Revision Notes for the DRCOG A Textbook of Women s Health

by Jamila Groves, Deena El-Shirbiny

Revision Notes for the DRCOG A Textbook of Women s Health First published as Mastering the DRCOG this highly acclaimed revision text has been completely updated and revised to follow the syllabus of the DRCOG examination This book

Publisher : CRC Press

Author : Jamila Groves, Deena El-Shirbiny

ISBN : 9781482226423

Year : 2015

Language: en

File Size : 22.81 MB

Category : Used Textbooks

Revision
Notes for the

DRCOG

A Textbook of Women’s Health

Second Edition
• Completely revised and updated
• Written by GPs for GPs
• Includes sample exam questions
and explanations

Jamila Groves
Deena El-Shirbiny

Revision
Notes for the

DRCOG

Revision
Notes for the

DRCOG

A Textbook of Women’s Health

Second Edition

Jamila Groves MBBS (London) BSc (Hons) MRCGP DRCOG DFSRH DCH
General Practitioner, Totnes, Devon, UK
Deena El-Shirbiny MBBS (London) MRCP MRCGP DFSRH DRCOG
General Practitioner, Nottingham, UK

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Version Date: 20150428
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From Jamila:
To my beloved husband and our children, Zahara, Zibelia and Tycho
From Deena:
To Loay, for your enduring support and love, and our daughters, Amira and Layla

Contents
Foreword xi
Authors xiii
Acknowledgements xv
1

Basic clinical skills
Basic female anatomy
Basic female physiology
Taking a gynaecological history
Examining women
Normal physiological vaginal discharge
Pregnancy testing
Blood testing for gynaecological problems
Microbiological testing
Imaging investigations
Legal and ethical issues
Maternity pay and benefits

1
1
3
5
6
8
9
10
11
13
15
17

2

Basic surgical skills
Pre-operative care
Peri-operative care
Surgical instruments
Post-operative care
Surgical procedures used in gynaecology

19
19
20
22
24
24

3

Antenatal care
Role of the midwife
Role of the obstetrician
Role of the general practitioner
Minor ailments of pregnancy
Moderately serious pregnancy complications
Very serious pregnancy complications
Maternal infection during pregnancy
Antenatal screening and prenatal diagnosis
Chromosomal abnormalities of the autosomal chromosomes
Chromosomal abnormalities of the sex chromosomes

31
31
33
33
36
38
39
44
51
54
56

viii

Contents

Haemoglobinopathies 56
Pre-existing medical conditions that affect pregnancy
58
Special antenatal areas
61
4

Management of labour and delivery
The weeks prior to delivery
Stages of labour
Management of normal labour
Assessment of fetal well-being
Induction of labour
Obstructed labour
Obstetric emergencies
Cultural and religious attitudes to childbirth

65
65
66
70
74
80
81
87
89

5

Postpartum and neonatal care
Management of the normal postpartum period
Management of the abnormal postpartum period
Neonatal care

91
91
94
98

6

Gynaecological problems
103
Ambiguous genitalia
103
Adolescent gynaecology
105
Adult gynaecology
109
Urogynaecology 118
Sexually transmitted infections
119
Non-sexual vaginal infections
127
Non-infectious vulvo-vaginal conditions
129
Early pregnancy problems
129
Gynaecological cancers
134
Reference 141

7

Fertility control
143
Contraception 143
Subfertility 161

8

Hot topics and tips
Sexual abuse and rape
Domestic violence
Commercial sex work (prostitution)
Human trafficking

167
167
167
168
168

Contents

ix

Cosmetic surgery
169
Female genital mutilation
170
Media, body image and eating disorders
171
Eugenics: Pre-implantation genetic screening
171
Egg and sperm donation
172
Three-parent babies
172
Surrogate motherhood
174
Services for foreign pregnant women in the United Kingdom
175
Female orgasm
175
Reference 176
9

Sample examination questions
Multiple choice questions (MCQs)
Single best answer questions (SBAs)
Extended matching questions (EMQs)

177
177
179
183

10

Sample examination answers and explanations
Multiple choice questions (MCQs): Answers and explanations
Single best answers (SBAs): Answers and explanations
Extended matching questions (EMQs): Answers and explanations

189
189
192
199

Appendix: Useful documents and websites

207

Foreword
The DRCOG website states that the Diploma of the
Royal College of Obstetricians and Gynaecologists
(DRCOG) is an assessment of knowledge and competence in obstetrics, gynaecology, sexual health
and family planning. This book comprehensively
covers these four clinical areas in a succinct and upto-date way. It is a complete and thorough rewrite
of the first edition with over 50% new material and
a totally new look. The authors, Dr. Jamila Groves
and Dr.  Deena El-Shirbiny, both work in general

practice and have brought that experience to this
book to set out what they feel practitioners need
to know for the DRCOG and also for their work
within primary care. The result is a book that provides an excellent revision guide as well as being a
useful aide-mémoire to keep handy in the surgery.

Tony Hollingworth
MBChB PhD MBA FRCS(ed) FRCOG
Consultant Obstetrician and Gynaecologist

Authors
Jamila Groves, BSc, MBBS, DRCOG, DFSRH,
MRCGP, DCH, is a general practitioner (GP) who
works as a partner
in Leatside Surgery,
Totnes, Devon. She
enjoys all aspects of
medicine, particularly contact with
patients, the building of relationships,
and holistic care.
Her
enthusiasm,
specialist skills and
advanced ­training
in women’s health have naturally led her into
provision of well woman clinics. This, along with
her strong belief and involvement in professional
development and appraisal, has resulted in this
book.
Dr. Groves’ approach respects the diversity of
women’s needs and the variety of personal and
cultural values they hold. She has worked for
extended periods with women in China, India and
Jamaica as well as in busy sexual health clinics in
London, Portsmouth and the Isle of Wight.
Dr. Groves’ practice is based on a highly individualised approach that, while incorporating
­evidence-based medicine and national guidelines,
is dedicated to assisting women choose their own
management pathways. She believes that in order
to empower individuals to make good decisions
about their health three things are key:
●●
●●
●●

The provision of accurate information
Opportunity for discussion
Time for reflection

This book has been written with the aim of assisting doctors and other healthcare professionals

gain the knowledge required to achieve this, and
thereby assist patients negotiate their way through
the myriad options that life throws at them.
Deena El-Shirbiny, MBBS, MRCP, MRCGP,
DFSRH, DRCOG, is a general practitioner with
a  range of experience in primary care.
After
­graduating,
she completed her
MRCP
(Member­
ship of the Royal
Colleges of Physi­
cians) and embarked
on training in general practice. During
her career, she has
gained ­clinical experience in a variety of clinical environments, including Nepal, Australia, Egypt and both rural and urban
areas in the United Kingdom. She has a particular
interest in health inequalities, which has led her
to volunteer with a number of organisations in the
United Kingdom, such as Medecins du Monde, with
whom she worked on a new primary healthcare
project.
Dr. El-Shirbiny has an interest in sexual health
and HIV  having spent a period of time working in this  field in a tertiary referral centre in
London. She also has experience in teaching
GP t­rainees  and medical students. In 2014, she
sat the DRCOG herself. This has ensured that
she has up-to-date, in-depth experience of the
current DRCOG curriculum and examination
procedure.
Dr. El-Shirbiny employs a holistic approach in her
care of women, utilising evidence-based medicine,
strong consultation skills and cultural awareness
to ensure that management is patient centred.

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