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MRCOG PART 2 SBAs and EMQs

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Topic: essay 191

Topic: essay 191 Posted by Tanzeem Sabina C.

In case of a woman requesting a termination of pregnancy (TOP), it is important to treat the patient with sympathy and respect. Those who require more support in decision making should be identified (those with a psychiatric history, poor social support, ambivalence before abortion, membership of a cultural group that consider abortion wrong) and facilities for additional support, including access to social services should be available.
The procedure should, ideally be done within a week of the appointment. But as a minimum standard, should not wait longer than 3 weeks. Because most of the complications occur in late pregnancy than early pregnancy. At the same time of course adequate time should be allowed for the woman to consider her decision. One must make sure that the abortion certificate is completed and signed.
Information for woman of professionals should emphasize the duty of confidentiality by which as for any form of health care, all concerned with the provision of induced abortion are found.
She should be given accurate knowledge about possible complication and sequelae of abortion.
Genital tract infection can occur in up to 10% of cases. This can be avoided by taking swabs at the time of the procedure and administering metronidazole 1g rectally at the time of the time of the procedure. Additionally, doxycycline 100 mg twice daily, should be commenced for a week.
Measurement of Hb concentration, ABO and Rh blood with screening for red cell antibodies should be carried out. Give anti-D following the procedure if the woman is Rh negative.
Testing for haemoglobinopathies, HIV, Hepatitis B and C is indicated if there are any individual risk factors
It is not cost effective routinely to crossmatch woman.
Scanning facilities should present, as it can be necessary in abnormal pregnancy, but not considered to be essential prerequisite of TOP.
The main complication at the time of abortion is haemorrhage with an incident of 1 in 1000, which may be reduced with oxytocic drugs.
Uterine perforation is not common with an incident of 1-4/1000. Cervical trauma at the time of surgical abortion is 1 in 100. These can be avoided by cervical priming prior to surgery and the performance of procedure by a fully trained and experienced surgeon.. Cervical priming can be done with gemeprost 1mg vaginally 3h prior to surgery.
Alternatively, misoprostol 400ug vaginally 3h prior to surgery can be used.
A third method of cervical priming is the use of mifepristone 200g orally 36h prior to surgery.
In case of suspected uterine perforation, a laparoscopy should be carried out, followed by a laparotomy if necessary.
Uterine rupture is uncommon in this situation.
There is small risk of failed abortion around 2.3 in 1000.
There are no proven association between induced abortion and subsequent ectopic pregnancy, placenta praevia or infertility, but may be small increase in the risk of subsequent miscarriage or preterm delivery.
Psychological sequelae must be born in mind that these findings do not imply a causal association and may reflect continuation of pre-existing conditions.
Conventional suction termination under general or local anaesthesia as a day case procedure is an appropriate method at this gestation.
Before she is discharged following abortion, the patient should have agreed a future contraceptive plan and should be offered contraceptive supplies. The chosen method of contraception should be initiated immediately following abortion.
On discharge the patient should be given a letter that give sufficient information about the procedure. A follow-up appointment within 2 weeks of the procedure should be offered to her. Facilities for additional counselling if required should be made available to her.
Posted by Tanzeem Sabina C.
Dear Paul please reply, this is my first attempt.
Topic: essay 191
A healthy 20 year old primigravida has been counselled and accepted for surgical termination of an unwanted pregnancy at 10 weeks gestation. Evaluate the measures that can be taken to minimise the risk of morbidity and mortality.
In case of a woman requesting a termination of pregnancy (TOP), it is important to treat the patient with sympathy and respect. Those who require more support in decision making should be identified (those with a psychiatric history, poor social support, ambivalence before abortion, membership of a cultural group that consider abortion wrong) and facilities for additional support, including access to social services should be available.
The procedure should, ideally be done within a week of the appointment. But as a minimum standard, should not wait longer than 3 weeks. Because most of the complications occur in late pregnancy than early pregnancy. At the same time of course adequate time should be allowed for the woman to consider her decision. One must make sure that the abortion certificate is completed and signed.
Information for woman of professionals should emphasize the duty of confidentiality by which as for any form of health care, all concerned with the provision of induced abortion are found.
She should be given accurate knowledge about possible complication and sequelae of abortion.
Genital tract infection can occur in up to 10% of cases. This can be avoided by taking swabs at the time of the procedure and administering metronidazole 1g rectally at the time of the time of the procedure. Additionally, doxycycline 100 mg twice daily, should be commenced for a week.
Measurement of Hb concentration, ABO and Rh blood with screening for red cell antibodies should be carried out. Give anti-D following the procedure if the woman is Rh negative.
Testing for haemoglobinopathies, HIV, Hepatitis B and C is indicated if there are any individual risk factors
It is not cost effective routinely to crossmatch woman.
Scanning facilities should present, as it can be necessary in abnormal pregnancy, but not considered to be essential prerequisite of TOP.
The main complication at the time of abortion is haemorrhage with an incident of 1 in 1000, which may be reduced with oxytocic drugs.
Uterine perforation is not common with an incident of 1-4/1000. Cervical trauma at the time of surgical abortion is 1 in 100. These can be avoided by cervical priming prior to surgery and the performance of procedure by a fully trained and experienced surgeon.. Cervical priming can be done with gemeprost 1mg vaginally 3h prior to surgery.
Alternatively, misoprostol 400ug vaginally 3h prior to surgery can be used.
A third method of cervical priming is the use of mifepristone 200g orally 36h prior to surgery.
In case of suspected uterine perforation, a laparoscopy should be carried out, followed by a laparotomy if necessary.
Uterine rupture is uncommon in this situation.
There is small risk of failed abortion around 2.3 in 1000.
There are no proven association between induced abortion and subsequent ectopic pregnancy, placenta praevia or infertility, but may be small increase in the risk of subsequent miscarriage or preterm delivery.
Psychological sequelae must be born in mind that these findings do not imply a causal association and may reflect continuation of pre-existing conditions.
Conventional suction termination under general or local anaesthesia as a day case procedure is an appropriate method at this gestation. Local anaesthesia is a better option, as it has lower anaesthetic complication.
After TOP analgesia will be given as paracetamol or NSAIDs for pain control.
Prophylactic antibioticshouldl be given to control infection if previously not given.
Before she is discharged following abortion, the patient should have agreed a future contraceptive plan and should be offered contraceptive supplies. The chosen method of contraception should be initiated immediately following abortion.
On discharge the patient should be given a letter that give sufficient information about the procedure. A follow-up appointment within 2 weeks of the procedure should be offered to her. Facilities for additional counselling if required should be made available to her.