The theory exams of the Final MBBS ended some days ago. I'm even thru the G&O practical exam. Next is surgery. Great subject, great teachers...
About the Gynae & Obs practical exam.
The pattern was as follows... One Long case, One Short case, one table for the partogram, an Obs table, and a Gynae table.
The Gynae and Obs tables had their separate sets of instruments and specimens. The Gynae table had HSGs in addition, and at the Obs table, a Fetal head and Maternal Pelvis.
My Long case was an Rh-ve pregnancy in a primigravid woman at 38 weeks of gestation. Everything was perfectly normal, and since this was her first baby, there was especially less to ask related to her Rh negative condition. She was diagnosed to be Rh negative during routine antenatal blood grouping.
Points to note:
1. How to present to the examiner the fact that she is Rh negative:
The Rh negative blood group is usually mentioned to you by the patient. Ask her, "How did you find out?" The answer is usually "During antenatal checkup". This is exactly what you should tell the examiner. "The patient received regular antenatal checkups, IFA tabs, blah, blah. Routine blood tests during her checkups revealed an Rh negative blood group (if she can't tell you the ABO group - this happened in my case, and she didn't have her ANC card in the exam hall)".
2. How will you manage the case?
As always, start with Investigations. Investigations for Rh-ve pregnancies are given in any book (including D.C. Dutta). You might want to leave out the "ABO & Rh grouping" coz it's already been done as a part of ANC. The first thing you would want to do is an Indirect Coomb's test on the mother's blood to check if she as Anti-RhD antibodies. Further tests are fine, depending on how much your examiner wants to hear.
3. Suppose she has no evidence of sensitization. Do you give her Anti-Rh globulin?
The answer is, there is no harm, but the stuff is quite expensive. If she can afford it, then yes.
Enough for now. Gotta study for Surgery. More coming later.
N.B. ANC = Antenatal Care
Wednesday, February 3, 2010
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