TEALE FENNING

Nick Raine-Fenning

Gynaecology 4: March 2008

Description of a 7 week confirmed missed miscarriage with intact sac;

Discuss her management options with particular reference to failure rates and complication rates (13 marks)

What factors might influence her decision (4 marks)

What would you tell her about subsequent pregnancies (3 marks)

Xerxes I · Posted: Sat Apr 19, 2008 4:39 pm Post subject:

Description of a 7 week confirmed missed miscarriage with intact sac;

Discuss her management options with particular reference to failure rates and complication rates (13 marks)

This is actually scary, When it seems easy god knows what they are after.
It specifies that they want us to "discuss Mx options" I'd rather it said: how would you manage her. What I am getting at is, it is not leaving room for quiet room, sensitive, feely touchy stuff, or does it?

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 949

touchy feely stuff, can still be put in. may be say ... the consultation for further options should be conducted in a quiet room, after having given condolences and offered her emotional support the options that can be offered are ................... may be end it with info leaflets and offer of counselor services if she wishes to avail of these etc.

go on give it a try
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region

Xerxes I · Posted: Sat Apr 19, 2008 5:33 pm Post subject:

I'm going to try this one on paper. This is my main worry: finger pain. I really have difficulty writing for more than half an hour. it just hurts and my handwriting becomes less and less legible.
Can we not dictate and give it to them to listen? I'm sure the examiners will be happier too. I'm being serious, have they considered it? It's a win-win situation.

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 949

S,

u need to try all of them on paper. i know the feeling, once u have started writing it gets better.

do write it. if you want me to take a look at it i don't mind.

r u on call today? spk to u soon.

r
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 949

premgunny · Joined: 09 Apr 2008 Posts: 16

I would like to consult the woman in a quiet room. I would approach her in a sympathetic supportive way and explaining to her about the scan findings and allow her to ask any queries and if she is uncertain then appropriate to arrange another scan in 10days. If she wants to move on, then the available options like surgical management under local and sedation or general anaesthesia. The suction curettage has advantage of less blood loss, less duration of procedure, day case procedure and less failure rate with complications like uterine perforation, cervical injury. The medical method using mifeprogesterone for cervical priming and misoprostol is an alternative. Even though it is cheap and highly effective, there chance of increase pain and prolonged bleeding and increased chance of retained products needing surgical procedure at the end. The expectant management should be conselled as non-interventional but complete resolution may take many weeks and increase risk of infection and need for surgical procedure and frequent hospital attendance.

Consell about the availability of dedicated early pregnancy unit availability for support and follow up whenever needed. Information leaflet to be given explaining all the options as only very little information is taken in these situations. Contact details for emergency and support groups should be provided.

premgunny · Joined: 09 Apr 2008 Posts: 16

Some women would prefer things to be done and dealt with and move on. They prefer surgical option as quick and complete as the psychological and physical stress due to prolonged pain and bleeding can be avioded. Some prefer to avoid invasive procedure with risk of uterine perforation and general anaesthesia therefore choosing medical management. Some prefer nature to take the course in whom expectant management will be the choice.

The availability of dedicated staff and facilities for support and followup will have implication on decision making by the woman.

premgunny · Joined: 09 Apr 2008 Posts: 16

Reassure her that the chances of subsequent ongoing pregnancy is promising and 10-20% of clinical pregnancy miscarry and most of the times it is difficult to find a cause. It is nothing which she did or didn't do is the cause for this time. It is better to leave atleast three months before trying to conceive for next time which allows recovery from the pregnancy changes. Advice folic acid to be taken preconceptional. Healthy lifestyle - avoiding smoking, alcohol and drug abuse, weight control. Because of the psychological stress and anxiety, to contact GP with early in next pregnancy for arranging a reassurance viability scan.

Abik · Posted: Fri Jul 25, 2008 4:01 pm Post subject:

Great answers Premgummy!

I hate the middle question - what might influence her decision???
Whether she's going out on Friday night and wants to get on with it?? Whether she was brought up Catholic...or has red hair!!

WHAT DO THEY WANT TO KNOW?

I think that that previous experiences are influential and perhaps the way in which she is given the information - I think here is the moment for the fluffy stuff.
What info she is given, how, where and who by will influence. How much time she has and who is with her.

Trying to get into the colleges mind is tricky.... but the key.