Renew Mechanics License Ontario

Case No. 2

Prenatal Control

A pregnant 37, enrolled in a pregnancy of 13 weeks is taken to the emergency room during the night. Her husband is on the way home from work, very upset, crying because the ultrasound was performed in birth control, told him he had a high risk of having a child with Down syndrome. The patient did not request that she received no special consideration during the scan and asked for his consent to be informed.

attending the clinic to have a new ultrasound machine, with a group of highly qualified doctors and continuous improvement in a referral center for maternal-fetal medicine college.

• Know you think is "risk of aneuploidy?

aneuploidy risk corresponds to a calculation based on ultrasound and biochemical variables to determine a probability of aneuploidy the patient to be tested.

• What are the markers of aneuploidy?

ultrasound findings are associated with the presence of aneuploidy, and in combination with the "risk of aneuploidy" to lessen the rate of false positives, in addition to a presumptive diagnosis of aneuploidies early without invasive methods. However, accurate diagnosis of aneuploidies is only possible through invasive methods.

• What risk does this patient? Do you know how to define the number of false positives in this situation? According

parameters analyzed at 13 weeks, this patient has a high risk that your child has an aneuploidy, however, when considering only aneuploidy markers evaluated the first trimester of pregnancy false positive rate reaches 5% .

• What medical, legal, ethical, experiential, do you think there are associated with the case presented?

Concerning

case referred to various problems arise.

First is the question about the diagnosis of aneuploidy. In calculating the risk of aneuploidy can not make a definitive diagnosis, even when the risk is high, since it represents a chance and will need to use invasive methods, which carry a 1% risk of reproductive loss to confirm the diagnosis.

And when we certify the diagnosis of aneuploidy that arises the question about the course of further action, since abortion is illegal in our country, besides being ethically reprehensible.

the question also arises about whether fully justified risk to the fetus using invasive methods to confirm the diagnosis, which I think should be analyzed case by case, according to the treatment options and possible benefits that could determine in any particular case the definitive diagnosis of aneuploidy versus a high suspicion at birth.

is important to ask about the patient's emotional response on the news. For any pregnant woman, the expectations for your child are high, and during the antenatal attachment is formed an idealized image of the child, to be contrasted with the real child when finally know. Taking this into consideration is important to analyze the impact that a diagnosis of this type, or only suspected, may have on the patient and the damage it can cause in the relationship of the mother-baby, in addition to the emotional harm to the mother.

• What other tests can be derived from this clinical situation? What are the risks? What would you advise?

From known facts, it would be important to evaluate them in relation to the markers that could be seen on ultrasound in the second semester to have a lower chance of false positives. Having assessed these parameters and determined the risk of aneuploidy, could raise the option of using invasive methods such as amniocentesis or chorionic villus sampling, to have a diagnosis.

Having assessed the patient using all available noninvasive methods, would talk to her about the existence of invasive methods, explaining their risk and also explain that through non-invasive methods is only a "risk" and not a definite diagnosis. I think the patient with proper emotional support and, ideally, with his partner, who must decide on the use of an invasive method, knowing what the possible benefits justifying the use of them.

• Comment or investigate the following concepts:

• verbal iatrogenic

is for the damage done when they say you should not say, either ignorantly say something false, when it is appropriate to say, put it empathy necessary to speak in a language incomprehensible to the patient or say when there is no time to allow the patient understands what is said.

right to be informed

patient has the right to receive information regarding their own person from the health personnel, in accordance with the principle autonomy.

• right not to know

A patient has the right to receive information regarding your medical condition, because that knowledge has emotional implications that the patient is entitled to avoid, in accordance with the principles of autonomy and personal health must respect this choice, preventing iatrogenic verbal, according to the principle of nonmaleficence.

Carlos Sáez Muñoz

Outlook 2010 Error 554 Spoam

Clinical Case Report # 4

}

Patient 32, married, multiparous than 3 vaginal deliveries, pelvic control goes to because he approached from the office for their Pap test.

, the patient is concerned and when interviewed by the midwife, it invites you to have a NIE cervicopatía 1 associated with HPV.

The patient does not understand what it is and asks for an explanation in simple terms.

Do I have cancer? If I have now, do I have chance of cancer? What chance? Is it false positive Pap? What about false negatives? What to do? How did this happen to me?

1. How do you inform the patient of the above?

intraepithelial neoplasia 1 (NIE I) is not cancer, but it is a disease that alters the normal barrier of the cervix, which is likely to get cancer, thus being a premalignant condition. The NIE 1 in more than half of the cases (70%) and improved return spontaneously, leaving a percentage of the injury remains stable, and a small percentage progressing to NIE 2 and 3 and possibly to cancer .

The PAP has false positives and negatives. Is estimated to have a sensitivity of 50-60% for the diagnosis of histological atypia, but its specificity is 90-99%. False positives are 16%, and false negatives 20%. This means that the test will not detect all patients with abnormal, but if detected, is very sure that you have an injury.

must have a serial control (clinical and PAP) on a regular basis to control the natural progression of this injury. In general has a good prognosis.

How would report it acquired a virus?

will inform you the truth about how he acquired the virus. What is sexual transmission. This is because the benefits we get with education and awareness are higher than hide this information.

Do you have the obligation to do so? What cases do you have?

the doctor is obliged to inform the way they acquired the virus, since in this particular disease, infection with this pathogen is a major risk factors and etiologies that explain their picture. For this reason, allows us to educate the patient, and to take all appropriate action.

2. A person with an STD is more likely to have another STD. Is this an STD?

A person with an STD, have a higher risk of having another STD depending solely on their risk factors (promiscuity, unsafe sex without protection methods, etc.). In this case we must evaluate the background to suspect in other infections. But the caveat is that this type of infection is highly prevalent in the general population, so given the high prevalence does not to think about other sexually transmitted infections if there are no risk factors.

3. The patient wants to explain to her husband. What did you say?

You must first find a comfortable and sheltered. It should be explained naturally, without falling in intonation or severity alarm. We explained that an infection is highly prevalent in the general population, which corresponds to a sexually transmitted disease course is often asymptomatic, and can generate lesions that have a partner. We partner education. We believe it is important to explain the possible form of timely transmission of the infection.

4. The patient tells you that, so this does not happen to their daughters, you want to vaccinate. Is there a vaccine to protect them?

There is a vaccine that can immunize against the human papilloma virus. It is necessary to investigate the ages of the girls, because to be effective, it has been shown to be applied before the start of sexual life. Anyway, once begun is effective sexual life, but it depends entirely on chance of not having a relationship where you purchased the virus. We advise you to vaccinate their daughters, as has been proven effective for 70 to 95% protection against the most prevalent strains that produce cancer cervical. It is also important to educate people about safe and healthy sexual behavior.