Wednesday, May 20, 2020

Module 16: Early Pregnancy Care

RCOG module Early Pregnancy Care miscarriage ectopic pregnancy

This post in an outline of Module 16: Early Pregnancy Care. My aim is to give you an idea about how to organize and plan your study. 
For MRCOG part 2 once you have collected the required materials (soft/hard copy), then start your preparation module-wise. Make a timetable to cover a module in a pre-defined time. It makes sure that you do not miss any topic. There is an overlap of many modules for example clinical governance principles, and ethical and legal issues are applicable to all modules.

I can give a suggestion based on my personal experience

  • Make a folder with the name “Early Pregnancy Care”
  • First of all, read the details of the module on the RCOG website and get to know what are the topics you are expected to cover
  • Collect the materials in that folder
  • You may make subfolders for Ectopic Pregnancy and Miscarriage Management (as there are >1 documents to read)
  • For each topic, you can make a ‘NOTE’ file which should be a summary of the points taken from all resources. (In case you prefer paper notes, write down the notes in a way which is easier to revise)
  • In the second reading, you can only revise your own notes. Keep adding the points you come across from different sources
  • The advantage of making your own notes is that ‘you can be sure that it is from authentic sources and it helps you to retain the information
  • Once you cover a topic practice SBAs & EMQs from different sources to check your understanding.

The following table is an example to help you clarify more

Module 16: Early Pregnancy Care Details

Ectopic Pregnancy
GTG 21
NICE 126
CA 8
TOG

Recurrent Miscarriage
GTG 17 
TOG 

Miscarriage
TOG
CA 10 
GP 
SIP 49

Please let me know if this is helpful and suggestions for improvement are welcome. Leave it in comments below if you would like me to give outline of other modules as well. 
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Monday, May 18, 2020

Module 14: Subfertility

Infertility RCOG


This post is an outline of Module 14: Subfertility. In this module, we need to demonstrate an understanding of subfertility causes, counselling of couples, investigations and treatment options.
  • The mainstay to mastering this module is to have a holistic approach to the patient and not just focus on presenting complaints
  • This can be achieved by keeping in mind all levels of subfertility starting from the hypothalamus, pituitary, ovaries, fallopian tubes, and uterus as well as psychological aspects
  • Good history with a focus to reach a diagnosis is paramount
  • Be clear about the indications, limitations and interpretation of investigations
  • Even though some treatment options are beyond the scope of ST5 but it is required to have appropriate knowledge and understanding in order to be able to provide appropriate counselling and further referrals
  • There are some ethical and legal issues like surrogacy, dealing with same-sex partnerships, single parenthood, gamete donations and the HFEA act which need to be covered well
  • Role of involving colleagues from other disciplines both clinical and non-clinical
  • There are certain UK practices which are required to be understood well e.g. referral pathways for IVF, and funding in NHS to name a few
  • If you look at the details on the RCOG website, it will be clear that this module can be broadly divided into
    • Female Subfertility
      • Ovulatory Dysfunction (PCO)
      • Endometriosis
      • Uterine and Tubal Factor Subfertility
    • Male Subfertility
    • Unexplained Subfertility
    • Assisted Reproduction
    • Surrogacy/Adoption
  • The following outline may be beneficial in collecting and organizing the study material
  • You can make a big folder “Subfertility” and then make sub-folders based on the tables provided below
  • Your NOTEs are the most crucial step in revision and help you to retain information
  • Keep practising SBAs and EMQs once a topic is covered. If you come across a ‘new fact’ during practising “do not forget to add that point in your notes”
  • You are strongly advised to modify it according to your own preferences, as all this is just a little effort from my end to give you an idea to approach this module
Kindly let me know if it was helpful and suggestions to improve future posts are welcome
Thanks

Module 14: Subfertility Details RCOG

NICE

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Unscheduled Bleeding with HRT




TOG Article: Unscheduled bleeding with HRT
Volume 21, Issue 2 April 2019

To download original article (Free Access): Click Here
For CPD Questions: Click Here

Introduction
  • Menopause is diagnosed retrospectively AFTER 1 Year of amenorrhea in absence of hormonal contraception & any pathological disorder
  • Average age: between 50-51 years (UK Median age 51 yrs)
Pathophysiology
  • Biological ageing process has some changes in hormone levels
FSH: first to increase
Estradiaol: last hormone to decrease
Inhibin A & B: fall 2-3 years before menopause
  • Cessation of ovarian function: FSH >50 mU/ml plus Estradiol < 20 pg/ml
  • Perimenopause: Transitional period until menopause with irregular menstrual cycles
  • PMB: any bleeding occurring after 1 year of menopause regardless of cause
  • Perimenopause & postmenopause are associated with certain symptoms
Psychological: 
mood swings, irritability, nervousness, dysphoria & decreased libido, depression, loss of cognitive function & insomnia
Vasomotor:
hot flushes (70-80% women experience it which gradually decreases, with only 25-30% after 5years), night sweats, headaches & palpitations.
Urogenital:
urogenital atrophy including a burning or itching discomfort in vagina, dysparunea & UTIs

 Postmenopausal osteoporosis :  
    • 1:3 women affected 
    • Mainly type 1 which involves trabecular bone
    • Reason for fracture in 50% of postmenopausal women
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