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MRCOG PART 2 SBAs and EMQs

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Essay 354

Essay 354 Posted by K9 S.

Hello Paul.

I have posted my answer quite early and it han't been corrected. Few questions posted after mine have been reviewed.  Would you check that and kindly review it please. 

BW

essay 354 answer Posted by sawsan M.

(a)-patient should be seen early to give her fair enough time to make informed decision for opting for irreveversible mode of sterlization.reasons  should be explored likehistory  menorahgia or birth trauma; with non judgmental and sympathetic way.she should be asked regarding her relation stability with her current partner..her past obstetric hx (no of living childeren and mode of delivery).request of serlizatuon immediate post prtum period is associated with high chance of regret.regarding past gynaecological history pt should be asked regarding PID,ENDOMETRIOSIS,and ECTOPIC PREGNANCY history.she should be asked regarding previous abdominal and pelvic surgical procedure which will make entry difficult duirng sterlization procedure.EXAMINATION;check BMI ,look for any scar mark of previous abdominal surgery.abdominal masses,bimanual pelvic examination for pelvic masses and uterine fixity.                                   (b);patient should be given evidence based information in a easily understand able way[information leaflet;videos etc].she should be informed regarding permanant nature of procedure and implication of this oto bladder n her future fertility and relation ship.she should be given information regading procedure ,that it is a key hole surgery in which camera is inserted through belly button ,one more hole may be required to complete the procedure and clips will be applied to her tubes.its a day case procedure can be dne under GA or LA.failure rate of the procedure is 1in 200.bladder or vasclar injury rate is 1in 1000 ,and risk of bowel injury is 2 in1000 risk of ectopic pregnancy is higher than the general population.she should be given information about other contraceptives like LARC and vasectomy.discussion should be properly documented and consent signed (.c )risk pregnancy can be reduced by doing sterlization procedure in follicular phase to prevent leuteal phase pregnancy.,and using effective contraception for a month before and after procedure .                                                                                                           .