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MRCOG PART 2 SBAs and EMQs

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About PPROM

About PPROM Posted by miss T.

Good day Sir!
What is the appropriate route to deliver cases of confirmed ruptured membranes before or at 34 weeks. The RCOG guideline, 2006 does not address this issue.
In last essay question, it is written  that before 34 weeks vaginal delivery to be conducted for all presentations and after 34 weeks, if presentation is non-cephalic, a CS is recommended.
What is the evidence of this info, is it RCOG recommendation?

And can you please tell what is the ideal answer for essay 340.
Thank you for considering reply sir!

PPROM Posted by PAUL A.

Which 'last essay question' are you referring to. I am not aware that we have recommended delivery by CS for non-cephalic presentations after 34 weeks. There are no guidelines for mode of delivery and you should have a discussion of risks and benefits and take account of the full clinical picture. If IOL is required then generally IOL would not be recommended for non-cephalic presentation near term. Whether you draw the line at 34 weeks or 36 weeks is subjective.

 

A marking scheme for essay 340 was posted several days ago.

Posted by miss T.

This is last essay question in the module of PPROM and pre-term labour and answer of part (c) is as highlighted below:

A healthy 27 year old woman presents with suspected rupture of the membranes at 28 weeks gestation. (a) How would you confirm the diagnosis? [4 marks] (b) You have confirmed the diagnosis and she is not in labour. What would you tell the woman? [10 marks] (c) Evaluate the factors that would determine the timing and mode of delivery [6 marks].

(c)
· Spontaneous onset of labour is the most likely consequence over the following 24h (1)

· Evidence of chorioamnionitis is the most likely indication for intervention to initiate delivery (1)

· Once pregnancy has progressed beyond 34 weeks, delivery should be considered and the risks and benefits discussed with the woman (1)

· Very rarely, membranes may re-seal. Vaginal loss stops, amniotic fluid re-accumulates. In these rare situations, pregnancy may be allowed to progress to term (1)

· If spontaneous labour ensures before term, vaginal delivery should be allowed even if breech presentation with CS for obstetric reasons (1)

· If induction of labour is required (chorioamnionitis or after 34 weeks), caesarean section should be recommended if non-cephalic presentation (1)

· Know the value of maternal wishes (1)