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bronwyn
Century Club
Joined: 19 Jul 2006
Posts: 144
Location: Alton, Hampshire
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 Posted: Fri Jul 28, 2006 12:54 pm Post subject: Sickle cell |
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The College seem to like Sicklers!
| Quote: | | A woman with Sickle cell disease comes to see you 6 weeks postnatally following an intra-uterine death at 36 weeks in her first pregnancy. Outline important aspects of your consultation. |
Enjoy!
I'll post my bubbles on return from hols 
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Bronwyn Bell
SpR
Portsmouth |
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Nick Raine-Fenning
Course Director
Joined: 27 May 2006
Posts: 1852
Location: Nottingham
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| Posted: Fri Jul 28, 2006 4:16 pm Post subject: |
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That's an excellent question Bronwyn
They could set something like this but it may not include the medical disorder.
Lots to bubble here 
Few basic points I would stress / consider:
1. counselling - lots of support / how are they coping
2. investigations and their results to date (there may have been an identifiable cause unrelated to her sickle cell such as an anomaly, pre-eclampsia, cholestasis, etc)
3. mode of delivery
4. then go with the basics:
History / Examination / Investigations / Treatment
This is a medical disorder in pregnancy question (or you can exlcude this eventuality) so you need to:
1. Assess the severity of her disease and her awareness of this
2. consideer her partners status and define the zygosity possibilities
3. discuss the effect of pregnancy on her SSD
4. briefly discuss the effect of her SSD on her pregnancy and do this for both her and her baby!
You also need to address how certain causes of stillbirth affect the next pregnancy if indeed there is to be a next one!
That's a lot of bubbles and that is the problem with Medical Disorder questions. You still have to mention all of these issues but superfiically.
Remember - you do not know where the marks are!!
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"Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997 |
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bronwyn
Century Club
Joined: 19 Jul 2006
Posts: 144
Location: Alton, Hampshire
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| Posted: Fri Jul 28, 2006 5:37 pm Post subject: |
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Thanks Nick
Few other bubbles I had
intro
* risk of maternal morbidity with sickle crisis (?1-2.5%)
* complications more common in pregnancy (crisis complicates 35% of pregnancies)
* 4-6x increase perinatal morbidity
Relevant steps while (if) planning another pregnancy
* Contraception (risks of IUCD and prothrombotic estrogens)
* Folic acid 5mg/day
* Penicillin prophylaxis, if required, safe to continue throughout pregnancy
screening
* partner
* role and risks of CVS & amnio
Antenatal monitoring
* Hb, ferritin, HbS level, LFT, UKE monthly (renal and liver function may be compromised)
*MSU at each visit
* Possible risks of top-up exchange transfusion antenatally
* Manage infection/ dehydration aggresively
* Ultrasound for fetal assessment from 28 weeks (IUGR/ PET)
* Screen for PET antenatally
* LSCS only for obs reasons (try to avoid GA)
* continuous fetal monitoring in labour
* iron chelation agents contra-indicated in pregnancy
* May have multiple antibodies due to previous transfusions, check when cross matching (role of haematologist)
* consider thromboprophylaxis when admitted/ immobilised
I think your second point is really good...not just assuming the IUD was related to SSD
Think this questions possible too "big" in that it involves IUD, medical disorder and pre-pregnancy counselling, and as you say to keep it superficial in the little time given.
Well at least that's sickling revised in one go!
Off to Gatwick soon
Byeee 
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Bronwyn Bell
SpR
Portsmouth |
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Nick Raine-Fenning
Course Director
Joined: 27 May 2006
Posts: 1852
Location: Nottingham
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| Posted: Fri Jul 28, 2006 6:24 pm Post subject: |
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Have a great holiday - we'll miss your contributions 
Back to the essay ...
| Quote: | | I think your second point is really good...not just assuming the IUD was related to SSD |
I think this is the key point actually!
The points you mention relate more to SSD than stillbirth. In fact this is one of those questions where you could score really badly if you focused on sickle cell rather than the actual scenario. Think clinically - what would you do in real life? Therein lies the crux of this question and the key to the essays.
I would expect the marking scheme to this question would be more like the marking scheme to a stillbirth question with a twist of sickle cell rather than vice versa - that's how I would write it anyway.
It's a very interesting question / point that you raise here therefore.
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"Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997 |
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