Yesterday was spent in the gynaecology out-patient department (Dr. Nicoll's teaching clinic) whilst today I was in the Early Pregnancy Assessment Clinic. I didn't realise until today that patients attending the teaching clinic are informed on their referral letter that they are coming to a teaching clinic and will be seen by students. I thought this was advantageous because it meant patients were willing to co-operate and I really appreciated the patients giving us their time and allowing us to observe with the examinations (bimanual, abdominal, speculum) and investigations (Pipelle biopsy).
I took a history from a 77 year old woman presenting with pelvic organ prolapse (dragging sensation), mixed incontinence and recurrent UTIs. It seems the cause of her problems may be bladder outlet obstruction as a result of failed TransVaginal Tape (TVT) surgery carried out in 2007 (a rare complication). Her prolapse was being managed presently with pessaries, however she was keen for surgery. Dr Nicoll councelled her against surgery (sacro-spinous fixation) due to her co-morbidites she had, and risk of the operation given her age. 2nd patient, interviewed by Jackie presented with prolapse after her partner told her after sex that it 'felt like the walls were caving in' (!). I learnt alot about pelvic organ prolapse (although maybe not quite enough to rival resident prolapse king Buchanan!), particularly the different ways in which prolapse can present ie.
anterior: urinary frequency, urgency, difficulty voiding, recurrent UTIs, stress incontinence. posterior: incomplete bowel emptying, digitation and other GI symptoms.
At the early pregnancy clinic 3 patients were seen; 1st was a very nervous, anxius woman and partner due to previous still birth (at term). Cannot even begin to imagine how awful that would be for the mother. In this unfortunate event, the woman is normally given an epidural and the fetus is delivered vaginally. 2nd patient was para 0+3 with bleeding at 11 weeks gestation but a viable (very bouncy) pregnancy was confirmed. The 3rd patient was para 0 + 2, very confused about dates of LMP and +ve pregnancy test. Based on the information, she would have been 10 weeks gestation, however on ultrasound scan there was only small gestational sac that would be more in keeping with approx 5 weeks. It is likely that this pregnancy had run into trouble and the patient was advised of this development. When the midwife left the room for a few minutes, I offered condolence and support to the patient and their partner but found this a difficult situation to manage. I think I coped quite well with the situation, and answered the couple's questions correctly.
Found out that numbers of ectopic pregnancies have shot up in recent years, ? due to chlamydia, gonorrhoea, increasing numbers of sexual partners and changes in contraceptive methods (less barrier).
Cervical screening tutorial offered alot of information this afternoon, such as aetiology, pathology, screening and treatment of CIN. Must remember that abnormal cells from a smear are NOT cancerous and patients must be councelled that it does not mean they have cancer. Hopefully what we covered today will be useful come visit to colposcopy on Friday.
England are going to South Africa 2010! Convincing 5-1 thrashing of Croatia, whilst Scotland are out, finishing third in the group and losing 0-1 on the night to the Netherlands. To top it off, the goal came 9 minutes from time on the 9th of the 9th, 2009. BlackBerry is on its way! Really looking forward to setting it up at the week - think I'm into a bit of a gadget fiend! Hopefully I'll be able to update this blog from my mobile - who knows!
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