4 - Operations and Procedures Flashcards

1
Q

What is a hysteroscopy and curettage and what is it used for?

A

Light tube through cervix and into uterus

Curette then scrapes tissue from uterus

After may have backache or cramps, small clots and light vaginal bleeding for a few weeks

Uses: investigate heavy periods, unusual vaginal bleeding, postmenopausal bleeding, pelvic pain, repeated miscarriages or difficulty getting pregnant. Look for fibroids. Remove dislodged IUDs

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2
Q

Diagnostic laparascopies can help diagnose certain gynaecological conditions. What are some operative laparoscopies?

A
  • Ovarian Cystectomy
  • Endometriosis removal
  • Myomectomy (can also be open)
  • Hysterectomy (can also be open)
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3
Q

What are the different classifications of hysterectomies?

A
  • Total hysterectomy: uterus and cervix
  • Sub-total hysterectomy: body of uterus only, leaving cervix behind
  • Total hysterectomy and bilateral salpingo-oophorectomy: removal of uterus, cervix, fallopian tubes and ovaries.
  • Radical hysterectomy: uterus and cervix, the parametrium, a vaginal cuff and part of or the whole of the fallopian tubes. For cervical cancer
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4
Q

What are the different approaches for a hysterectomy?

A
  • Abdominal
  • Vaginal
  • Laparoscopic
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5
Q

What are the steps of an abdominal hysterectomy?

A

Low transverse or midline incision depending on size of the uterus

  • Round ligaments divided.
  • If the tubes and ovaries are to be removed, the infundibulopelvic ligaments are ligated and tied (the ureters should be identified first).
  • The uterovesical peritoneal fold is divided and the bladder reflected down past the cervix.
  • The parametrial tissue is divided.
  • The uterine vessels and ligated and tied.
  • The paracervical tissue and uterosacral ligaments are ligated and tied.
  • The vagina is opened and the uterus and cervix removed.
  • The vagina is usually closed with an absorbable suture.
  • Haemostasis is confirmed at all pedicles.
  • The abdomen is closed.
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6
Q

What anaesthetic is used for a hysterectomy?

A
  • General for abdominal and laparoscopic
  • Regional for vaginal
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7
Q

What are some examples of indications for a hysterectomy?

A
  • Heavy menstrual bleeding
  • Pelvic pain
  • Uterine prolapse
  • Gynaecological malignancy (usually ovarian, uterine or cervical)
  • Risk reducing surgery, usually in cases of BRCA 1 or 2 mutations, or Lynch syndrome
  • Major postpartum haemorrhage
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8
Q

What are some complications with a hysterectomy?

A

General: haemorrhage, infection, pain

  • Damage to the bladder and/or the ureter
  • Damage to the bowel
  • Return to theatre because of bleeding/wound dehiscence
  • Pelvic abscess/infection
  • VTE/PE
  • Early menopause by 1-2 years if ovaries left
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9
Q

What is a myomectomy?

A

Surgery to remove fibroids

It may be considered as an alternative to a hysterectomy if want to have children in the future

Can be done open or laparoscopically

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10
Q

What is an endometrial ablation?

A

Destroys the endometrium in HMB with no apparent cause

Hysteroscopy is done first to determine suitability for procedure

Only done if not planning to have anymore children and should take contraception afterwards as if become pregnant (low chance) can have high risks e.g placenta praevia/accreata

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11
Q

What are the different methods used for endometrial ablation?

A

Transcervical Resection of the Endometrium (TCRE): Diathermy loop, needs general anaesthetic, time consuming

Balloon Ablation: A balloon filled with heated fluid sits inside the uterus for a pre-specified length of time to destroy the endometrium. Needs cervical dilation. More suitable for irregularly shaped endometrium

Microwave Energy: IUD with microwave energy destroys endometrium. 72 seconds, no cervical dilation needed

Bipolar Mesh: bipolar energy mesh is inserted into the uterus, expanded and then energy delivered to the endometrium, needs cervical dilation

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12
Q

What are some contraindications for endometrial ablation?

A
  • Those who still want children
  • Endometrial hyperplasia
  • Malignancy
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13
Q

What are some complications with endometrial ablation?

A
  • Electrolyte disturbance due to fluid overload
  • Uterine Perforation
  • Pelvic pain due to scarring
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14
Q

What is a tension free vaginal tape?

A

Used to treat stress incontinence

Synthetic tape placed around the urethra to form a sling to support it and prevent leakage

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15
Q

What procedure needs to be performed after a tension free vaginal tape and why?

A

Cystoscopy to check no bladder perforation

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16
Q

What are some complications of tension free vaginal tape?

A

Long term effectiveness of these is unknown so need to counsel

  • Bladder perforation
  • Damage to pelvic blood vessels or viscera.
  • Urinary retention
  • Urgency
  • Groin pain
  • Vaginal tape erosions
17
Q

What are some alternatives to a tension free vaginal tape?

A
  • Mid urethral tape: trans-obturator tape (TOT)
  • Open colposuspension
  • Autologous rectus fascial sling
  • Anterior vaginal repair
  • Injection of bulking agents into the bladder neck
18
Q

How is a pipelle biopsy done?

A

Used to biopsy endometrium

Use speculum and put pipelle through endocervical canal

Pipelle will suction out endometrial tissue and then put into preservative and send for histology

19
Q

How is the Nexplanon implant inserted?

A

Small, flexible 40mm plastic rod with barium in so can be seen via x-ray

Usually done in first 5 days of the menstrual cycle, and is effective immediately. If inserted after that window, it takes 7 days so use condoms for this time

Local anaesthetic to upper arm. Metal device pierces skin and positions implant sub-dermally

20
Q

What are some contraindications for the contraceptive implant?

A
  • Already pregnant
  • St John’s Wort
  • Arterial disease, history of stroke or serious heart disease.
    • Liver disease
    • Breast cancer
    • Unexplained vaginal bleeding
21
Q

What are some advantages and disadvantages of the progesterone implant?

A
22
Q

How long after IUD/IUS insertion is it effective as a contraceptive?

A

IUD - Immediately

IUS - Immediate if within first 7 days of cycle, otherwise 1 week

23
Q

How is an IUD/IUS inserted?

A
  • Do STI screening 2 weeks before as STI is CI
  • Perform bimanual examination is performed
  • Insert speculum and cervical dilator
  • Small plastic T-shaped device then pushed through the cervix into the uterus. Cut strings so sit in vagina so woman can check to ensure device not expelled
24
Q

What are some indications for an IUD/IUS?

A
  • Long term contraceptive
25
Q

What are some contraindications to an IUD/IUS?

A
  • History of PID
  • Recent exposure to STI
  • Recent infection of the uterus
  • Current pregnancy or up to 4-weeks post-partum
  • Uterine structural abnormalities (e.g. bicornuate uterus)
  • Current gynaecological malignancy
  • Current unexplained vaginal bleeding
  • Allergy to copper (IUD only)

IUS (Progesterone)

  • Current DVT or PE
  • Current liver disease
  • History of breast cancer
26
Q

What are some advantages and disadvantages of the coil?

A
27
Q

What are the maternal complications with placental abruption?

A
  • DIC
  • Haemorraghic Shock
  • AKI
  • Emergency hysterectomy
28
Q

What are the fetal complications with placental abruption?

A
  • Stillbirth
  • Hypoxic injury (HIE)
  • IUGR
  • Premature delivery
29
Q

What are the marker cells for BV?

A

Clue cells

30
Q

Why do we need to treat premature menopause?

A
  • Prevent osteoporosis
  • Prevent dementia
  • Prevent CVD risk
  • Prevent Parkinson’s
31
Q

What immediate blood tests do you need to do for an ectopic pregnancy?

A
  • Serial Serum b-HCG
  • Clotting screen
  • G+S
32
Q

What advice do you need to give someone following an ectopic pregnancy about future conception?

A
  • 10% chance of it happening again
  • Avoid pregnancy for three months if taken Methotrexate
  • Avoid pregnancy for two period cycles with surgical management
33
Q

What are the symptoms of placental abruption?

A
  • PV bleeding
  • Abdo pain
  • Woody tense uterus
  • Continuous contractions
34
Q

If someone tests positive for GDM on their OGTT, what management should you offer?

A
  • Allow them to trial diet and exercise for 1-2 weeks, if fails then give Metformin, if fails again then give Insulin
35
Q

Does Anti-D need to be given for management of an ectopic pregnancy?

A
  • Yes surgical always
  • No if medical up to 12 weeks
36
Q

What are some symptoms of TTTS in the mother?

A
  • Breathlessness
  • Rapid increase in abdomen size
37
Q

What ART prophylaxis is given to a baby with a HIV positive mother?

A
  • Intrapartum Zidovudine
  • 4-6 weeks Zidovudine to baby if viral load <50. If >50 needs triple ART
38
Q

What is a complication of hyperemesis gravidarum that can cause secondary seizures?

A

Sagittal Sinus Thrombosis

39
Q

How often should you have smear tests and up to what age?

A

25 - 64 with a change at 50