Describe a Maylard incision.
The critical difference between a Maylard and a Pfannensteil is transection of the rectus muscles. The skin incision itself is often 3cm to 8cm above the symphysis depending on the surgery.
Advantages: better access, possibly better cosmesis.
Disadvantages: more pain, greater distortion of anatomy.
Discuss the advantages and disadvantages of the vaginal approach.
Advantages include no scar, less pain and early mobilisation. In obese women there is a reduced risk of wound infection.
Disadvantages include limited access.
Relative contraindications include a uterine size over 12 weeks or pelvic adhesions due to endometriosis or pelvic inflammatory disease.
What is the prevalence of BRCA gene mutations?
Between 0.1 and 0.8 percent. Women of Ashkenazi Jewish heritage are somewhat higher at 2.3 percent.