MRCOG Part Two: 3 Ws & General Advice

This blog post is aimed to explore the 3 Ws of the MRCOG part 2 exam. It may ease your journey to get through this tedious and nerve-wracking exam. The first thing before embarking upon this journey is to know your 3 Ws.

Why do you want to take it?

What is the right way to prepare for it & What to study?

When is the right time to take it?

I hope if you keep reading this blog till the end you might clarify these Ws.

WHY DO YOU WANT TO TAKE IT?

This is the answer which has to come from YOU. You need to decide and know your WHY. Here I can help you decide by quoting just one sentence from RCOG website “MRCOG: A global exam. The Gold Standard Qualification in O&G”

WHAT IS THE RIGHT WAY TO PREPARE FOR IT & WHAT TO STUDY?

This is a long answer and I will try to explore this step by step.

Understand the exam:

The first step is to understand what is this exam all about and what is expected from you in MRCOG part 2 exam. It is to demonstrate that your knowledge is of a level of “Competent ST5 according to RCOG curriculum”. Visit the RCOG website and go through the MRCOG part 2 section in detail. It clearly mentioned the format of the exam, syllabus, modules tested and details of all topics in each module. Most of the candidates keep asking What to study? So RCOG website is the best and most authentic source to answer this. Do not forget it's a UK-based exam and you need to prepare according to that standard, regardless of your job status in practical life. For example, you might be working as a senior consultant in your workplace, but you need to think & act like ST5 for this exam. It is essential to understand how things work in the UK system being an overseas candidate is not an acceptable excuse.

Plan the exam:

Once you decide to sit for the exam, you need to plan well ahead of time with adequate preparation. It is generally recommended that if you are sitting for the first time, at least 6 months of dedicated study time are required and if it is your second attempt onwards, then 3-4 months are adequate. In my opinion, it all depends on your personal & professional circumstances. So there is no hard and fast rule. All you need to keep in mind is that MRCOG part 2 requires sheer hard work, serious commitment and an in-depth understanding of Ob/Gynae. This has to come from self-motivation and persistence to achieve your goal. You can seek guidance from others but all the hard work has to be ultimately done by you. 

The approach of the preparation:

You must decide your approach towards the exam. This is a fast-paced world of internet & technology. First, you need to decide whether you prefer to study in hard form or soft form, how well-versed you are with the latest technology and how much are you willing to invest in the latest gadgets. I suggest that for this exam it is a MUST to be updated in the required knowledge which is only possible if you are familiar with the proper and positive use of your smartphones & tablets (as almost all of us have it these days). Look at those gadgets with a new vision and as a potential source of your success. You do not need flagship devices but you must analyse what's best for you and how you can take maximum benefit from whatever device you have. This is the single most important change you will need to adapt in your approach towards the exam. Late Steve Jobs (CEO of Apple) played a very important role in my MRCOG journey :)

Gather the reading material:

Oophorectomy or Ovarian Conservation at Hysterectomy for Benign Disease

This blog post is based on the TOG article Oophorectomy or Ovarian Conservation at the Time of Hysterectomy for Benign Disease published in April 2022. This is one of the important and most debated aspects of the care of women undergoing hysterectomy due to benign conditions. This has almost always been a grey area in gynaecology, where clinical evaluation and judgment plays an essential role in the crucial decision to conserve or remove ovaries in women above the age of 40 years. This article provides the latest evidence related to this topic. 

I hope you will find this quick summary helpful not only the exam preparation but also for your clinical practice as well. 

Thanks.

To download the original article: Click Here

To access ALL TOGs: Click Here

Introduction

• When a perimenopausal or menopausal woman is undergoing a hysterectomy for benign conditions, one of the concerns is whether to remove or conserve the ovaries. Leaving the ovaries can be associated with the risk of ovarian cancer later in life. However, the removal is also associated with some ill effects. All this will be discussed as follows.

Ovarian cancer has poor prognosis

• Diagnosis of cancer at 70 years — associated with 80% mortality
• Incidence — increases with age 10 in 100 000 in 40s 50 in 100 000 in 50s
• > 50% of women diagnosed at the advanced metastatic disease
• The lifetime risk of ovarian cancer - 1.4% 
• With hereditary ovarian cancer syndromes risk is 25-50% for epithelial ovarian cancer
• BRCA mutation — associated with 90% of hereditary ovarian cancers but overall makeup only 10-15% of all ovarian cancers 
• If this high-risk group is excluded, then the incidence for low-risk women <1%

Non-inherited risk factors

• Obesity & PCO
• Ovarian endometriosis can transform into cancer in 2.5% of cases

Ovarian function in the menopause

• Ovaries continue their endocrine function
• After menopause, women with intact ovaries have higher amounts of androgens

Advanced Abdominal Pregnancy

This blog post comprises of important points taken from the TOG article ‘Advanced abdominal pregnancy’ published in July 2022. It is strongly recommended to read the full article to have a complete understanding of this topic as this post is just a quick summary.

To download the original article: Click Here

To access ALL TOGs: Click Here

Introduction

• Abdominal pregnancy — when implantation occurs within abdominal cavity / an extra uterine pregnancy in which all or most of the foetus develops within the abdominal cavity
• A rare form of ectopic pregnancy 
• Incidence ~1% of all ectopic pregnancies
• Associated maternal mortality  0-12% 
• Overall risk of maternal death 7x that of ectopic pregnancy 90x that of an intrauterine pregnancy
• Fetal survival >78%

Classification

Based on gestation at diagnosis

• Early Abdominal Pregnancy (EAP) - before 20 weeks
• Advanced Abdominal Pregnancy (AAP) - after 20 weeks

Based on site of implantation 

• Primary abdominal pregnancy — implantation directly occurs in the abdominal cavity
• Secondary abdominal pregnancy — when conception extruded from its primary site of implantation and re-implants in abdominal cavity (usually after ruptured ectopic)

Risk Factors

• Most have no identifiable risk factors
• Risk factors are same as any other ectopic pregnancy — tubal pathology, in situ IUCD, previous ectopic 
• Uterine anomalies & history of previous uterine surgery (esp CS) are associated with abdominal pregnancy
• AAP can also occur post scar rupture, previous myomectomy and post uterine perforation at surgical TOP, after IVF

Clinical Presentation

• Diagnosis is often missed & usually made after fetal demise
• Only 50% diagnosed before surgery
• High suspicion is key to pre-operative diagnosis
• No specific S&S of AAP

Symptoms 

• Commonest presentation — abdominal pain ± vaginal bleeding (pain often persistent & increases by fetal movements)
• Bloating & vomiting

Signs 

• None pathognomonic
• Reasonable sign of AAP - displaced cervix (anteriorly) 
• Others— severe anaemia, abnormal fetal lie, oligohydramnios, SGA 

Ultrasound 

• Abdominal pregnancy hard to diagnose with advancing gestation
• Any first-trimester scan should include - location of gestational sac in relation to cervix, endometrial cavity and uterus
• Intraabdominal pregnancy suspected on USG — extrauterine amniotic sac & an empty uterine cavity - foetus & placenta outside uterus, lack of uterine myometrium around foetus 
• Skills & techniques of sonographer matters

Patient Information Leaflets Links

This post is a compilation of downloadable links of Patient Information Leaflets (PILs) which are to be covered for MRCOG Part 3 exam.

Just click the topic and leaflet (pdf) will open in a new window.

Kindly have a look through this page as well: Medical Terms Explained

Thanks

Patient Information Leaflets Links

Abdominal Hysterectomy

Acute Pelvic Inflammatory Disease

Air travel and Pregnancy

Alcohol and Pregnancy

Treatment for Symptoms of Menopause

Amniocentesis and Chorionic Villous Sampling

Routine antenatal care for healthy pregnant women

Assisted vaginal Birth (Ventouse or Forceps)

Being overweight during pregnancy and after birth

Beta thalassaemia and pregnancy

Birth options after previous caesarean section

Bleeding and/or pain in early pregnancy

Blood transfusion, pregnancy and birth

Breech baby at the end of pregnancy

Cervical smears and pregnancy

Cervical stitch

Chickenpox and pregnancy

Choosing to have a caesarean section

Chronic (long-term) pelvic pain

Corticosteroids in pregnancy to reduce complications from being born prematurely

Diagnosis and treatment of venous thrombosis in pregnancy and after birth

Early miscarriage

Ectopic pregnancy

Endometrial Ablation

Endometriosis

Epilepsy in pregnancy

Female genital mutilation

Genital herpes and pregnancy

Gestational diabetes

Gestational trophoblastic disease

Group B Streptococcus (GBS) in pregnancy and newborn babies

Having a small baby

Healthy eating and vitamin supplements in pregnancy

Heavy bleeding after birth (postpartum haemorrhage)

HIV and pregnancy

Induction of labour

Abortion care

Laparoscopic Hysterectomy

Laparoscopy

Malaria and pregnancy

Managing premenstrual syndrome (PMS)

Mid-urethral Sling Operation for Stress Urinary Incontinence

Multiple pregnancy: having more than one baby

Obstetric cholestasis

Outpatient hysteroscopy

Ovarian cancer

Ovarian cysts before the menopause

Ovarian hyperstimulation syndrome

Pelvic Floor Repair Operation

Pelvic girdle pain and pregnancy

Pelvic organ prolapse

Physical activity for pregnant women

Placenta praevia, placenta accreta and vasa praevia

Polycystic ovary syndrome

Pre-eclampsia

Pregnancy and breast cancer

Pregnancy sickness (nausea and vomiting of pregnancy and hyperemesis gravidarum)

Surgical Management of a Miscarriage

Recurrent and late miscarriage

Reducing the risk of venous thrombosis in pregnancy and after birth

Shoulder dystocia

Sickle cell disease and pregnancy

Skin conditions of the vulva

Smoking and pregnancy

Male and female sterilisation

Surgery for Stress Incontinence

A third- or fourth-degree tear during birth

Treatment for symptoms of the menopause

Umbilical cord prolapse in late pregnancy

Understanding how risk is discussed in healthcare

Vaginal Hysterectomy

When your baby dies before birth

When your waters break prematurely

Your baby’s movements in pregnancy

Preterm labour and birth

Some other useful links:

GTGs with Links
TOG Topics Links

SIPs with Links
FSRH & NICE Links
RCOG Guidance: Consent, Clinical Governance, Best/ Good Practice

Starting Point For MRCOG Part 2

Join RK4 Courses 

www.rubabk4courses.com/courses 

Domestic Violence

This blog post is a Quick Note on Domestic Violence, one of the vital topics for MRCOG exams. The points have been taken from various resources including NICE and TOGs.

I hope this post is helpful for you. 

Please feel free to leave your feedback and suggestion for new blog posts are welcome.

Thanks

www.rubabk4courses.com/courses

Introduction

• Abuse of an individual >16 yrs by a current or former partner or family member, regardless of gender or sexuality 
• It could be   Physical   Emotional   Psychological   Financial or   Sexual

Worldwide 1 in 3 women experienced DV b/w 2000-18

UK figures

• Incidence  1:4 lifetime risk DV
• 2 women per wk murdered by partner/ex  
• 30% of DV starts or escalates in pregnancy  
• 4-9% during pregnancy ± after childbirth  

Dec 2020 Ref TOG

• Due to the Covid-19 pandemic → there was a 7% ↑ in the total number of domestic abuse-related offences 
• Helpline calls ↑ by up to 5-fold

Impact of DV

• Devastating for the health and well-being of women
• Associated with ↑ risk of poor current health, chronic disease, substance abuse and also a negative impact on mental health 
• Also an issue of child protection
• 10% of postnatal depression attributable to DV & abuse
• Victims are 4x more likely to have anxiety disorders and a 7-fold increased likelihood of PTSD

Adverse Effects of DV on pregnancy outcomes

• Preterm birth, chorioamnionitis, low birth weight baby, unexplained stillbirth

Factors in pregnancy linked to increased risk of DV

• Teenager
• Late booker
• Concealed Pregnancy
• Bleeding in early pregnancy
• Substance abuse
• Having pre-existing mental health conditions like PND, anxiety & PTSD

Why do women hesitate to seek help?

Fear of 

• stigma or shame
• HCP not believing them
• the consequences

Possible Signs  COULD BE ANYTHING

• Vague symptoms Frequent visits
• Missed visits Late bookers 
• Non-compliance with t/m
• Suicidal attempts
• Partner attends unnecessarily

NICE recommendations for DV

• All healthcare providers MUST ask about DV every woman
• Mandatory training for safeguarding vulnerable adults & children
• Screening increases the identification of DV
• Women to be given enough time and opportunity for disclosure
• Consultations are to be conducted in an open, supportive and non-judgmental way
• If identified, refer to specialist services, ensure safety and arrange follow-up
• Support groups are KEY
• Must ensure confidentiality
• Information should be shared among HCP for safeguarding purposes

UK Domestic Abuse Act 2021

• Helps to provide greater support
• DV is not just physical violence but could also be emotional, controlling, coercive and economic
• Local authorities to provide accommodation-based support

You may also like

• MRCOG Part 2 Courses
• TOG Topics List
• MRCOG Part 2 Modules
• Starting Point for MRCOG Part 2