Acute Gynae

Question 1

Early and late miscarriage

Answer 1

Early <13 weeks

Late 13-24 weeks

Question 2

When is miscarriage most common?

Answer 2

First trimester

Question 3

How may miscarriage present?

Answer 3

Bleeding: usually scanty, may recur over several days. Could be a large bleed
Lower abdo pain/ cramping/ back ache (usually follows bleeding)

Question 4

What signs indicate cervical shock?

What is this?

Answer 4

Severe pain + bleeding + hypotension with bradycardia

Products of conception stuck in the cervical os

Question 5

5 types of miscarriage

Answer 5

Complete - all products expelled and bleeding stopped
Incomplete - bleeding but tissue still in the uterus
Missed (silent) -without pain or bleeding, seen on USS
Threatened - bleeding in presence of viable pregnancy
Inevitable - non-viable pregnancy. Bleeding has begun

Question 6

What is recurrent miscarriage?

Answer 6

Loss of >3 consecutive pregnancies before 24 weeks

Question 7

Most common cause of miscarriage

Answer 7

Abnormal foetal development

Question 8

Acne drug that can cause miscarriage

Answer 8

Isotretinoin

Question 9

Endocrinological causes of miscarriage

Answer 9

PCOS, thyroid, DM (poorly controlled)

Question 10

Age RFs for miscarriage

Answer 10

Increasing maternal + paternal age

Question 11

Investigating suspected miscarriage

Answer 11

Screen for ectopic pregnancy
Vaginal exam
USS
Pregnancy test

Question 12

Pregnancy test findings in miscarriage

Answer 12

Will be +ve for several days after foetal death

Question 13

Management of cervical shock

Answer 13

ABCDE

Removal of contents with sponge forceps

Question 14

Medical management of miscarriage

Answer 14

misoprostol - for incomplete/ missed to stimulate expulsion of uterine contents

Question 15

Surgical management of miscarriage options (2)

Answer 15

Manual vacuum aspiration (LA)

Surgical (GA)

Question 16

Where is an ectopic pregnancy most commonly found?

Answer 16

fallopian tube (95%)

Question 17

How may ectopic pregnancy present?

Answer 17

Sudden lower abdo pain
Collapse
Amenorrhoea/ missed period - 8 weeks
Discomfort going to the toilet
Vaginal bleeding
N+V

Question 18

Where may pain in ectopic pregnancy be referred to?

Answer 18

Shoulder tip! (blood irritating the diaphragm)

Question 19

When does ectopic pregnancy most commonly present?

Answer 19

4-12 weeks

Question 20

How common is ectopic pregnancy?

Answer 20

around 1 in 100 pregnancies

Question 21

What are the 3 results of ectopic pregnancy?

Answer 21

Extrusion
Spontaneous involution of pregnancy
Rupture through tube causing pain + bleeding

Question 22

What is common about RFs for ectopic pregnancy?

Answer 22

The delay of of normal transit of fertilised ovum to uterus

Question 23

5 risk factors for ectopic pregnancy?

Answer 23

IVF
PMH of pelvic inflammation
Adhesions (e.g. endometriosis)
ICUD (if device fails)
Progesterone-only pill

Question 24

Where is particularly dangerous for ectopic pregnancies to implant?

Answer 24

Uterine horn (may reach 10-14 weeks before rupture)

Question 25

What 2 investigations must be done in suspected ectopic?

Answer 25

Pregnancy test (ALWAYS +VE!!) Transvaginal USS (to identify location of the pregnancy)

Question 26

What is the first line medical management for ectopic pregnancy?

Answer 26

Methotrexate

Question 27

ectopic pregnancy Mx: | <6 weeks, bleeding but no pain

Answer 27

Expectant management

Question 28

When is surgical management of ectopic required? | salpingectomy

Answer 28

In significant haemorrhage

Question 29

What is pelvic inflammatory disease?

Answer 29

Infection of the upper genital tract

Question 30

What is the most common cause of PID?

Answer 30

ALMOST ALWAYS STI!! | most commonly chlamydia

Question 31

What are RFs for PID?

Answer 31

Same as for STIs/ interruption of the cervical barriet (IUD insertion/ abortion etc)

Question 32

How is PID diagnosed?

Answer 32

Diagnosis is CLINICAL!

Question 33

Symptoms of PID

Answer 33

Bilateral lower abdo pain Deep dyspareunia Abnormal bleeding/ prurulent discharge RUQ pain

Question 34

Signs of PID

Answer 34

Bilateral lower abdo tenderness Prurulent cervical discharge Cervical motion tenderness Fever

Question 35

Where should women with PID be managed?

Answer 35

GUM clinic

Question 36

What are the complications of PID?

Answer 36

Tubal infertility, ectopic pregnancy, chronic pelvic pain

Question 37

How is PID managed?

Answer 37

Empiric abx

Question 38

How severe PID managed?

Answer 38

pain relief Epiric IV abx asap! e.g. ceftriaxone, doxycycline + metranidazole Broad spec for C trach, N gon + anaerobes