TEALE FENNING

Nick Raine-Fenning

Having spent some time thinking about the Essay Questions in September 2006 I thought I would post a few questions that I think may come up next time. I am sure you would all appreciate a bit of 'hot topic' spotting Cool

I am almost certain that you will be asked a similar question to the severe pre-eclampsia one in one form or another. The idea of pre-pregnancy counselling for a high risk patient is ideal for a question as it tests lots of different apsects of obstetric care.

Have a go at this one ...

You are asked to see a 29-year old woman who is considering becoming pregnant again. She suffered a stillbirth at term in her last pregnancy following an episode of decreased fetal movements. She is fit and well and the post-mortem was normal. She is worried about this happening again.

 What would you tell her about the risk of recurrence?(4 marks)

 What would you want to know from her past obstetric history and how would this affect your management specifically? (8 marks)

 Describe your management plan for her next pregnancy (8 marks)

Question

_________________
"Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997

mridulaben · Posted: Sun Dec 17, 2006 11:00 am Post subject:

Any CLUES to get me started Smile

Recurrence dependant on cause but do we have any quoted figures Confused

Previos obstetric would focus on her AN course last pregnancy, family history of genetic or metabolic disorders, social history of any illicit drugs, medical disorders & infections, & go through the exhausting list of investigations on mother, fetus & placenta. Also confirm gest. age. Wt of baby, her blood grp. If no cause most likely placental insufficiency. Healthy life style advice as folic acid, stop smoking & alcohol. Optimise her BMI if too low or too high. Check rubella status

Management in this pregnancy with early GTT, consultant booking, reassurance that second SB if no cause is very rare, monitoring for IUGR in third trimester as In unexplained SB Small babies more common( 14th vol. Studd says 20%, one of the mcq book says as high as 50%??). Doppler for umblical artery notching at 22 weeks.

Have to add a lot after your advice.

Nick Raine-Fenning · Posted: Mon Dec 18, 2006 12:15 pm Post subject:

Pretty good answer to be honest although you need to compartmentalise your answer more and address exactly what you have been asked.

The second stem asks you to link her antenatal history to specific things that affect your management.

You need to discuss timing and mode of delivery in part 3.

mridulaben · Posted: Tue Dec 19, 2006 10:40 am Post subject:

Thanks for the encouragement, am confused about the reccurance still.
OH!! forgot about delivery in current pregnancy Embarassed

Nick Raine-Fenning · Posted: Tue Dec 19, 2006 11:05 am Post subject:

mridulaben · Posted: Wed Dec 20, 2006 1:22 am Post subject:

Thanks for the reply

Where can we see those figures for reccurance? Cuurrent Obst. & gynae. jounal, aug/ ? sept 2006 mentions about IUFD in detail including causes, labour & FU.

Nick Raine-Fenning · Posted: Thu Dec 21, 2006 3:47 pm Post subject:

Not sure where I got them from as they are in my database but probably from CESDI and associated reports. They are accurate.

bronwyn · Posted: Fri Dec 22, 2006 7:15 pm Post subject:

Nick Raine-Fenning · Posted: Fri Dec 22, 2006 9:43 pm Post subject:

nice one Bronwyn and the baseline is 1 in 200 or 0 so my figures are correct 5%

mridulaben · Posted: Sat Dec 23, 2006 6:55 am Post subject:

Thanks to both of you.