Surgical procedures in O&G Flashcards
(118 cards)
1
Q
What is the percentage risk of serious complication with diagnostic hysteroscopy?
A
0.2% or 2 in 1,000
2
Q
What is the percentage risk of uterine perforation with diagnostic hysteroscopy?
A
0.13%
Mnemonic 1 for 1 uterus
3
Q
What is the percentage risk of uterine perforation with THERAPEUTIC hysteroscopy?
A
0.76%
Mnemonic I would 0.8 (hate) for perforation
4
Q
What is the risk of death with diagnostic hysteroscopy per 100,000
A
3 to 8 per 100,000 women
5
Q
True or False?
Uterine distension with saline provides superior images than with CO2
A
True
6
Q
What is the first choice for uterine distension when doing diagnostic hysteroscopy?
A
Saline provides a superior images compared to CO2
7
Q
What size hysteroscope should be used for outpatient diagnostic hysteroscopy?
A
2.7 mm miniature hysteroscope with a 3.0 - 3.5mm sheath
8
Q
With regards to diagnostic outpatient hysteroscopy what is green top guideline #59 recommendations regards routine use opiates?
A
Opiates routine use should be AVOIDED
9
Q
With regards to diagnostic outpatient hysteroscopy what is green top guideline #59 recommendations regards NSAIDs use?
A
Should be GIVEN 1 hour before the procedure
10
Q
With regards to diagnostic outpatient hysteroscopy what is green top guideline #59 recommendations regards cervical dilation?
A
NOT advised
No benefit interms of reduced incidence of trauma
11
Q
CAESAREAN SECTION
A
CAESAREAN SECTION
12
Q
What is the Joel Cohen incision?
A
This is a straight line incision made 3cm above the pubic symphysis used in c sections
13
Q
With regars to C-sections in how many layer(s) is the uterine incision sutured in?
A
TWO
14
Q
With regards to C-sections what is the recommendation when it comes to suturing of the visceral and parietal peritoneum
A
DONOT SUTURE visceral and parietal peritoneum
why? to reduce operating time
15
Q
With regards to C-sections what is the recommendation when it comes to routine closure of the subcutaneous tissue space.
A
routine closure of the subcutaneous tissue space is NOT recommended
16
Q
With regards to C-sections what is the recommendation when it comes to prophylactic antibiotics.
A
Prophylactic antibiotics are given BEFORE skin incision
Ideally given atleast 30minutes before C section to ensure bactericidal concentration is reached by time of incision
17
Q
According to RCOG greentop guidelines #52 with regards to C-sections which drug and dose is recommended to reduce blood loss
A
Oxytocin 5 units IV slowly
18
Q
According to NICE guidelines 2023 with regards to C-sections which drug is recommended to reduce post partum hemorrhage
A
Carbetocin by slow intravenous injection
19
Q
With regards to C-sections what is the risk of fetal of fetal laceration in %
A
2%
20
Q
With regards to C-sections what is the risk of persistent wound and abdominal discomfort in the first few months after surgery per 100 women
A
9 in 100
Mnemonic the 9 resembles a chest n tummy
21
Q
With regards to C-sections what is the risk of repeat c-section when vaginal delivery attempted in subsequent pregnancies?
A
1 in 4
22
Q
With regards to C-sections what is the risk of readmission to hospital per 100 women
A
5 in 100
Mnemonic A handful which is five fingers will be readmitted
23
Q
With regards to C-sections what is the risk of hemorrhage per 1,000 women
A
5 in 1,000
Mnemonic hemprrhage sounds like porridge for a 5 year old
24
Q
With regards to C-sections what is the risk of infection per 100 women
A
6 in 100
Mnemonic the f in infection looks like a 6
25
With regards to C-sections what is the risk of emergency hysterectomy per 1,000 women
7 - 8 in 1,000
Mnemonic I would 8 to remove my womb.
26
With regards to C-sections what is the risk of need for further surgery at a later date per 1,000 women
5 in 1,000
Mnemonic further surgery needed as last one was subpar 5/10
27
With regards to C-sections what is the risk of ICU admisssion per 1,000 women
9 in 1,000
Mnemonic ICU at the 9 night
28
With regards to C-sections what is the risk of thromboembolic disease per 10,000 women
4 to 16 per 10,000
Mnemonic ThromBOWEmbolic is a concert for kids 4 to 16 years
29
With regards to C-sections what is the risk of bladder injury per 1,000 women
1 in 1,000
Mnemonic one bladder therefore 1 in 1000
30
With regards to C-sections what is the risk of ureteric injury per 10,000 women
3 in 10,000
Mnemonic u3teric injury
31
With regards to C-sections what is the risk of DEATH per 12,000 women
1 in 12,000
32
OASIS
OBSTETRIC ANAL SPHINCTER INJURIES
OASIS
OBSTETRIC ANAL SPHINCTER INJURIES
33
In the management of obstetric anal sphincter injury, what is rcog stance on routine antibiotic use?
The use of broad spectrum antibiotic is recommended following repair of obstetric anal sphincter injury to reduce risk of post operative infections and wound dehiscence
34
In the management of obstetric anal sphincter injury, what is rcog stance on laxative use?
The use of post operative laxative is recommended to reduce the risk of wound dehiscence
35
In the management of obstetric anal sphincter injury, what is rcog stance on bulking agents use?
Not recommended
36
In the management of obstetric anal sphincter injury, which laxative can be use?
Lactulose is recommended for 10 days post opt
37
What is the incidence of obstetric anal sphincter injury in primipare in the UK in %?
6.1%
Mnemonic primipare looks like primary school You start primary school at 6 year old or 6.1%
38
What is the overall incidence of obstetric anal sphincter injury in the UK in %?
2.9%
39
What is the incidence of obstetric anal sphincter injury in multipare in the UK in %?
1.7%
40
What % of women are asymptomatic following delivery and external anal sphincter repair in 12 months time?
60 to 80%
41
In the management of obstetric anal sphincter injury, what is the rcog stance on figure of 8 suturing technique?
Figure of 8 suturing are hemostatic in nature and can cause ischemia and should be avoided.
42
In the management of obstetric anal sphincter injury, what is the recommended post opt follow up
Follow up in 6 to 12 weeks post repair
43
In the management of obstetric anal sphincter injury, what suture technique(s) are used for closure of the anorectal mucosa?
1. Continuous
2. Interrupted
44
In the management of obstetric anal sphincter injury, what suture technique(s) are used for closure of the internal anal sphincter?
1. Mattress
2. Interrupted
Mnemonic
Donot interupt activities on the mattress
45
In the management of obstetric anal sphincter injury, what suture technique(s) are used for closure of the external anal sphincter?
1. End to end
46
In the management of obstetric anal sphincter injury, what suture (s) are used for closure of the external anal sphincter?
PDS 3.0
Polyglatin 2.0
PDS is a synthetic absorbable monofilament
Polyglatin is a synthetic absorbable braided suture aka vicyl
47
In the management of obstetric anal sphincter injury, what suture (s) are used for closure of the internal anal sphincter?
PDS 3.0
Polyglatin 2.0
PDS is a synthetic absorbable monofilament
Polyglatin is a synthetic absorbable braided suture
48
In the management of obstetric anal sphincter injury, what suture (s) are used for closure of the anorectal mucosa?
Polyglactin 3.0
49
Additional OASIS questions after reading RCOG greentop #29
Additional OASIS questions after reading RCOG greentop #29
50
What is a first degree perineal tear?
Injury to perineal skin and or vaginal mucosa
51
What is a second degree perineal tear?
Injury to perineum involving perineal muscles only.
The anal sphincter complex is not involved.
52
What is a third degree perineal tear
Injury to the perineum involving the anal sphincter complex
53
What is Grade 3a perineal tear?
< 50% of external anal sphincter thickness torn
54
What is Grade 3b perineal tear?
>50% of external anal sphincter thickness torn
55
What is Grade 3c perineal tear?
Both external and internal anal sphincters torn
56
What is a fourth degree perineal tear?
Injury to perineum involving the anal sphincter complex (EAS and IAS) and anorectal mucosa
57
What epithelium lines the proximal anal canal?
Rectal mucosa which is columnar epithelium
58
What epithelium lines the distal 1 to 1.5cm of the anal canal?
Modified squamous epithelium
59
When the term OASIS or Obstetric Anal Sphincter Injuries is used which tears are been referred to?
Third and fourth degree tears
60
What is a rectal button hole tear?
Tear involving the rectal mucosa with an intact anal sphincter complex
61
A rectal buttonhole tear is defined as a tear involving the rectal mucosa with an intact anal sphincter complex, if this is not repaired what is a possible complication?
Rectovaginal fistula
62
With regards to OASIS, List two non modifiable maternal risk factor
Asian ethnicity
Nulliparity
63
Relating to the intrapartum period list five (5) risk factors for OASIS
Relating to baby
1. Weight > 4kg
2. Shoulder dystocia
3. Occipito posterior position
Others
4. Prolonged second stage of labor
5. Instrumental delivery higher risk for forcep or vaccum delivery without an episiotomy
64
True or False
Episiotomy should be routinely performed to prevent OASIS?
False
Episiotomy should be performed if indicated such as instrumental delivery
65
What angle does NICE guidelines recommend for mediolateral episiotomy?
45 to 60 degrees from the midline
66
What angle does Green top guidelines #29 recommend for mediolateral episiotomy?
60 degrees from the midline
67
The RCOG greentop guideline #29 recommends a 60 degrees angle mediolateral episiotomy, what is the resultant post delivery angle?
45 degrees
68
True or False
Mediolateral episiotomy should be performed with instrumental deliveries as it appears to have a protective effect on OASIS
True
69
What does NICE intrapartum guidelines say about perineal protection and OASIS risk
Found no difference between 'hands poised' or 'hands on' the perineum as protection for OASIS
70
What does RCOG green top guidelines #29 say about perineal protection and OASIS risk
Encourages perineal support as it reduces incidence of OASIS
71
What does RCOG green top guidelines #29 say about warm compress and OASIS risk
Recommends warm compress applied to the perineum in the second stage of labour to reduce OASIS risk
72
What does RCOG green top guidelines #29 say about perineal massage and OASIS risk
Perineal massage during the last month of pregnancy can enable perineal tissue to expand more easily during birth
Inconclusive data regarding perineal massage during the seond stage of labour.
73
Where should repair of OASIS take place?
List the specific conditions
In operating theatre under general or regional anesthesia with good lighting and appropriate instruments
74
What type of anesthesia should be used to repair OASIS?
Regional or general anesthesia
75
In the repair of OASIS what technique(s) can be done to minimize the risk of knot and suture migration?
1. Bury surgical knots beneath the superficial and deep perineal mucles
2. Trimming suture ends
76
Following OASIS repair what is the incidence of suture migration quoted by RCOG greentop guidelines
7%
77
How would a patient present with suture migration after OASIS repair?
1. Pain or irritation around the perineum
2. The exposed end of suture material can be seen or felt on digital examination
78
A patient presents with pain around the perineum and exposed end of suture material seen or felt on digital examination following OASIS repair
What is the likely diagnosis?
Suture Migration
79
A patient presents with pain around the perineum and exposed end of suture material seen or felt on digital examination following OASIS repair. Suture migration is suspected what can be done?
Exposed ends of suture material can be trimmed in the out patient under local anesthesia
80
In the repair of OASIS, PDS is used. What does PDS stand for?
polydioxanone
81
In the repair of OASIS what muscles are repaired by PDS or polydioxanone?
Internal and External anal sphincter
82
In the repair of OASIS the Internal and External anal sphincter are repaired by PDS or polydioxanone?
What size PDS is recommened?
3.0
83
What type of suture is PDS interms of material filament and absorbability?
Synthetic and monofilament
Absorbable
84
In the repair of OASIS, 3.0 PDS is recommended for repair of the internal and external anal sphincters.
What other suture can be used?
2.0 Polyglactin
85
What is another name for Polyglactin?
Vicryl
86
What type of suture is Polyglactin interms of material and filament?
Synthetic
Braided
Absorbable
87
In the repair of OASIS, which muscles can be repaired by Polyglactin?
1. Anorectal mucosa used 3.0 polyglactin
2. Internal and External Anal sphincters used 2.0 polyglactin
88
What two tools can be used at follow up after OASIS repair to decide future deliveries?
1. Endoanal ultrasonography
2. Anal manometry
89
LAPAROSCOPIC SURGERY
LAPAROSCOPIC SURGERY
90
With regards to laparoscopic surgery, what is another name for the open entry technique?
Hassan technique
91
With regards to laparoscopic surgery, what is another name for the closed entry technique?
Veress needle technique
92
With regards to laparoscopic surgery, what is the closed entry technique?
This is also known as the veress needle technique.
A veress needle is used to create a pneumoperitoneum to increase safe entry of the tocar
A trocar is then blindly inserted into the peritoneal cavity through a small skin incision made previously when passing veress neddle
93
With regards to laparoscopic surgery, what is the open entry technique?
This is also known as the Hassan technique
Blunt dissection is done to access the peritouem then trocar inserted
94
With regards to laparoscopic surgery, what is overall risk of serious complication in 1000 people
2 in 1000
95
With regards to laparoscopic surgery, what is overall risk of bowel injury in 1000 people
0.4 in 1000
96
With regards to laparoscopic surgery, what is overall risk of vascular injury in 1000 people
0.2 in 1000
97
With regards to laparoscopic surgery, what is overall risk of death in 100,000
5 in 100,000
Mnemonic A handfull which is five fingers will die
98
With regards to laparoscopic surgery an intraabdominal pressure of ________ mmhg should be used fo gas insufflation before inserting primary trocar
20 - 25 mmhg
With regards to laparoscopic surgery an intraabdominal pressure of *20- 25mmHg mmhg should be used fo gas insufflation before inserting primary trocar
99
With regards to laparoscopic surgery the distension pressure should be reduced to _______mmHg once the insertion of the trocar is complete
12- 15 mmhg
With regards to laparoscopic surgery the distension pressure should be reduced to 12- 15 mmHg once the insertion of the trocar is complete
100
With regards to laproscopic surgery in the obese woman what does the green top guidelines #42 recommends for primary entry
In the obese woman Hassan open technique or entry at Palmer point are recommended.
Palmer's point the veress needle is inserted and pneumoperitonuem created followed by insertion of trocar
101
With regards to laproscopic surgery in the VERY THIN woman what does the green top guidelines #42 recommends for primary entry
In the very thin woman Hassan open technique or entry at Palmer point are recommended.
Palmer's point the veress needle is inserted and pneumoperitonuem created followed by insertion of trocar
102
With regards to laproscopic surgery in the normal BMI (18.5 to 24.9) woman what does the green top guidelines #42 recommends for primary entry
No preferential entry methods
103
With regards to laproscopic surgery in the obese woman why does the green top guidelines #42 recommends Hassan open technique or entry at Palmer point for primary entry
Difficult penetration with veress needle at the umbilicus
104
With regards to laproscopic surgery in the very thin woman why does the green top guidelines #42 recommends Hassan open technique or entry at Palmer point for primary entry
Risk of vascular injury with veress at the umbilicus
105
What is abdominal hysterectomy?
Surgical procedure where the uterus is removed through incision in the lower abdomen
106
What % of unilateral ureteric injuries are diagnosed postoperatively?
70%
107
List FOUR symptoms of a ureteric injury
1. flank pain
2. hematuria
3. fever
4. urine discharged vaginally or via wound
108
What lab test would indicate a ureteric injury
Elevated serum creatinine
109
What is the first clinical sign of bilateral ureteral injury?
anuria
110
What is the % risk of serious complication for abdominal hysterectomy for benign conditions as per RCOG
4%
111
What is the risk of hemorrhage requiring blood transfusion for abdominal hysterectomy for benign conditions as per RCOG
2.3%
112
What is the % risk of bladder or ureter injury OR long term disturbance of bladder function for abdominal hysterectomy for benign conditions as per RCOG
0.7%
113
What is the % risk of return to theatre (due to bleeding or wound dehiscence) for abdominal hysterectomy for benign conditions as per RCOG
0.7%
114
What is the % risk VTE after abdominal hysterectomy for benign conditions as per RCOG
0.4%
115
What is the % risk pelvic abscess or infection after abdominal hysterectomy for benign conditions as per RCOG
0.2%
116
What is the % risk of bowel injury for abdominal hysterectomy for benign conditions as per RCOG
0.04% (4 in 10,000)
Mnemonic boowel = 0.04
117
What is the % risk of death within 6 weeks after abdominal hysterectomy for benign conditions as per RCOG
0.03%
Represent 3 scores that god promised
118
