TEALE FENNING

Nick Raine-Fenning

Having started by being asked a pre-pregnancy question about advanced maternal age the candidates in September 2006 were surprised that the very next question was another pre-pregnancy counselling one!

The question was markedly different however and related to a woman who had been delivered prematurely for severe pre-eclampsia. A great question if you ask me and one I expect to be repeated in one form or another (e.g. previous sevre IUGR, stillbirth, caesarean, 3rd or 4th degre tear, ... the list goes on and on).

Anyway here it is in all its glory ...

You are asked to see a 29-year old Para 1 who is considering a second pregnancy. Her first pregnancy was complicated by severe pre-eclampsia for which she was delivered by caesarean section at 26 weeks gestation and had to go to ITU. The baby was small but recovered and is developing normally.

 What would you tell her about the risk of recurrence?(3 marks)

 Is it possible to identify the factors which will show her to be at an increased risk? (6 marks)

 Describe your management plan for her next pregnancy? (7 marks)

 How would you deliver her? (4 marks)

Now this question is very much like the old style 'open essay'. Essentially in the old style exam you had to create these artificial divisions in your plan but the College are now doing this for you. The last part which relates to care in pregnancy requires you to address every aspect of antental care right up to delivery. I am surprised the puerperium was not mentioned but I would still throw in something about breast feeding and contraception.

Hope all of you considered her fertility!
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"Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997