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Y5 O&G > Gynae Procedures > Flashcards

Gynae Procedures Flashcards

1
Q

What is endometrial ablation?

A
  • Outpatient procedure to remove or destroy endometrial layers (can prevent periods / heavy bleeding)
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2
Q

What are the indications for endometrial ablation?

A
  • Menorrhagia in premenopausal or perimenopausal women with normal endometrial cavities
  • Postmenopausal bleeding of unknown origin
  • Anovulatory bleeding and bleeding secondary to fibroids – higher risk of failure as does not remove fibroids
  • No desire for future fertility but desire to retain uterus or avoid hysterectomy
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3
Q

What are the complications of endometrial ablation?

A
  • General = infection, bleeding, failure, damage to local structures (i.e. cervical os, uterus lining)
  • Minor SE = cramping, nausea, frequent urination, watery discharge mixed with blood
  • Rarely = pulmonary oedema due to fluid used to expand uterus being absorbed into blood stream
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4
Q

What device is most widely used for endometrial biopsy and why?

A

Pipelle

  • Can be used without cervical dilatation
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5
Q

What are the indications for a endometrial biopsy?

A
  • Over 55 +
    • PMB (unexplained bleeding 12+ months after LMP)
    • Unexplained discharge if its new, has thrombocytosis or reports haematuria
    • Visible haematuria and low Hb, thrombocytosis, raised blood glucose
  • Under 55 with unexplained bleeding 12+ months after LMP
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6
Q

What are the complications of endometrial biopsy?

A
  • General = infection, bleeding, failure, damage to local structures
  • Pipelle has poor negative predictive value
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7
Q

What are the indications for gynaecological laparoscopy?

A
  • Diagnostic - pelvic pain, diagnose endometriosis, infertility (dye test for tubal patency)
  • Therapeutic - sterilisation, adhesiolysis, ovarian cystectomy, salpingectomy, endometrial ablation
  • Major surgery - myomectomy, hysterectomy
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8
Q

What are the complications of gynaecological laparoscopy?

A
  • Infection
  • Bleeding
  • Failure
  • Damage to local structures
  • GA complications
  • VTE
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9
Q

What different approaches are there for a hysterectomy?

A
  • Vaginal (removed through vagina) - quickest recovery
  • Laparoscopic-assisted vaginal
  • Laparoscopic hysterectomy
  • Midline-incision
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10
Q

What structures are removed in a total, radical and subtotal hysterectomy?

A
  • Total → uterus and cervix
  • Radical → removal of structures ± BSO
    • Cervix, uterus, fallopian tubes and ovaries
  • Subtotal → upper part of uterus removed
    • Cervix not removed so smears at 6 and 18 months are needed
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11
Q

What are the contraindications to a vaginal hysterectomy?

A
  • Malignancy
  • Uterus 12w+ pregnancy
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12
Q

What are the indications to a vaginal hysterectomy?

A
  • Menstrual disorders with uterus <12w size
  • Microinvasive cervical carcinoma
  • Uterovaginal prolapse
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13
Q

What are the indications to am abdominal hysterectomy?

A
  • Uterine, ovarian, cervical, fallopian tube carcinoma
  • Pelvic pain from chronic endometriosis or chronic PID where pelvis is frozen and vaginal impossible
  • Symptomatic fibroid uterus 12w+ in size
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14
Q

What incision is made for an abdominal hysterectomy?

A
  • Pfannenstiel incision
  • Midline incision if larger masses or malignancy
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15
Q

What are the complications of a hysterectomy?

A
  • Infection - co-amoxiclav given intra-operatively
  • Bleeding
  • Failure
  • Damage to local structures
  • GA complications
  • VTE
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16
Q

Describe uterine artery ablation.

A
  • May preserve fertility but may also make ovaries fail
  • Embolise both uterine arteries → infarct/degenerate fibroids
  • Patients need admission to deal with pain associated (opiate analgesia)
  • Complications: fever, infection, fibroid expulsion, potential ovarian failure
  • 33% of women require further medical, radiological or surgical treatment <5 years
  • As effective as myomectomy for alleviating fibroid DUB and pressure symptoms
17
Q

What is colposcopy?

A

A diagnostic procedure obtaining a magnified view of the cervix, the lower part of the uterus and the vagina in order to examine the transformation zone and detect malignant or premalignant changes

18
Q

What are the indications for colposcopy and/or cervical punch biopsy?

A
  • Severe or moderate dyskaryosis
  • Borderline/mild dyskaryosis smear with HPV +ve test
  • 3x inadequate smear
  • Suspicious looking cervix
  • Glandular neoplasia on smear
19
Q

What are the complications of colposcopy?

A
  • Few/No complications from colposcopy alone
  • Colposcopy + excisional treatments:
    • Bleeding
    • Infection
    • Cervical incompetence in future pregnancies
20
Q

What are the complications of cervical punch biopsy?

A
  • Rare but include:
    • Excessive bleeding for 1-week
    • Mild cramping
    • Vaginal soreness
    • Dark discharge
21
Q

What is an epidural?

A

Regional anaesthesia performed by injecting anaesthetic into epidural space (different from a spinal).

22
Q

What are the indications for an epidural?

A
  • Pain relief during labour - stop thromboprophylaxis 24 hours before
  • Anaesthesia for C-section
23
Q

What are the complications of an epidural?

A
  • Urinary retention
  • Shivering
  • Pruritus
  • Headache (anaesthesia going to head)
  • Hypotension
  • Epidural haematoma
  • Epidural meningitis
  • Respiratory depression
  • General = infection, bleeding, failure, damage to local structures
24
Q

What is hysteroscopy?

A

Passing a small diameter telescope (flexible or rigid) through the cervix to inspect the uterine cavity

  • Flexible hysteroscope - used in OPD setting with CO2 as filling medium
  • Rigid instruments - use circulating fluids so can be used to visualise uterine cavity even if the woman is bleeding
25
Q

What are the indications for a hysteroscopy?

A
  • Abnormal bleeding from uterus:
    • PMB, PCB, IMB
    • Menorrhagia and/or abnormal discharge
    • Suspected uterine malformations or suspected Asherman’s
26
Q

What are the complications of hysteroscopy?

A
  • Infection
  • Bleeding
  • Damage to local structures (i.e. cervical os, uterus lining)
27
Q

What is large loop excision of the transformation zone (LLETZ)?

A

Use of a small wire diathermy to cut away affected cervical tissue and seal the wound.

28
Q

What are the indications for large loop excision of the transformation zone (LLETZ)?

A
  • High grade squamous intraepithelial lesion of the cervix (CIN 2 and 3)
  • Persistent low-grade squamous intraepithelial lesion of the cervix (CIN 1)
29
Q

What are the complications of large loop excision of the transformation zone (LLETZ)?

A
  • Bleeding
  • Discharge for 3-4 weeks
    • Avoid tampons, sex, swimming until discharge has stopped to avoid infection
  • General = infection, bleeding, failure, damage to local structures (i.e. uterus lining, bladder)
  • Risk of recurrence of CIN up to 10%
30
Q

What is a myomectomy?

A

Surgical removal of fibroids from the uterus.

31
Q

What is given for fibroids prior to myomectomy?

A

GnRH agonists

32
Q

What are the indications for a myomectomy?

A
  • Laparoscopy – removing 1 or 2 fibroids ≤ 2 inches that are growing outside the uterus
  • Open – large fibroids, many fibroids, fibroids deep into the uterine wall
  • Myomectomy is the only treatment to improve pregnancy
33
Q

What are the complications of myomectomy?

A
  • Hysterectomy if large haemorrhage
  • Fibroids return in 10-20% of women - larger and more numerous
  • General = infection, bleeding, failure, damage to local structures (i.e. bladder)
34
Q

What is a ovarian cystectomy?

A

Surgical excision of an ovarian cyst.

35
Q

What are the indications for a ovarian cystectomy?

A
  • Diagnostic (and exclude ovarian cancer)
  • Removal of symptomatic cysts
  • Cyst ≥7.6cm
  • Cysts that do not resolve after 2-3 months
  • Bilateral lesions
  • USS finding that deviate from simple functional cyst
36
Q

What are the complications of an ovarian cystectomy?

A
  • Infection
  • Bleeding
  • Failure
  • Damage to local structures (i.e. bladder, fallopian tubes)

Y5 O&G (69 decks)

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