- Green top guide lines from RCOG
- NICE guidelines
- Collection of 96 guidelines from various resources(from e-meducation)
- Clinical knowledge summaries
- SIGN guidelines on Women's health
- Society of Obstetricians and Gynaecologists of Canada (SOGC)
- Guidelines from North America(from TRIP)
- Guidelines from Europe(from TRIP)
- Systematic reviews in Obstetrics & Gynaecology from TRIP
- Cochrane Library-Pregnancy & Childbirth group
Thursday, 1 January 2009
Guidelines in Obstetrics & Gynaecology
Wednesday, 10 December 2008
Child protection
Child protection is governed by law
children act(1989)-It describes 4 important concepts
1.The child's welfare is paramount
2.Parental responsibility
3.Children are best cared by both parents
4.Children are individual in their own right
Other important documents related to child protection:
A.Section 28 of the children act 2004
B.Lord Laming recommendations 2003
Child protection overrides confidentiality.Don't promise confidentiality when dealing with child protection.
Needs ensure effective inter agency communication.
Assessment framework
Parenting capacity
Child development needs
Family&social interaction
Child abuse is linked domestic violence-Antenatal routine enquiry into domestic abuse is helping to identify potential cases.
Child abuse is handled by MARAC-multi agency risk assessment conference
Child abuse is linked to substance abuse.
Managing disclosure
1-take allegation seriously
2-record accurately sign date
3-don't promise confidentiality
4-listen don't press for information
5-explain what you will do next
6-reassure the child or person
Types of abuse
1-physical abuse(non accidental injury)
2-neglect-difficult to set the limits
3-emotional abuse-difficult to set the limits long term implications difficult to prove witnessing domestic violence
4-sexual abuse
Role of the doctor
1.Examination of child
2.Record
3.Arrange treatment medical follow up
4.Prepare written report
Consent
1-medical emergency consent is not required
2-16 years and over can give own consent
3- Children under 16 years Fraser/Gillick competence
4-parental responsibility
5-may need PPO(police protection order)
more information on consent on children
Child over friendliness with strangers could be a sign emotional neglect.
Child abuse photograph taken by police officers because they need to be submitted in the court.
Any baby with unexplained bruises- skeletal survey is important
children act(1989)-It describes 4 important concepts
1.The child's welfare is paramount
2.Parental responsibility
3.Children are best cared by both parents
4.Children are individual in their own right
Other important documents related to child protection:
A.Section 28 of the children act 2004
B.Lord Laming recommendations 2003
Child protection overrides confidentiality.Don't promise confidentiality when dealing with child protection.
Needs ensure effective inter agency communication.
Assessment framework
Parenting capacity
Child development needs
Family&social interaction
Child abuse is linked domestic violence-Antenatal routine enquiry into domestic abuse is helping to identify potential cases.
Child abuse is handled by MARAC-multi agency risk assessment conference
Child abuse is linked to substance abuse.
Managing disclosure
1-take allegation seriously
2-record accurately sign date
3-don't promise confidentiality
4-listen don't press for information
5-explain what you will do next
6-reassure the child or person
Types of abuse
1-physical abuse(non accidental injury)
2-neglect-difficult to set the limits
3-emotional abuse-difficult to set the limits long term implications difficult to prove witnessing domestic violence
4-sexual abuse
Role of the doctor
1.Examination of child
2.Record
3.Arrange treatment medical follow up
4.Prepare written report
Consent
1-medical emergency consent is not required
2-16 years and over can give own consent
3- Children under 16 years Fraser/Gillick competence
4-parental responsibility
5-may need PPO(police protection order)
more information on consent on children
Child over friendliness with strangers could be a sign emotional neglect.
Child abuse photograph taken by police officers because they need to be submitted in the court.
Any baby with unexplained bruises- skeletal survey is important
Sunday, 7 December 2008
Friday, 28 November 2008
Fetal well being
Fetal Growth & Fetal well being are different aspects fetal evaluation.
Deficiencies in fetal well being could be associated with fetal growth restriction but it may also be present in fetal macrosomia(diabetes).
Fetal Growth is evaluated by
(I) clinical assessment of uterine size
(II)symphysiofundal height
(III)USS measurements of abdominal circumference
Fetal well being is evaluated by
(I)kick count chart
(II)CTG-non stress test
(III)Amniotic fluid index
(IV)biophysical profile
(V)umbilical artery doppler
Components of biophysical profile are.Each component is given a score of 2.
(I)Fetal movements
(II)Fetal respiratory movements
(III)Fetal tone
(IV)Amniotic Fluid index
(V)CTG-non stress test
Liquor assess chronic hypoxia other 4 parameters assess acute hypoxia
10/10 risk of fetal asphyxia in week 1<1000>2 weeks
3-abnormal venous Doppler
4-abnormal cardiograph/BPP
Deficiencies in fetal well being could be associated with fetal growth restriction but it may also be present in fetal macrosomia(diabetes).
Fetal Growth is evaluated by
(I) clinical assessment of uterine size
(II)symphysiofundal height
(III)USS measurements of abdominal circumference
Fetal well being is evaluated by
(I)kick count chart
(II)CTG-non stress test
(III)Amniotic fluid index
(IV)biophysical profile
(V)umbilical artery doppler
Components of biophysical profile are.Each component is given a score of 2.
(I)Fetal movements
(II)Fetal respiratory movements
(III)Fetal tone
(IV)Amniotic Fluid index
(V)CTG-non stress test
Liquor assess chronic hypoxia other 4 parameters assess acute hypoxia
10/10 risk of fetal asphyxia in week 1<1000>2 weeks
3-abnormal venous Doppler
4-abnormal cardiograph/BPP
Genetics
Chromosomal findings in early miscarriage
40% normal 60% abnormal
Chromosomal abnormalities
1-number
2-structure
Downs syndrome-
1-trisomy 21
2-Robertsonian translocation
3-mosaicism
60% aborted
20%still birth
Robertsonian in Downs 96% denovo
21:21 trans location is 100% recurrence
Maternal age related to all trisomies
Autosomal recessive
Cystic fibrosis 1:2500 babies in U.K
Sex linked recessive
Duchenne Muscular dystropy free fetal DNA can be done to check the sex
40% normal 60% abnormal
Chromosomal abnormalities
1-number
2-structure
Downs syndrome-
1-trisomy 21
2-Robertsonian translocation
3-mosaicism
60% aborted
20%still birth
Robertsonian in Downs 96% denovo
21:21 trans location is 100% recurrence
Maternal age related to all trisomies
Autosomal recessive
Cystic fibrosis 1:2500 babies in U.K
Sex linked recessive
Duchenne Muscular dystropy free fetal DNA can be done to check the sex
Tuesday, 11 November 2008
Subscribe to:
Posts (Atom)