O&G Written - Procedures

Question 1

Options for TOP

Answer 1

<9 weeks = medical
- mifepristone + prostaglandin e.g. misoprostol 48 hours later

Up to 13-14 weeks = surgical vacuum aspiration
+/- misoprostol for cervical ripening

> 14-15 weeks = surgical or medical

• surgical dilation + evacuation of uterine contents (aspiration + forceps), USS after to confirm complete evacuation
• medical same as before ‘mini labour’

After 22 weeks, Potassium chloride injected into umbilical vein/foetal heart to prevent any signs of life

Question 2

Additional Tx in TOP

Answer 2

Abx - all surgical TOP

VTE - LMWH for 7 days after TOP, If high risk consider starting before procedure

Anti D if Rh -ve woman and >10 weeks medical OR surgical (any gestation)?

Contraception

Question 3

Indications for medical / surgical Tx of miscarriage

Answer 3

increased haemorrhage risk - late 1st trimester

Increased risk of haemorrhage complications - coagulopathy, declines blood transfusion

Heavy bleeding

Signs of infection

Previous adverse/traumatic experience e.g. stillbirth

Question 4

Indications for surgical management of ectopic

Answer 4

foetal sac >35mm
Rupture
Pain
Visible foetal heartbeat
hCG > 5000IU/L
Another intrauterine pregnancy

Question 5

Requirements for expectant management of ectopic

Answer 5

Foetal sac <35mm
unruptured
Asymptomatic
No foetal heartbeat
hCG <1000

Can be used if another intrauterine pregnancy

Question 6

Requirements for medical management of ectopic

Answer 6

Foetal sac <35mm
Unruptured
No significant pain
No foetal heartbeat
hCG < 1500
No intrauterine pregnancy

+ willing to attend follow up for serial hCG

Question 7

Genetics of complete molar pregnancy / complete hydatidiform mole

Answer 7

2 sets of paternal genes + no maternal genes –> no foetus

Question 8

Genetics of partial molar pregnancy / partial hydatidiform mole

Answer 8

3 sets of genes (1 maternal + 2 paternal) –> non viable foetus

• dysfunction in hardening of egg membrane after fertilisation
• additional sperm enters the egg

Question 9

USS findings in molar pregnancy

Answer 9

Complete = mixed echogenic ‘snowstorm’ pattern

Partial = small volume abnormal placenta, partial foetal development, no foetal cardiac activity, ‘bunch of grapes’

Question 10

Management of molar pregnancy

Answer 10

Not desiring fertility –> hysterectomy

Desiring fertility

• singleton or twin foetus wanting TOP –> suction dilation + evacuation
• twin foetus not wanting TOP –> expectant Tx

Fluids
Anti-emetic of H2 antagonist if hyperemesis
Anti D if Rh -ve
Propanolol if throtoxicosis

Question 11

Follow-up for molar pregnancy

Answer 11

Register to Regional centre if confirmed molar pregnancy

regular hCG monitoring for ca.