Monday 7 December 2015

Tutorial 7th. December 2015


7th. December 2015.

19
How to read exercise. Air Travel & Pregnancy. SIP 1. 2013. Extract key facts for the exam.
20
SBA. Operative vaginal delivery.
21
EMQ. Antenatal steroids.
22
EMQ. Cystic fibrosis.
23
Communication skills.

19.        Air travel & pregnancy. SIP 1. 2013.
Read the document, highlighting the important facts. See how long it takes. To complete the exercise, you need to put the facts into your revision system, but you can do that later.

20.         Operative vaginal delivery.  Based on work done by Aqeela Ayaz.

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
A
it reduces UI from about 50% to about 40%
B
it reduces UI from about 50% to about 30%
C
it reduces UI from about 40% to about 30%
D
it reduces UI from about 40% to about 20%
E
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 severe 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


21.         EMQ. Antenatal steroids and the neonate.
Lead-in.
The following scenarios relate to antenatal steroid use and the neonate.
Pick one option from the option list.
Each option can be used once, more than once or not at all.
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?

22.         EMQ. Cystic fibrosis.
For each scenario choose the option that gives the best answer.
Each option can be used once, more than once or not at all.
And, to make you behave in a model fashion, there is no option list, so you have to decide the correct answer.
Scenario 1.
A woman is 8 weeks pregnant and known to be a carrier of cystic fibrosis.
Her husband is Caucasian.
What is the risk of the child having cystic fibrosis?
Scenario 2.
A healthy woman attends for pre-pregnancy counselling.
Her brother has cystic fibrosis. Her husband is Caucasian.
He has been screened for cystic fibrosis. The test was negative.
What is the risk of them having a child with cystic fibrosis?
Scenario 3.
A healthy woman is a known carrier of cystic fibrosis.
She attends for pre-pregnancy counselling. Her husband has cystic fibrosis.
What is the risk of them having a child with CF?
Scenario 4.
A healthy woman attends for pre-pregnancy counselling. Her sister has had a child with cystic fibrosis.
What is her risk of being a carrier?
Scenario 5.
A woman attends for pre-pregnancy counselling. Her mother has cystic fibrosis.
What is the risk that she is a carrier?
Scenario 6 .
A woman attends for pre-pregnancy counselling. Her mother has cystic fibrosis.
The partner’s risk of being a carrier is 1 in X.
What is the risk that she will have a child with CF?
Scenario 7.
A healthy Caucasian woman is 10 weeks pregnant.
Her husband is a known carrier of cystic fibrosis.
Which test would you arrange?
Scenario 8.
A woman attends for pre-pregnancy counselling. She has read about diagnosing CF using cffDNA from maternal blood. Is it possible to test for CF in this way?
Scenario 9.
A woman and her husband are known carriers of cystic fibrosis.
What is the risk of them having an affected child.
Scenario 10.
A woman and her husband are known carriers of cystic fibrosis.
What can they do to reduce the risk of having an affected child?
Scenario 11.
A woman and her husband are known carriers of cystic fibrosis.
Can CVS exclude an affected pregnancy?
Scenario 12.
A woman with cystic fibrosis is planning pregnancy. Her husband is a  known carriers of cystic fibrosis. What is the risk of having an affected child?
Scenario 13.
A woman with cystic fibrosis has a normal delivery of a healthy, 3.2 kg. baby at term. She has been advised not to breastfeed because her breast milk will be protein-deficient due to malabsorption.
Is this advice correct?
Scenario 14.
A woman with cystic fibrosis has a normal delivery of a healthy, 3.2 kg. baby at term. She has been advised not to breastfeed because her breast milk will contain abnormally low levels of sodium.
Is this advice correct?



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2 comments:

  1. Unknown27 March 2016 at 05:07

    How can I get answers?

    ReplyDelete
    Replies
    1. drtmcf27 March 2016 at 11:09

      E-mail your answers and I'll e-mail mine. Contact details above. Tom.

      Delete

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