Last post from sunny Oban then its back to Dundee - only 4 more weeks of 4th year to go! The next two articles were sent from The Obstetrician & Gynaecologist - a publication from the Royal College of Obstetricians and Gynaecologists.
1) Smoking During Pregnancy
there is still a high incidence of smokers in pregnancy. Effects on the unborn child can be devastating. Smoking is still the single largest preventable cause of fetal and infant morbidity in the UK. Potential problems include placental abruption/praevia (3x greater risk), prematuire rupture of membranes, fetal growth restriction, ectopic pregnancy, intra-uterine infection, fetal growth restriction, sudden infant death syndrome etc. Motivational assessment, 'talking' therapy and one to one councelling are ways of helping mothers quit. The aim really is to empower the individual. Carbon monoxide tests can be used to assess maintenanct. Nicotine replacement therapy is best avoided in pregnancy because nicotine crosses the placenta. One way of helping people quit is to dispel any untrue theories mothers ay have eg. that a small baby is good because it won't hurt so much when its born. Perhaps eduction is the best way forward...
2) Improving Outcomes from Gynaecological Surgery
A cancer 'survivor' is someone who has 'completed the initial cancer treatment, is living with progressive disease before the terminal stages of illness or who has had cancer treatment in the past. Most gynae cancers are curable IF THEY PRESENT EARLY. In the majority of cases treatment-related morbidity IS PREDICTABLE. Major morbidities include: GI adhesions, bowel obstruction, chronic diarrhoea after radiotherapy, radiation cystitis, ureterovaginal fistulae, infertility, decreased sexual function, peripheral neuropathy and lymphoedema which can become severe. It is important to be aware of all of the potential sequelae of treatment but the majority of survivors can look forward to a good quality of life, supportive relationships and the many positive aspects of a continued life.
Also every 3 months the MPS sends its 'Casebook' magazine for members which at the back contains a series of medico-legal cases of recent interest. Here is one interesting case - a 30 year old man attends A&E after noticing a widespread skin rash. He has rheumatoid arthritis and is taking Methotrexate, however the junior doctor on call forgets to ask him what medications he is on and the patient doesn't reveal this info. The doctor correctly recognises that the man has chickenpox (varicella zoster viral infection) and sends him home. He feels worse and both out-patient phone services and the GP agree with the provisional diagnosis and tell him his symptoms will improve with treatment. He goes on to collapse at home, is taken to hospital and diagnosed with disseminated meningoencephalitis. Despite therapy with IV acyclovir, he dies due to multi-organ failure secondary to sepsis. The family made a claim against all aprties involved and the case was settled for a high sum.
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