baby

  1.  
all OVDs with injury to the baby or low 5-minute Apgar scores

Question 16.
Lead-in.
What is the main reason for medical litigation in relation to OVD
Option List

  1.  
sneezing during traction

  1.  
not abandoning the procedure at the appropriate time

  1.  
pulling too hard, too long or too many times

  1.  
using more than one instrument

  1.  
failure to push the head up when C section is needed to deliver the baby

Question 17.
Lead-in
What advice is given in GTG26 in relations to sequential use of instruments for OVD.
Option List

  1.  
sequential use should be avoided if possible

  1.  
sequential use increased the risk of trauma to the baby

  1.  
sequential use increases the risk of the neonate needing mechanical ventilation

  1.  
sequential use may particularly indicated with outlet deliveries

  1.  
all of the above

  1.  
some of the above, but I don’t know which.

Question18.
Lead-in. With regard to prophylactic antibiotics for OVD, which, if any, of the following statements is true?
Option List

  1.  
a broad spectrum antibiotic + metronidazole should be prescribed and continued for 5 days

  1.  
erythromycin + metronidazole or clindamycin should be prescribed and continued for 5 days

  1.  
a broad spectrum antibiotic + metronidazole should be prescribed initially and the drugs reviewed with the results of rectal and vaginal swabs taken at delivery. The final drug regime should be continued for 5 days

  1.  
prophylactic antibiotics should be decided with advice from the bacteriologist to reflect local trends in infecting organism and antibiotic sensitivity for genital and urinary tract infections.

  1.  
prophylactic antibiotics are not required.

Question 19.
Lead-in. What prophylaxis should be provided after OVD to reduce the risk of DVT & VTE
Option List

  1.  
early mobilisation and good hydration unless the woman has thrombophilia

  1.  
early mobilisation, good hydration, graded compression stockings + warfarin

  1.  
early mobilisation, good hydration, graded compression stockings + LMWH

  1.  
early mobilisation, good hydration, graded compression stockings + warfarin

  1.  
none of the above

Question 20.
Lead-in. What pain relief should be prescribed after OVD?
Option List

  1.  
aspirin

  1.  
aspirin + codeine

  1.  
aspirin + codeine + paracetamol

  1.  
paracetamol and diclofenac

  1.  
paracetamol and ibuprofen

Question 21.
Lead-in. Which, if any, of the following would represent minimum bladder care after OVD in women not having regional anaesthetic blocks?
Option List

  1.  
documentation of the timing and volume of the first void

  1.  
24 hour input / output chart

  1.  
self-reporting of voiding difficulty

  1.  
physiotherapy-directed strategies to reduce risk of UI

  1.  
bladder training

Question 22.
Lead-in. Which, if any, of the following would represent minimum bladder care after OVD in women who have had regional anaesthetic blocks topped up for trial of OVD?
Option List

  1.  
indwelling catheter for ≥ 12 hours

  1.  
input / output charting to ensure good voiding volumes

  1.  
self-reporting of voiding difficulty

  1.  
physiotherapy-directed strategies to reduce risk of UI

  1.  
bladder training

Question 23.
Lead-in. How effective is physiotherapist-provided intervention in reducing UI after OVD?
Option List

  1.  
it reduces UI from about 50% to about 40%

  1.  
it reduces UI from about 50% to about 30%

  1.  
it reduces UI from about 40% to about 30%

  1.  
it reduces UI from about 40% to about 20%

  1.  
it doesn’t work at all – it is just a measure to keep women happy that something is being done

Question 24.
Lead-in. After OVD, the pre-discharge review is best done by whom?
Option List

  1.  
a midwife with de-briefing skills

  1.  
the senior midwife on the postnatal ward

  1.  
the doctor who performed the delivery

  1.  
the consultant under whose care the woman booked

  1.  
the SpR on-call for the postnatal wards

Question 25.
Lead-in. GTG26 mentions that OVD can be linked to women developing a PTST syndrome with sever fear of childbirth. What is this called?
Option List


  1.  
androphobia

  1.  
iatrophobia

  1.  
parturophobia

  1.  
spermatophobia

  1.  
tocophobia

Question 26.
Lead-in. What advice does GTG give about strategies to reduce the risk of tocophobia.
Option List

  1.  
midwife de-briefing is effective but to only a small extent

  1.  
operator de-briefing is more effective than midwife de-briefing

  1.  
combined midwife & operatory de-briefing is the most effective intervention

  1.  
fortnightly visits to the same hospital antenatal team are of proven value

  1.  
there are no interventions of proven value

Question 27.
Lead-in. What proportion of women at 3 years after OVD indicate that they plan not to have further children?
Option List

  1.  
5%

  1.  
10%

  1.  
25%

  1.  
50%

  1.  
100%

Question 28.
Lead-in. What advice should women be given about future deliveries after OVD?
Option List

  1.  
aim for normal delivery

  1.  
best with planned Caesarean section

  1.  
anticipate likely need for OVD

  1.  
best not to get pregnant


55. DSDs: AIS, MRKH and Swyer’s syndrome
Lead-in.
The following scenarios relate to disorders of sexual development.
Pick the option from the option list that best fits each scenario.
Each option can be used once, more than once or not at all.
Abbreviations.
AIS:       androgen insensitivity syndrome.
AMH:    anti-Mullerian hormone.
CAH:     congenital adrenal hyperplasia.
CAI:       complete androgen insensitivity syndrome.
DSD:     disorder of sexual differentiation.
KS:         Kallmann’s syndrome.
LMB:     Laurence-Moon-Biedl syndrome.
MRKH:  Mayer-Rokitansky- Küster-Hauser syndrome.
PAI:       partial androgen insensitivity syndrome.
PW:       Prader-Willi syndrome.
SW:       Swyer’s syndrome.
TU:        Turner’s syndrome.
UPD:     uni-parental disomy.
Option list 1.
A.        has a uterus of normal size for her age.
B.         has a uterus that is hypoplastic for her age.
C.         has a vestigial uterus (anlagen).
D.        has no uterus.
E.         commonly has esthiomene
F.         I don’t know and I don’t care.
G.        the question makes no sense.
H.        none of the above.

Scenario 1.         a girl with congenital adrenal hyperplasia at the start of puberty.
Scenario 2.         a girl with complete androgen insensitivity syndrome at the start of puberty.
Scenario 3.         a girl with a disorder of sexual differentiation at the start of puberty.
Scenario 4.         a girl with Kallmann’s syndrome at the start of puberty.
Scenario 5.         a girl with Laurence-Moon-Biedl syndrome at the start of puberty.
Scenario 6.         a girl with Mayer-Rokitansky-Kuster-Hauser syndrome at the start of puberty.
Scenario 7.         a girl with partial androgen insensitivity syndrome at the start of puberty.
Scenario 8.         a girl with Prader-Willi syndrome at the start of puberty.
Scenario 9.         a girl with Swyer’s syndrome at the start of puberty.
Scenario 10.       a girl with Turner’s syndrome at the start of puberty.

56. Haemophilia 1.
Lead-in.
The following scenarios relate to haemophilia A, factor VIII deficiency  (HA).
For each, select the most appropriate answer  from the option list.
Each option can be used once, more than once or not at all.
Scenario 1.
A woman attends for pre-pregnancy counselling. Her brother has haemophilia A. What is her risk of being a carrier?
Scenario 2.
A woman attends for pre-pregnancy counselling. Her father has haemophilia A. What is her risk of being a carrier?
Scenario 3.
If she is tested and found to be a carrier, what tests will you arrange for her partner?
Scenario 4.
If she is a carrier, what is the risk to her male offspring?
Scenario 5.
If she is a carrier, what is the risk to her female offspring?
Scenario 6.
If she is a carrier and her partner has haemophilia A, what are the risks to their female offspring?
Scenario 7.
If she is a carrier and her partner has haemophilia A, what are the risks to their male offspring?


57. Haemophilia 2.
Lead-in.
The following scenarios relate to haemophilia A and pre-pregnancy counselling.
For each, select the most appropriate risk from the option list.
Pick one option from the option list.
Each option can be used once, more than once or not at all.
Option list.
A.
0 %
B.
0.1 %
C.
1 %
D.
12.5 %
E.
13.3%
F.
20 %
G.
25 %
H.
33 %
I.
50 %
J.
66.6%
K.
68 %
L.
75 %
M.
80 %
N.
90 %
O.
100 %
P.
200 %

Scenario 1.
A nulliparous 20-year-old wishes to know the risk of her being a carrier as her father has mild haemophilia A.
Scenario 2.
A nulliparous 20-year-old wishes to know the risk of her being a carrier as her father has severe haemophilia A.
Scenario 3.
A para 3, 30-year-old wishes to know the risk of her being a carrier as her mother is a carrier.
Scenario 4.
A para 0+4, 25-year-old wishes to know the risk of her being a carrier as her sister has an affected son.
Scenario 5.
A para 6, 40-year-old wishes to know the risk of her being a carrier as her daughter has had an affected baby.
Scenario 6.
 A nulliparous woman wishes to know the risk of a son having haemophilia as she is a carrier.
Scenario 7.
A nulliparous woman wishes to know the risk of a son having haemophilia as her husband has haemophilia A.
Scenario 8.
A nulliparous woman wishes to know the risk of a daughter being a carrier as she is a carrier.
Scenario 9.
A nulliparous woman wishes to know the risk of a daughter being a carrier as her husband has haemophilia A.
Scenario 10.
A nulliparous woman wishes to know the risk of a son having haemophilia as her paternal grandfather had haemophilia A.
Scenario 11.
A nulliparous woman wishes to know the risk of a son having haemophilia as her maternal grandfather had haemophilia A.
Scenario 12.
A nulliparous woman wishes to know the risk of a son having haemophilia as her husband’s paternal grandfather had haemophilia A.
Scenario 13.
A nulliparous woman wishes to know the risk of a son having haemophilia as her husband’s maternal grandfather had haemophilia A.
Scenario 14.
A nulliparous woman wishes to know the risk of a son having haemophilia as her mother’s brother has haemophilia A.
Scenario 15.
A nulliparous woman wishes to know her risk of being a carrier as she has read about it in a magazine. There is no family history of haemophilia A.






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