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MRCOG PART 2 SBAs and EMQs

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EMQ1476
SBA2073
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answer essay 366

answer essay 366 Posted by suha F.

A.Hysteroscorilisation using Essure is safe  up to 98% effective can be done under local anaesthesia in outpt. setting but laparoscopy shoud be general anaesthesia inpt. setting it is arelatively new technique for it only short term data available as compared to laparoscopy where there is short and long term safety data . Hysteroscopy need the woman to use alternative contraception till 12wk later or till confirmation of tubal blockage by imaging  but laparoscopy need contraception till onset of next peroid. Laparoscopy confirm on spot proper placement of the clip but Hysteroscpy need further imaging 3 month later or even 6 month . Laparoscopy allow evaluation of the pelvis but hysteroscpy doesnot. Hysteroscope assocociated with low complication rate

but lap. associated with bowel and visceral.inj.

 

B. to minimise risk with laparoscopy there shoud be proper training of surgeom and proper selection of pt. 

use alternative entry technique in case of high risk pt where there is prev, mid line scar or inflammatory bowel disorder. the verres needle shoud be sharp with agood tested spring action disposaple needle better used the operating table shoud be horizontal at the start of the procedure the creation of pneumoperitoneum

to 20-25 mmhg before the primary trocar and canula 

early identification of the injury and involvement of consultant at an early stage.incident report form shoud be filled in case of complication.