Gynaecology emergencies Flashcards
(45 cards)
What is an ectopic pregnancy
Pregnancy that occurs when the fertilised egg implants outside of the uterus
Where is the most common location of an ectopic pregnancy
fallopian tube - 90%
Give 5 RFs for an ectopic pregnancy
- Previous ectopic
- previous STI/ PID
- endometriosis
- age >35
- IUD (coils etc)
What investigations would you do when suspecting ectopic pregnancy
- Urine pregnancy test (hcg)
- BHCG
- transvaginal ultrasound
Give 5 ways an ectopic pregnancy may present
- PV bleeding
- unilateral low abdominal pain
- shoulder tip pain (peritonitis)
- dizziness
- missed period
- cervical excitation
What are the possible findings of an ectopic pregnancy on an ultrasound
- adnexal mass moving separately to the ovary comprising of gestational sac +/- fetal pole
- free fluid may be seen
State the 3 options for terminating an ectopic pregnancy
- Expectant management - natural termination
- Medical management
- Surgical management
Describe expectant management for an ectopic pregnancy
- Repeat BHCG on day 2,4 and 7
- If BHCG reduced by 15% each 48h then can repeat weekly until <20iu
What is the criteria for expectant management of an ectopic pregnancy
- clinically stable pt w no significant pain
- unruptured ectopic
- adnexal mass < 35mm with no fetal pole
- BHCG < 1000iu
- pt able to return for follow up
What drug is used in the medical management of an ectopic pregnancy
IM methotrexate
What is the criteria for medical management of an ectopic pregnancy
- no significant pain + clinically stable
- unruptured ectopic <35mm
- confirmed absence of intrauterine pregnancy
- can return for follow up
- BHCG < 1500iu
What are the two options for surgical management of ectopic pregnancy
- laparoscopic salpingectomy (1st line) - whole tube w ectopic
- laparoscopic salpingostomy - just ectopic removed
When is surgical management first line for an ectopic pregnancy
- significant pain
- adnexal mass > 35mm
- live/ ruptured ectopic
- HCG >5000iu
- haemodynamically unstable
When should salpingostomy be considered over salpingectomy for removing an ectopic and why
Salpingostomy should be considered for women with contralateral tube damage, as this is a risk factor for infertility
What is a miscarriage
Involuntary, spontaneous loss of a fetus before 24 weeks
Describe a complete miscarriage (presentation, cervical Os, USS findings)
- PV bleeding and passing of products of conception
- Open/ closed cervical Os depending on stage
- USS: empty uterus
Describe an incomplete miscarriage (presentation, cervical Os, USS findings)
- Heavy bleeding inc some passing of products
- Os: open
- USS: retained tissues
Describe a threatened miscarriage (presentation, cervical Os, USS findings)
- mild PV bleeding, some abdo pain, intact membranes
- Os: closed
- USS: viable intrauterine pregnancy detected
Describe a missed miscarriage (presentation, cervical Os, USS findings)
- asymptomatic
- Os: closed
- USS: nonviable pregnancy, retained products with no fetal heartbeat or empty gestational sac
Describe an inevitable miscarriage (presentation, cervical Os, USS findings)
- Pv bleeding and abdo pain +/- intact membranes
- Os: open
- USS: gestational sac in the uterus without fetal HB or other signs of a non-viable pregnancy.
How is a miscarriage managed conservatively
- allow miscarriage to occur spontaneously
- bHCG - decrease of >50% in 48h indicates early pregnancy loss
- repeat UPT in 3 weeks to confirm miscarriage is complete
- follow up USS (1w) for threatened/ inevitable miscarriages
Describe the medical management of a miscarriage
- Mifepristone followed by misoprostol 48h later for missed miscarriage
- single dose oral/ vaginal misoprostol for others
- analgesia
- anti-emetics
- UPT after 3w to confirm
What are the two types of surgical management for a miscarriage
- Manual vacuum aspiration under local anaesthetic
- Electric vacuum aspiration under general anaesthetic
Why is infection more common in an incomplete miscarriage
retained products of conception create a risk of infection
treat with abx