Gyn surgery

Question 1

What are the complications of uterine artery embolization?

Answer 1

Pain from fibroid degeneration
Myometrial infarction, necrosis
Myometritis
Bacteremia from arteriotomy
Uterine perforation 
Uterine artery perforation/hemorrhage 
Loss of ovarian function in 5 to 14% of cases

Question 2

Patient risk factors for surgical site infection

Answer 2

1. Glucose >180
2. Smoking
3. Obesity
4. Subcu >3
5. ASA physical status
6. Immunodeficiency

Question 3

What is MTX?

Answer 3

Folate antagonist, blocks dihydrofolate reductase

Inhibits DNA synthesis

Question 4

Relative contraindications to MTX

Answer 4

Embryonic CA
High HCG (>5k)
Ectopic >4cm
Refusal to accept blood

Question 5

MTX SINGLE DOSE REGIMEN

Answer 5

50 mg/m2 on day1
HCG day 4,7 should decrease by 15%
If not, admin 2nd dose
If so, continue to measure weekly until undetectable

Question 6

MTX 2 DOSE

Answer 6

Admin 2nd dose on day 4
Check HCG day 4 and 7
Decrease 15%, continue to check weekly
If not, admin another dose

After 4,surgical management

Question 7

Risk factors for ectopic

Answer 7

Age >40
Prior ectopic (1 20%, 2 50%)
Hx PID
Smoking 
ART
tubal surgery

Question 8

Contraindications to methotrexate

Answer 8

immunodeficiency 
Active PUD, pulmonary disease
Breastfeeding
Hemodynamically unstable
Ruptured ectopic
Hepatic or renal dysfunction 
Unreliable or unable to follow up

Question 9

What’s in 1u RPBC

Answer 9

250cc RBC , isotonic fluid and citrate
hb up 1g, hct 3g
No clotting factors

Question 10

What’s in 1u FFP

Answer 10

250cc /unit
Fibrinogen and all clotting factors
NO RBC, WBC, plt

Question 11

What’s in pack of platelets?

Answer 11

300-500cc in a 6pack 50cc units

Plts should increase by 5000 for each pack

Question 12

Most common sites for ureteral injury

Answer 12

Clamping IP ligament
Uterine artery
Uterosacral ligament
Vaginally cuff closure

Question 13

Repair of ureteral injury

Answer 13

<5 cm from UVJ, bladder reinplantation

> 5 cm, ureteroureterostomy
Stents for 6w
Foley for 10 days

Question 14

What To do if ureteral injury cannot be repaired without tension

Answer 14

Psoas hitch

boari flap

Question 15

At the time of hysterectomy how do you manage vaginal apex

Answer 15

Incorporate uterosacral ligaments into cuff to provide apical support

Question 16

How do you predict who needs anticoagulation prophylaxis prior to GYN surgery

Answer 16

Caprini score

Greater than or equal to five gets ppx unless high bleeding risk

Question 17

What is the baseline risk of ectopic pregnancy?

Risk of recurrence?

Answer 17

2%

10%

Question 18

Minerva

Answer 18

Combined thermal and bipolar radio frequency

Question 19

What are the risks of pregnancy following ablation

Answer 19

IUGR
Malpresentation
Abnormal placentation
Preterm birth
Perinatal mortality

Question 20

Advantages of LEEP OVER CKC

When is CKC better

Answer 20

easier to learn and teach
Can be performed with colposcopy so margins can be examined

For lesions that extend into the Endocervical canal, persistent or recurrent CIN After LEEP Or Ablation