Mark sheet
Appears to be in control of the situation.
0
1
2
Describes clearly what to do.
0
1
2
3
Logical progression of actions.
0
1
2
3
Initiates basic safety measures.
0
1
2
Suggests main causes and solutions.
0
1
2
Importance of vital signs.
0
1
2
Examination.
0
1
2
Global score
0
1
2
3
4
Totaclass="underline"
/20
159
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Circuit C, Station 6
Air travel and pregnancy
Candidate’s instructions
The patient you are about to see has been referred to your antenatal clinic by her general practitioner. A copy of the referral letter is given below. Read the letter and obtain a relevant history from the patient, discuss the management of this pregnancy and address any concerns she may have regarding it.
The general examination of this patient is normal for her gestation.
Dear Doctor
Re: Ania Wiesnewski
Please see and book this 30-year-old Polish woman for antenatal care. She has been in the UK for 3 years. She is currently 18 weeks pregnant, which was confirmed by a first trimester ultrasound scan in your early pregnancy assessment unit.
Her first pregnancy ended with a fetal death in utero at 28 weeks in 1998. Her history would appear to be otherwise unremarkable. She is keen to visit her grandmother in Poland for her 80th birthday and would like your advice.
Yours sincerely
Dr Lawrence
MARKS WILL BE AWARDED FOR:
●
Obtaining a relevant obstetric history
●
Explaining the risk factors for this pregnancy
●
Addressing any patient concerns
You have 14 minutes.
161
CIRCUIT C
Role-player’s instructions
●
You are a 30-year-old Polish woman who has been in this country for 3 years.
You have been married for 7 years and work as a part-time cleaner. Your periods are regular, bleeding for 4–5 days every 28 days. You have never had a cervical smear test.
●
You smoke 10 cigarettes per day and drink only at the weekend.
●
You have no medical history of note, except that you were in a road traffic accident as a child and seem to remember that you may have had a blood transfusion. You are unaware of your blood group. There is no family history of note.
●
This is a planned pregnancy – you had some bleeding in early pregnancy for which you had an ultrasound scan so are sure of your dates. Otherwise, there have been no other problems so far in this pregnancy. You are still worried because of previous problems.
●
1998 – planned pregnancy, did not receive very much in the way of antenatal care. You did not see a doctor until about 28 weeks when you noticed that the baby had not moved for about 12 hours. You went to hospital and the baby was found to be dead on scan. A labour was induced and you delivered a stillborn male infant weighing 2.3 kg after 12 hours. There was no PM. There was not much in the way of explanation at home.
●
You are keen to visit your grandmother next month for her 80th birthday and you want to know what advice the doctor would give you regarding airline travel.
162
AIR TRAVEL AND PREGNANCY
Mark sheet
●
Relevant obstetric histories
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Acknowledges IUFD and obtains further details
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Recognizes SB weight
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May be a macrosomic or a hydropic baby
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Smear discussed – may do opportunistic smear
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Advice re. smoking and alcohol
0
1
2
3
4
5
●
Risk factors for this pregnancy
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Recognizes that the weight of the baby was not normal for 28 weeks
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Discusses the possible causes and appropriate investigations in this pregnancy
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Screen for GDM
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Scan to monitor growth/heart defect
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Checks blood group and possible antibodies
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Viral infections, particularly parvovirus
0
1
2
3
4
5
6
Air travel during pregnancy
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Usually not a risk to a healthy pregnant woman
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International travel all right up to 32–35 weeks; advise patient to carry her own notes with the EDD and appropriate insurance
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Aisle seat over a bulkhead provides most space and a seat over the wing in the midplane region will give the smoothest ride
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Advise to walk every 30 minutes and flex and extend ankles frequently
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Safety belt to be fastened at pelvic level
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Fluids to be taken liberally because of dehydrating effect of low humidity in the aircraft
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Support stockings
●
If BP raised, should not go; should have BP checked during the time away 0
1
2
3
4
5
Global score
0
1
2
3
4
Totaclass="underline"
/20
163
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Circuit C, Station 7
Risk management
Candidate’s instructions
Monitoring the frequency of critical incident (or adverse incident) events is an important part of ensuring a high quality of obstetric practice. Your unit wishes to introduce a scheme, which automatically reports critical/adverse incidents during labour.
DISCUSS WITH THE EXAMINER HOW YOU WOULD DEVELOP AND USE
A LIST OF IMPORTANT CRITICAL INCIDENTS OR MARKERS TO
MONITOR THE INTRAPARTUM CARE IN YOUR MATERNITY UNIT. HOW
WOULD YOU INTRODUCE AND MONITOR ITS IMPLEMENTATION?
MARKS WILL BE AWARDED FOR A LOGICAL APPROACH AND
EXPLANATION
You have 14 minutes.
165
CIRCUIT C
Mark sheet
Understands the concept of critical or adverse incidents
●
Has a logical approach to the problem, e.g. subcategories/classification system
0
1
2
3
4
Introduction of implementation
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Meeting, report forms, risk manager, complaints/medicolegal department, regular review of forms, audit cycle
●
Forms a team – multidisciplinary
●
Visit other hospitals to see their setup
●
Run training programmes
●
All staff to know chain of control
●
Cross-check that appropriate reporting is occurring (e.g. computer statistics on incidence correlates with number of forms for each incident) 0
1
2
3
4
5
6
7
8
Critical or adverse incident – examples
The candidate should mention examples from the following list which is not exclusive; others can be included – just need to provide a comprehensive list. We would expect a good candidate, in order to score full marks, to mention at least 10.
●
Failed induction of labour
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Excess use of prostaglandin agents
●
Excess induction delivery interval > 24 hours
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Excess syntocinon infusion
●
Uterine hypertonus – initiation of treatment
●
Precipitate labour – 3 cm to full dilation < 2 hours
●
Malpresentation in labour
●
Prolapsed cord in labour
●
Fetal disease