Tutorial 13th. November 2017

13^th. November 2017.

1	How to prepare. What to read. Revision system. Study buddies. Statistics. Urogynae.
2	RCOG sample EMQs and SBAs. These have featured in the exam, so you need to be able to answer them. Links are below.
3	EMQ. Surrogacy.
4	SBA. Placenta accreta, increta & percreta.
5	SBA. Cowden syndrome
6	Basic communication skills.

1.     How to prepare.

2.     RCOG Sample EMQ & SBA questions

         The RCOG has general advice about how to complete the questions, proportions of marks etc.

         here.

         There are sample questions that have also featured in the exam, so make sure you can answer them. Sample EMQs. Obstetric SBAs. Gynaecology SBAs.

3.     EMQ. Surrogacy.

Lead-in.

This question is about surrogacy. For each scenario, pick the best choice from the option list or provide the appropriate answer – some are not EMQs! Each option can be used once, more than once or not at all.

Abbreviations.

CF:              commissioning father

CM:            commissioning mother

CPs:            commissioning parents

PO:             parental order

SM:             surrogate mother

Option List.

a)      CM

b)      CF

c)       CPs

d)      SM

e)      Chairman of the HFEA

f)        Senior judge at the Children and Family Court

g)       traditional surrogacy

h)      gestational surrogacy

i)        HFEA

j)        SSAEW

k)       RCOG Surrogacy Sub-Committee

l)        false

m)    true

n)      none of the above

Scenario 1

List the different types of surrogacy.

Scenario 2.

“Gestational” surrogacy has better “take-home-baby” rates than “traditional” surrogacy.

Scenario 3.

There are approximately 1,000 surrogate pregnancies per annum in the UK. True/False

Scenario 4.

Which national body regulates surrogacy in England?

Scenario 5.

Privately-arranged surrogate pregnancies are illegal and those involved are liable to up to 2 years in prison. True/False

Scenario 6.

List the risks of surrogacy.

Scenario 7.

Obstetricians are legally obliged to take the CPs’ wishes into consideration in managing pregnancy complications or problems.

Scenario 8.

The psychological outcomes of surrogacy are fully understood. True/False.

Scenario 9.

The psychological outcomes of surrogacy are more severe after traditional surrogacy. True/False

Scenario 10.

Who has the right to arrange TOP if the fetus is found to have a major congenital abnormality?

Scenario 11.

A PO is active from the moment it is completed and signed by the relevant parties.  True/False

Scenario 12.

A SM can change her mind at any time and keep the child, even if the egg was not hers.  True/False

Scenario 13.

The CPs can change their mind, leaving the SM as the legal mother.  True/False

Scenario 14.

A SM’s husband is the legal father until adoption is completed or a PO comes into force.

Scenario 15.

A lesbian couple in a stable, co-habiting relationship can be CPs and become the legal parents of the child of a SM.

Scenario 16.

CPs are likely to get faster legal status as the legal parents through application for a PO rather than applying for adoption.

4.     SBA. Placenta accreta, increta & percreta

Placenta accreta increta & 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.	Placenta which 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 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
B.	1-2 per   1,000 maternities
C.	1-2 per   5,000 deliveries
D.	1-2 per   5,000 maternities
E.	1-2 per 10,000 deliveries
F.	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.	Any pregnancy, including ectopic pregnancy
B.	Any pregnancy, excluding ectopic pregnancy
C.	Any pregnancy resulting in a live birth
D.	Any pregnancy resulting in live birth or stillbirth
E.	Any pregnancy ending from 24 completed weeks plus any pregnancy resulting in a live birth.

Question 6.

Lead-in

Why is the term “maternity” important.

Option List

A.	We should take best possible care of our pregnant patients
B.	It is used as the denominator in calculations of the maternal mortality rate
C.	It is used as the numerator in calculations of the maternal mortality rate
D.	It is used as the denominator in calculations of the maternal mortality ratio
E.	It is used as the numerator in calculations of the maternal mortality ratio

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
BMI > 30
Cigarette smoking in pregnancy
Ethnic group non-white
IVF pregnancy
Maternal age > 35
Parity ≥ 2
PIH or PET
Placenta previa diagnosed pre-delivery
Previous Caesarean section > 1
Previous Caesarean section x 1
Previous uterine surgery – not C. section

Option List

Adjusted odds ratio
0.53
0.57
0.66
0.9
1.0
2.0
3.06
3.4
3.48
10
14
16.31
32.13
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
No previous C section
≥ 1 C section
Placenta previa not diagnosed pre-delivery
Placenta previa diagnosed pre-delivery
Previous C section but placenta previa not diagnosed pre-delivery
Previous C section + placenta previa diagnosed pre-delivery

Option List

0.3
0.6
1
3
5
9
108
577
1,000

5.     SBA. Cowden syndrome

Cowden syndrome.

Scenario 1.

Lead in.

Which feature is associated with Cowden syndrome?

Option list.

A.     albinism

B.     hamartoma

C.     hammer-toe

D.     hypertrichosis

E.     stammer

Scenario 2.

Lead in. Which condition has the highest risk of occurrence in women with Cs?

Option list.

A.     breast cancer

B.     bowel cancer

C.     congenital absence of Müllerian tract derivatives

D.     hypertension

E.     hypothyroidism

Scenario 3.

Lead in. Which gynaecological cancer is a particular risk for women with Cs?

Option list.

A.     Bartholin’s gland cancer

B.     cervical cancer

C.     choriocarcinoma

D.     endometrial cancer

E.     vulval cancer

Scenario 4.

Lead in. Which cancer is more common in men with Cs?

Option list.

A.     breast cancer

B.     colon cancer

C.     melanoma

D.     renal cancer

E.     thyroid cancer

F.      all of the above

6.     Basic communication skills.