Page 1 of 2: a tough mcq came in my part1 exam mrcpch

ghaylank · Credits: 938 My Scrapbook

please give your answer for the following best of five Question:
you are called to counsel a woman in premature labour at 23 weeks .which one of the following is the most appropriate information to give initially?
A_Unfortunately at this gestation there is 10-20%survival of which 50%will have some degree of handicap
B_Unfortunately at this gestation there are the following survival and handicap statistics (tell her the figures of your own unit)
C_Survival at this gestation is generally poor,and survivors may have long-term problems(then discuss with her the option of not resuscitating if the baby in a poor condition)
D_Babies at this gestation are very immature and will have long and difficult time in the NICU(then discuss the likely problems and interventions that may be necessary)
E_Babies at this gestation are extermely early and often dont survive but we will do everything we can...

Nile_Courses · Credits: 958 My Scrapbook

I would go for E.

ghaylank · Credits: 938 My Scrapbook

are you sure?
as pepole who appeared with me were choosing other answer..

Aahad · Credits: 267 My Scrapbook

i would like to go for C

pakidr · Credits: 466 My Scrapbook

hello dr!
according to book neonatology chapter...........in this regard only one study in uk in 1995 that shows survival at 23 weeks is (11%)and almost half of children followed have mild to moderate disability n 49% did well.........

Aahad · Credits: 267 My Scrapbook

hi would you please give us the link of that book or the refernce of that study????

pakidr · Credits: 466 My Scrapbook

i have given this from essential revision notes book's neonatology chapter from topic "outcome after preterm birth".................

fahi · Credits: 2535 My Scrapbook

A - probably the most appropriate according to gestational age

Epicure

term ‘borderline of viability’ to describe
extremely premature babies who are born at or
before 25 weeks and six days (pregnancy usually
lasts for 40 weeks). In England, 1,600 out of
584,000 (0.28 percent) deliveries were at the
borderline of viability in the year 2004-2005.1 This
percentage has been increasing since the
beginning of the 1980s, which may be due to
several factors, including the rise in fertility
treatment. Most extremely premature babies die,
but the age at which they can survive has dropped
by about one week for every decade in the past 40
years. A 1995 UK-wide study called EPICure showed
that the percentage of babies born alive in 1995
between 22 to 23 weeks who survived to leave
hospital was 1%; at 23 to 24 weeks it was 11%; at
24 to 25 weeks, 26%; and 25 to 26 weeks, 44% (see
Table 1 ). Survival before 22 weeks is very rare.2
More recent data from other countries and specific
areas in the UK indicate that survival rates have
become higher since EPICure, and these may be
more useful for providing advice to parents

pakidr · Credits: 466 My Scrapbook

A
I have searched for outcome from other books as well....the study i and dr fahi mentioned is every where so its authenticated and useful uptill now as explained by dr fahi.......atleast we have found 1 answer right so cheers.

Aahad · Credits: 267 My Scrapbook

The resuscitation of extremely preterm infants presents complex medical, social and ethical issues for the families and the health professionals. The principle of a systematic resuscitation "temporary intensive care" does not prohibit the question of a limit in terms of gestational age and birth weight. In France, a do not resuscitate order (comfort care alone) is appropriate for newborns weighing less than 500g and/or with a gestational age of less than 24 weeks' since the mortality is nearly 100%. The survival of infants born at 24 weeks' gestational age remains low with significant risks of chronic medical problems and neurodevelopmental disabilities. The decisions regarding the extent of resuscitative efforts depend on antenatal factors, condition of the neonate at birth and the parental opinion. Before the delivery, parents should receive appropriate information about survival and risks of adverse long-term outcome. The physician should follow the parents' desires whenever the parents' decision would not obviously violate the infants' best interests. However, they must be informed that decisions about neonatal management made before the delivery can have to be changed in the delivery room, depending on the condition of the neonate at birth. At 25 weeks of gestational age, the prognosis is better and the resuscitation should be more intensive.
Article published in journal of france in feb 2004 in journal of gyn &Obs
now??????

		Sign In New User? Sign Up Sign in to access your control panel and messenger!
				TechZone \| SpiderNevi \| HowTo? \| Scrapbook!