Acute gynaecology and early pregnancy complication Flashcards by Jamie Craig

investigations of ectopic pregnancy

FBC
HCG
G&S
Transvaginal/FAST USS

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location of ectopic pregnancy and most common?

98% in tube 
c/s scar
cervix
corunal 
ovary 
peritoneum 
liver

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what is a heterotopic ectopic pregancy

twins

one has a normal birth and the other is ectopic

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risk factors for ectopic

smoking 
previous ectopic 
infertility 
infertility treatment 
extremes of age 
tubal damage, infection, endometriosis or surgery 
IUD/IUS

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management of ectopic pregnancy

resus
laparoscopy/laparotomy
salphingectomy/salphingotomy
anti-D

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what would you expect to find in PUL and how would you manage

static HCG in clincially well patient

watchful waiting or medical management with methotrexate

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investigations of ovarian torsion

FBC, CRP, G&S
Transvaginal USS
Examination - palpable ovary and pain

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what increases risk of ovarian torsion

cyst >5cm

usually benign premenopause and malignant postmenopause

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management of ovarian torsion

resus 
laparoscopy/laparotomy 
detorsion and look for blood supply 
cystectomy 
oophorectomy

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causes of cyst accident

spontaneous

traumatic - sexual intercourse, contact sport

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investigation for cyst accident

FBC, CRP, G&S
check for peritonism
USS

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management of cyst accident

Resus 
conservative if limited free fluid 
lararoscopy, lavage 
stop bleed 
oophorectomy

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investigation of PID

Genital swabs x2

FBC, CRP, LFTs (FHCs)

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examination finding of PID on cervical exam

cervical motion tenderness

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causes of PID

chlamydia
gonorrhoea
gardenella
anaerobes

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possible consequences of PID

ectopic pregnancy
infertility
chronic pelvic pain

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management of PID

14 days metronidazole/doxy 
consider IV for 24hr 
remove IUD 
laparoscopy to drain an abscess 
barrier contraception and contact tracing

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what is PID and what can it cause

ascending infection from endocervix
endometritis
salphingitis
tubo-ovarian abscess

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menstrual causes acute bleed

anovulatory
fibroids
anticoagulant
von-willebrands

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non-menstrual causes acute bleed

miscarriage
cervical or endometrial cancer
vaginal trauma

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investigation of acute bleeding

FBC, LFT, CRP, Coag, G&S
HCG
Ferritin
endometrial biopsy 
cervical biopsy 
USS

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management of acute gynae bleed

resus 
tranexamic acid and mefanemic acid 
norehistheorne 
IUS 
COCP
GnRH analogue

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features of HSV infection

pain
ulceration 
discharge 
dysuria 
urine retention

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investigation of HSV infection

viral swabs

examine for lymphadenopathy

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management of HSV infection

local anaesthetic aciclovir catheter??

features of bartholins gland infection

swelling, pain of bartholins gland at 5/7 oclock

management of bartholins abscess

conservative broad spec abx incise and drain if not working with word catheter marsupialisation if nothing else

what are the clinical features of miscarriage

+ve UPT bleeding and cramping period type cramps passed products

investigation of miscarriage

USS transabdo or transvaginal ±foetal heartbeat | speculum exam

what is cervical shock

cramping, N&V, sweating, fainting resolves if products removed from cervix resus with IVI, uterotonics

open os with products sited at cervix is a?

inevitable miscarriage

closed os with no products sites is a?

threatened miscarriage

closed os with products in vagina is a?

complete miscarriage

what is a threatened miscarriage

risk to pregnancy

what is an inevitable miscarriage

pregnancy cannot be saved

what is an incomplete miscarriage

part of pregnancy lost

what is a complete miscarriage

all pregnancy lost and uterus empty

what is a NCP and how can it be seen on USS

pregnancy in situ, stagnating HCG, mean sac diameter >25mm and foetal pole >7mm

what is an anembryonic pregnancy

no foetus and empty sac

causes of miscarriage

``` chromosome issue APLS CMV, rubella, toxoplasma, listeria severe upset or stress iatrogenic - CVS heavy smoking, alcohol or cocaine diabetes bleeding from placental bed of chorion leading to hypoxia ```

what is a recurrent miscarriage and possible causes

``` >3 miscarriages APLS thrombophilia balanced translocation uterine abnormality age and previous risk ```

how may recurrent miscarriage be managed

LDA and fragmin in APLS | progesterone pessay in unexplained cases if >35 and >2 losses

investigation of miscarriage

assess haemodynamic stability | FBC, G&S, hCG, USS, histology

management of miscarriage

conservative vs medical vs surgical consider admitting manual vacuum aspiration anti-D if surgical options needed

features of PUL

amenorrhoea and abdo pain no evidence of pregnancy in uterus, fallopian tube, cervix, c/s scar, abdomen level of hCG confirms pregnancy

how may PUL be managed

methotrexate

what is a molar pregnancy

fertilisation of a non viable egg | leads to overgrowth of placental tissue with swollen chorionic villi

true/false - partial mole increases risk of choriocarcinoma

false - complete mole does

what is a complete molar pregnancy

egg has no DNA and 1/2 sperm fertilise to result in paternal only DNA no foetus and overgrown placental tissue

what is a partial molar pregnancy

haploid egg 1 sperm with replicated DNA or two sperm fertilise egg leading to triploidy can have foetus but overgrown placenta

management of molar pregnancy

surgical uterine evacuation and tissue for histology | medical management possible

issues associated with molar pregnancy leading to diagnosis

``` hyperemesis hyperthyroid early onset pre-eclampsia varied bleed, grapelike tissue SOB due to lung embolisation or seizure due to brain mets ```

USS appearance of molar pregnancy

snowstorm

what is implantation bleeding and how is it managed

``` egg implanting into endometrial lining 10 days post ovulation light brown bleed, self limiting signs of pregnancy emerge can be mistaken as pregnancy ```

what is a chorionic haematoma, what symptoms does it cause and management

pooling of blood between endometrium and embryo bleed, cramp, threatened miscarriage usually self limited, large haematoma can be source infection, miscarriage surveillance

cervical causes of bleeding in early pregnancy

ectopy infection, chlamydia, gonorrhoea, other bacteria polyp malignancy

vaginal causes of bleeding early pregnancy

``` trichomoniasis BV chlamydia malignancy ulcers forgotten tampon ```

management of BV

metronidazole

management of chlamydia in pregnancy

erythromycin | amoxicillin

what causes of bleeding may be missed as part of early pregnancy

urinary | bowel

when is anti-D injection advised

follwowing surgical procedure with rh-ve mother

what is hyperemesis gravidarum

vomiting in 1st trimester, excessive, protracted and altering quality of life can lead to weight loss, altered liver function, malnutrition, instability, anxiety, dehydration, ketosis, electrolyte imbalance

other possible differentials to consider instead of HG

``` UTI gastritis PUD viral hep pancreatitis ```

management of HG

``` rehydrate and replace electrolytes IV antiemitic nutrition thiamine NG/PTN feed steroid - pred VTE prophylaxis ```

antiemitics to use in HG

1st line is cyclizine or prochlorperazine | 2nd line is metclopramide

Acute gynaecology and early pregnancy complication Flashcards

(65 cards)