CIRCUIT C
Case 6
Mrs Brough is a 44-year-old woman with a 3-month history of amenorrhoea. She has had one early miscarriage and one full-term normal delivery. Her current BMI is 25. She is not currently using any contraception.
Results
●
Serum oestradiol – < 20 pmol/L
●
FSH – 69.4 IU/L
●
Prolactin – 238 mU/L
Answers
Questions
●
Any hot flushes and night sweats?
●
Any other symptoms?
●
Could she be pregnant and has a pregnancy test been done?
Explanation
●
May be climacteric but caution in view of age.
Options
●
Repeat FSH 3 months in view of age
●
Treat symptomatically with HRT
●
Would need contraceptive advice in view of age
Global score
0
1
2
3
4
182
RESULTS INTERPRETATION
Case 7
A 35-year-old woman presents with a long-standing history of painful periods but the cycle is regular: 7 days’ loss every 28 days. She has had a previous loop cone biopsy for CIN2. On examination, the uterus is clinically 16 weeks size.
Results
Hb – 9.7 g
Ultrasound scan
An enlarged anteverted uterus with multiple small fibroids, the largest being 3–4 cm in diameter. The ovaries look normal.
Answers
Questions
●
Any clots or flooding?
●
What is her fertility expectation?
●
What is her sickle status?
●
Any previous treatment?
Explanation
●
The haemoglobin level is probably a reflection of chronic blood loss
●
Most likely secondary to the fibroids
Options
●
Depends on her fertility status and what has been tried before
●
Needs oral iron
●
Hormonal or non-hormonal treatment, possibly mirena
●
Surgery, myomectomy or hysterectomy
●
May be a candidate for embolization
Global score
0
1
2
3
4
Mark scored
0–1
2
3
4
5–6
7
8–9
10
11
12–13
14
Mark
/20
0
1
2
3
4
5
6
7
8
9
10
Mark scored 15–16
17
18
19–20
21
22–23
24
25
26–27
28
Mark
/20
11
12
13
14
15
16
17
18
19
20
183
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Index
abbreviations viii
Circuit B 99–138
abdominal pain in premature labour 105–7
Circuit C 140–85
abnormal smear 121–4
colposcopy 121–4, 180
adenocarcinoma of endometrium 59
colposuspension 114, 115
AFP (alpha-fetoprotein) 35, 36
communication skills 3–4, 9, 25–8, 67–70
air travel and pregnancy 161–3
congenital dislocation of hip (CDH) 68
algorithm, ultrasound scan audit 48–9
contraception, emergency 91–3
alpha-fetoprotein (AFP) 35, 36
contraceptive pill (OCP) 53
amenorrhoea 178, 182
counselling
amniocentesis 78
bereavement 87
anencephaly 35–9
colposcopy 124
audit 48–50
Down’s syndrome 129
molar pregnancy 173–5
bereavement 87–9
prenatal 75–8
bleeding
skills 3
intermenstrual 95–7
counselling station 59
post menopausal 180
critical incidents 165–7
B-Lynch suture 158
CTG see cardiotocograph
breaking bad news
cystic fibrosis 75–7
anencephaly 35–9
cystourethrocele 109
cancer 59–62
ovarian cancer 149–51
D&C see evacuation of uterus
breast cancer 71, 72, 122
delivery suite
breech presentation 21, 105, 137–9
management 16
Burch colposuspension 115
patients résumé 100–1
prioritization 16–20
caesarean hysterectomy 80
diagnosis, premature labour 105
caesarean section 19, 21, 22, 117–19
Down’s syndrome 68, 129–31
cancer
dyskaryosis 121
breaking bad news 59–62
breast 71, 72, 122
early pregnancy problems 11–14
cervix 180
ectopic pregnancy 25–8
ovarian 72, 149–51
laparoscopy 133–5
womb 7
embolization 183
carbamazepine 96, 97
emergency contraception 91–3
carcinoma of the cervix 180
endometrial polyps 177
cardiotocograph (CTG) 87
endometriosis 41–2, 44, 64
abnormality 125–8
endometritis 181
trace 126, 127
endometrium adenocarcinoma 59
cave of Retzius/retropubic space 115
enterocele 114
CDH see congenital dislocation of hip
epidural 19
cervical cancer 180
episiotomy 147
cervical smear 54
ethics 141–3
chemotherapy 150, 151
evacuation of uterus (D&C) 153–5, 173, 177,
chlamydia 30, 54
181
chorionic villous sampling 68, 78, 129, 130
choroid plexus cyst 106
fertility investigations 179
Circuit A 58–98
fetal death 87, 161–2
185
INDEX
feto-maternal transfusion 128
oral contraceptive pill (OCP) 53, 96, 97
fibroids 6, 153–4, 183
oral examination see Vivas
anterior fundal 71
O’Sullivan’s (Hydrostatic) method 80
submucosal 63, 64, 65, 71
ovarian cancer 72, 149–51
Fraser Guidelines 143
ovarian cyst 150
frequency, urinary incontinence 111
painful periods 183
Gillick competency 143
Pap smears 72
pelvic floor exercises 113
history taking 2, 6–9, 95, 105, 111
pelvic pain 30
hydatidiform moles 173
period problems 6, 18
hydropic baby 163
placenta praevia 21–4
Hydrostatic (O’Sullivan’s) method 80
polypectomy 177
hysterectomy 63–4, 80, 114, 158
post menopausal bleeding 180
hysterosalpingogram 43, 179
postpartum haemorrhage collapse 157–9
hysteroscopy 59, 177
pouch of Douglas 178
practical skills 145
in vitro fertilization (IVF) 68
pre-eclampsia 19, 181
incontinence 109–15
pregnancy
intermenstrual bleeding 95–7
molar 173–5
intracytoplasmic sperm injection 68
problem management 11–14
intrapartum care 165
twin 169–71
intrauterine fetal death 87
pregnancy assessment unit 48–9
IUCD, mirena 177
premalignant disease 124
IVF see in vitro fertilization
premature labour 19, 105–7
premenstrual syndrome 29–34
labour ward prioritization 100–4
prenatal counselling 75–8
see also delivery suite
preoperative ward round 63–5
laparoscopy 26, 41–2, 44, 63–4, 133–5, 153
prioritization 3
laparotomy 80, 153
delivery suite 16–20
loop cone biopsy 183
labour ward 100–4
operating list 82–6
McRoberts manoeuvre 147
macrosomic baby 163
results interpretation 176–83