Abnormal Placenta

Abnormally invasive placenta—prevalence, risk factors and antenatal suspicion: results from a large population-based pregnancy cohort study in the Nordic countries


'A total of 205 cases of AIP in association with laparotomy were identified, representing 3.4 per 10 000 deliveries. 

The single most important risk factor, which was reported in 49% of all cases of AIP, was placenta praevia. 

The risk of AIP increased seven-fold after one prior caesarean section (CS) to 56-fold after three or more CS. 

Prior postpartum haemorrhage was associated with six-fold increased risk of AIP (95% confidence interval 3.7–10.9). 

Approximately 70% of all cases were not diagnosed antepartum. 

Of these, 39% had prior CS and 33% had placenta praevia.'

• How do you define and diagnose abnormally invasive placenta (AIP)?
• How common is AIP in your practice?
• What are the benefits of prospective registration of rare complications of pregnancy (compared to existing retrospective registration systems based on ICD-10 codes)?
• What are the strengths and pitfalls of amalgamating data from multiple countries?
• What are the major risk factors of AIP identified in this study? How much more likely are women with these risk factors to have AIP?
• Is antenatal suspicion of AIP associated with improved maternal and neonatal outcomes?
• How would the results of this study influence your daily practice?

Thurn L, Lindqvist PG, Jakobsson M, Colmorn LB, Klungsoyr K, Bjarnadóttir RI, Tapper AM, Børdahl PE, Gottvall K, Petersen KB, Krebs L, Gissler M, Langhoff-Roos J, Källen K. Abnormally invasive placenta—prevalence, risk factors and antenatal suspicion: results from a large population-based pregnancy cohort study in the Nordic countries. BJOG 2015; DOI: 10.1111/1471-0528.13547.

Consent

'All women aged 18 or over are considered to have capacity to give consent unless there is evidence to the contrary. 

For young women and children under the age of 16, consent can be obtained from a parent or those with parental responsibility. Although parents have the legal right to give consent for treatment, where appropriate it is good practice to involve children and young people as much as possible in decisions about their care, even when they are not able to make decisions on their own. 

In some circumstances a young person under the age of 16 may wish to seek medical treatment without her parent’s knowledge. Mature minors may acquire the right to give their consent, provided that they fulfil certain criteria and are deemed to be Gillick or Fraser competent.

Each case must be judged on its own merit and if there is any uncertainty you should seek advice from an experienced colleague or specialist. Although 16- and 17-year-olds and minors under the age of 16 may have the right to consent to treatment, they do not necessarily have the same right to withhold consent. Refusal of treatment may be overridden by parental consent, or the courts, however each case should be considered individually (see section 6).9 It is important to be aware that Scottish law states that those aged 16 and over are able to give consent and also refuse consent provided that they are considered capable of understanding the nature and consequences of the treatment'

https://www.rcog.org.uk/globalassets/documents/guidelines/clinical-governance-advice/cga6.pdf

UKOSS

UKOSS website figures should always be in your last minute revision especially the leading causes of direct and indirect maternal health

Vaccines in Pregnancy

Vaccines in pregnancy
MCQ's or EMQ's based on this

Vaccines contraindicated

BCG,MMR,Varicella,HPV

Vaccines to be given especially in pregnancy

Pertussis
Influenza & polio (inactivated)
Diptheria & TT

Vaccines in special circumstances

Hep A,B
Puneumococcal
Menningococcal
Typhoid
Yellow fever

D & C is associated with subsequent preterm birth

"This meta-analysis shows that D&C is associated with an increased risk of subsequent preterm birth. The increased risk in association with multiple D&Cs indicates a causal relationship. Despite the fact that confounding cannot be excluded, these data warrant caution in the use of D&C for miscarriage and termination of pregnancy, the more so since less invasive options are available."

http://humrep.oxfordjournals.org/content/31/1/34.full?hwoaspck=true

MRCOG Exam

MRCOG exam is conducted by the RCOG twice a year.
RCOG consists of more than 12500 members of which more than half reside outside UK.

At present it consists of two parts ( subject to change soon)

For information regarding part one
https://www.rcog.org.uk/en/careers-training/mrcog-exams/part-1-mrcog/

For information regarding part two
https://www.rcog.org.uk/en/careers-training/mrcog-exams/part-2-mrcog/

Breaking Bad News


Pls take part in this 5 minute survey and let me know what you think of breaking bad news scenario
Your comments will be highly appreciated

https://surveyplanet.com/568acd117ded0a752f38ff87

Thanks

Introduction

Dear All Friends,

Happy New Year to all!!

Welcome to my new MRCOG Buddy blog.

Here I intend to post useful information about MRCOG exams and courses. I also intend to post useful questions MCQ's  & EMQ's on a regular basis.
Not to say anything helpful in view of MRCOG exams would also find its way here.

Pls do support my new venture and do let me know if you want me to post on any particular topic
Thanks

Mr Abhijit Kulkarni