Counselling: Trial of Scar

1. Introduce yourself
   
2. Confirm the patient's name and problem
   
3. Inform the patient that it is good to have her husband together during the discussion
   
4. Ask patient whether she knows about her condition, any preference in her option
   
5. Inform the patient of the options that she has:
   
   • vaginal delivery --> Trial of Scar 
   • LSCS
     
6. Tell patient that we need to assess the patient condition first whether the condition is favourable for:
   • any short stature -->CPD 
   • pelvic cavity size 
   • exclude placenta previa 
   • exclude other contraindication
     
7. Explain that there is risk in every procedure
   • risk of scar dehiscence 0.5% (if use oxytocin 0.8%, if use prostaglandin 2.45%)--> Therefore need to deliver in tertiary hospital where OT ,NICU and blood bank available
   •  we will monitor her closely (baby and vital sign to see sign of uterine rupture ie tachycardia, hypotension, vaginal bleeding, sudden loss of contraction, scar tenderness, continuous abdominal pain in between uterine contraction) 
   • can give option to patient for epidural 
   • however there is still risk of failed TOS --> need to proceed to LSCS
     
     
8. Explain pro and con TOS
   • fast recovery 
   • but we don’t know exact time for delivery, need to see progress of labour
     
9. Explained another option (LSCS), also explained pro and con
   • risk of adhesion lead to difficult surgery 
   • risk of injury to bowel and bladder 
   • risk of bleeding and blood transfusion 
   • the advantage is operation is done in planned environment 
   • explain that 2nd LSCS will limit family size 
   • if want to do BTL, can do together 
   • explained that the next pregnancy should be manage by LSCS
     
10. Give opportunity to patient to ask any further questions
    
11. Ask patient preference whether have decided or not
    
12. If can’t answer question from patient, get an appointment to refer patient to senior colleague or consultant for better picture
    
13. Provide patient pamphlet for any further information

Source: Teaching with dr nasir (this is one of osce question for pro exam last year,2010)

Hanisah A115275