14 November 2016.
1
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How to prepare. What to read. Revision
system. Study buddies. Statistics. Urogynae.
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2
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SBA. RCOG sample obstetric
questions.
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3
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EMQ. Surrogacy.
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4
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Basic communication skills.
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5
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SBA. Placenta accreta, increta &
percreta.
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6
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EMQ. Antenatal steroids.
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1 How
to prepare.
What to
read. Revision system. Study buddies. Statistics. Urogynae.
2 SBA.
RCOG sample obstetric
These can be downloaded from the RCOG website: https://www.rcog.org.uk/en/careers-training/mrcog-exams/part-2-mrcog/format/part-2-mrcog-sbas-single-best-answer-questions/part-2-mrcog-obstetric-sbas/. Some of
the sample questions have come in the exam, so it is worth going through them.
3 Surrogacy.
I have put this in to illustrate the point that even seemingly
super-specialised TOG articles can feature in the exam. There was a TOG
article: “Surrogate pregnancy: ethical
and medico-legal issues in modern obstetrics” by Celia Burrell and Hannah
O'Connor, that I suspect that most people barely read. TOG. Volume 15,
Issue 2, April 2013; Pages 113–9. The topic turned up as part of an
OSCE a year or two later. There are a number of key legal points, which we will
discuss.
Abbreviations.
ART: assisted
reproductive technology
CF: commissioning father
CM: commissioning mother
CPs: commissioning parents
PO: parental order
SM: surrogate mother
SSAEW: Surrogacy Supervisory
Authority England and Wales.
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. True/False
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. True / False
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 SM
decides at 10 weeks that she does not wish to be pregnant and arranges to have
a TOP. The CPs. hear about this and object strongly. To whom should they apply
to have the TOP blocked?
Scenario
12.
A woman
has hysterectomy and BSO to deal with extensive endometriosis at the age of 30.
She marries two years later and her sister offers to act as surrogate. She
undergoes IVF and 4 embryos are created. One is transferred and a successful
pregnancy ensues. The baby is adopted by the woman and her husband. The 3
remaining embryos were frozen. Four years later the woman falls out with her
sister, but finds another surrogate and wishes to proceed with another
pregnancy. The sister says she does not want her eggs to be used and that the
frozen embryos should not be transferred. Does the sister have the legal right
to block the use of the embryos? Yes / No.
Scenario
13.
A girl
born from donor sperm reaches the age of 16 and wishes to know the identity of
her genetic father. Does she have the right to this information? Yes / No.
Scenario
14.
A girl
born from donor sperm reaches the age of 18 and wins a place at Oxford
University to read medicine. Does she have the legal right to get the donor to
contribute to her fees? Yes / No.
Scenario
15.
A PO is active from the moment
it is completed and signed by the relevant parties. True/False
Scenario
16.
A SM can change her mind at any
time and keep the child, even if the egg was not hers. True/False
Scenario
17.
The CPs can change their mind,
leaving the SM as the legal mother.
True/False
Scenario
18.
A SM’s husband is the legal
father until adoption is completed or a PO comes into force. True/False
Scenario
19.
A
lesbian couple in a stable, co-habiting relationship can be CPs and become the
legal parents of the child of a SM. True/False
Scenario
20.
CPs are
likely to get faster legal status as the legal parents through application for
a PO rather than applying for adoption. True/False
4 Basic
communication skills
5 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
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B.
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Placental villi invade
the decidua, but not the myometrium
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C.
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Placental villi invade
the decidua and myometrium but not the serosa
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D.
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Placental villi invade
the decidua, myometrium and serosa
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E.
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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.
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1-2 per 1,000 deliveries
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B.
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1-2 per 1,000
maternities
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C.
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1-2 per 5,000 deliveries
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D.
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1-2 per 5,000
maternities
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E.
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1-2 per 10,000 deliveries
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F.
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1-2 per 10,000 maternities
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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.
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Any pregnancy, including ectopic pregnancy
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B.
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Any pregnancy, excluding ectopic pregnancy
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C.
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Any pregnancy resulting in a live birth
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D.
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Any pregnancy resulting in live birth or stillbirth
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E.
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Any pregnancy ending from 24 completed weeks plus any pregnancy
resulting in a live birth.
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Question
6.
Lead-in
Why is the term “maternity”
important.
Option
List
A.
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We should take best possible care of our pregnant patients
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B.
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It is used as the denominator in calculations of the maternal
mortality rate
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C.
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It is used as the numerator in calculations of the maternal
mortality rate
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D.
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It is used as the denominator in calculations of the maternal mortality
ratio
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E.
|
It is used as the numerator in calculations of the maternal
mortality ratio
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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
|
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Cigarette
smoking in pregnancy
|
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Ethnic
group non-white
|
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IVF
pregnancy
|
|
Maternal
age > 35
|
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Parity
≥ 2
|
|
PIH
or PET
|
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Placenta
previa diagnosed pre-delivery
|
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Previous
Caesarean section > 1
|
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Previous
Caesarean section x 1
|
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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
|
6 EMQ.
Antenatal steroids
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.
Abbreviations.
ANS: antenatal steroids.
FGR: fetal growth restriction.
GTG: Green-Top Guideline No 7 from the RCOG.
“Antenatal Corticosteroids to Reduce Neonatal Morbidity and Mortality.”
RDS: respiratory distress syndrome. In ancient
times known as “hyaline membrane disease”. Now better known as
“surfactant-deficient lung disease of the new-born”.
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?
