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MRCOG PART 2 SBAs and EMQs

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essay 295

essay 295 Posted by wafa T.

 

A                                                                                                                                          

.  I will ask about last menstrual period  and if  any irregularity and if she  completed her family ,current contraceptive history which method she uses . Pervious history of pelvic inflammatory disease  or abdominal surgery because it increase risk of abdominal and pelvic adhesions .Cervical smear history   .                     

Examination  abdominal  examination for abdominal masses . pelvic examination for pelvic  tenderness  uterine tenderness  and mobility also cervical motion tenderness.                                                                   

Urine pregnancy test to exclude pregnancy.                                                                                                        

              B                                                                                                                                                                         

Women  should be competent to give consent for sterilization  ,explanation to her procedure and use of alternative method  for contraception  including   long term reversible methods , vasectomy which has failure rate 1/2000 but tubal ligation failure rate 1/200 . tubal ligation should be done  during follicular phase of period to exclude  luteal phase pregnancy . Sterilization can be done through minilaparotomy ,  laparoscopy or hysteroscopy.  Laparoscopic  tubal ligation carries risk of vascular and bowel injury  and incisional hernia  but laparoscopic surgery faster than minilapartomy and less postoperative pain and will be done in day care clinic. Reversal of sterilization or Ivf are not funded by NHS. There is increase risk of ectopic pregnancy0—7%  but risk less than that in women non sterilized  . There no increase risk of menorrhagia  after tubal ligation . supply the women  with written informations.                                                                                                             

                                                                                                                                                                                     C

Patient selection  decrease risk of procedure . surgeon must be competent familiar with the equipment , instrument and energy source . staff also must be trained well. Choice of entry method  suitable for patient  in case of obese or pervious abdominal surgery  open method decrease risk of vascular injury. Incision should be subumblical . verres needle should be tested to its spring action . operating table should be horizontal . palpation  to feel any  abdominal   masses and abdominal aorta . stabilization of abdominal wall and insertion of verres  needle at 45 degree  , keep intra abdominal  pressure from 20---25 mmhg during insertion of primary trocar . After introduction of laparscopy   360 degree  view af abdominal cavity to make sure that no vascular or bowel injury . insertion of secondary trocar under vision to avoid injury of inferior  hypogatric vessel

Posted by Farrukh G.

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