Case again

Ag The

Role-play cases simulate real clinical practice to guide how candidates respond to clinical scenarios and real life practice.

You are a doctor in your routine clinic, ready to begin your day of consultations. A patient has been booked to see you,

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These are the key issues in this clinical scenario.

Approach: Women’s Health.

Follow the consultation steps.
Ask about the pregnancy; number, order, previous pregnancy, LMP, was it difficult getting pregnant?
Ask about planned, accepted – do not be too quick to give congratulation without checking if appropriate. How does she feel about being pregnant?
Red flags; PV bleeding and discharge, Abd pain, fetalmovement if preg > 20 weeks + appropriate clinical red flag for case.
Past Medical History: Think DM, Epilepsy – folic acid requirement, complications in pregnancy.
Contraception and cervical smear
Partner – Where? Supportive? How do they feel about the pregnancy?
Finances and career (Impact, PSO)
ANC – Healthy Start Questions

Clinical Management
• Agenda setting in your clinical management – gives you structure.
• Laws regarding paternity testing: private, only licensed gov labs, will need to partner involvement (DNA testing consent: it is illegal to do any DNA test without consent) - https://www.gov.uk/paternity-pay-leave
• State you will talk about managing clinical and then other pregnancy aspects.
• If noted parts of healthy start not done, need to address.
• if unplanned pregnancy requesting TOP, will need contraception afterwards
• If pregnant asking about Down’s syndrome, need f/up to offer more support after screening.
• Keep medical options short and feasible. Address any emergency.
• Negotiate; show understanding of the unique situation pregnancy has on parenting, career, etc.

Healthy Start Scheme

Registered for ANC? – got their pregnancy pack? What has been done/shared? (open question)
Dating Scan – depending on age of pregnancy (some patient may have early private scans).
Vitamins – folic 400mcg (5mg in risk of neural defects, DM, epilepsy) + 10mg Vit D (10mcg daily)
Food to avoid: Vit A, liver, blue-cheese (Listeria), fish high in methylmercury or partially cook meats/fish/egg.
Fish to eat: healthy meals + peanuts (if not allergic), limit caffeine to 200mg (one mug daily, caffeine also present in coffee, tea, chocolate, and colas.
Annual flu vaccine
Lifestyle: Exercise, Smoking, Alcohol, Stress
Avoid OTC meds not prescribed – can speak to pharma
MATB1 certificate, Paternity Leave, NHS Prescription Exemption.