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MRCOG PART 2 SBAs and EMQs

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AnswerQ.367

AnswerQ.367 Posted by suha F.

A. Initial assessment of pt by taking hx. of her presenting symptoms fatigue dizzines tiredeness,Medical disorder that affect absorbtion or lead to bleeding and associated anaemia as inflamatory bowel disorder,personal and family HX. of haemoglobinopathy and bleeding disorder,surgical HX.asgut resection surgery affect iron abs., Iwill perform general EX. looking for palor ,abd. for splenomegaly associated with haemoglobinopathy,looking for fudal level and listen to F,H. Then iwill do routine booking investigation and estimate blood indicies including MCH,MCV ,MCHC, LOOking for iron binding capacity and serum ferritin to confirm iron deficiency, blood film,haemoglibinopathy screen if +ve F.HX. 

B.In case of cnfirmed iron deficiency anaemia oral iron the prefered ist line R. provided there is good compliance but associated with GIT. A.E. monitored by blood indicies every 2wk expected .8 gm increase. parenteral iron if oral not tolerated ,not absorbed, or pt. compliance in doubt, itis associated with more rapid increase in HB. level and fewer GIT.  A.E. in case of no response till 3rd trimester or in extreme circumstances blood transfusion will be offered ,esp if itis associated with haemoglobinopathy.

C. this is high risk pregnancy as anaemia associated with risk of pih. abriptio plcenta, pph, so shoud be documented plan for her intrapartum care and mode of deliveryagred by consultant OBST. and haematologist involved. blood bank shoud be notified and sample for gp and save or X-match acc. to locally agreed protocol and in line with pt clinicalm condition there shoud be cont. electronic fetal monitoring and low threshold for AB. as pt at risk of infiction ,watch for sign of abruption and keep monitoring of B.P. ,there shoud be active MGT of 3rd stage of labour, POST Partum risk of pph and fbc shoud be sent to guide continuing mgt in fit healthy no role for B.T. if hb above 7gm ,avoid contraception associated with irregular bleeding and breast feeding encoureged in high risk gp N.N. screened for haemoglibinopathyand pt encoureged to take iron supplement and advised early booking next pregnancy.