Acute Gynae Flashcards
Early and late miscarriage
Early <13 weeks
Late 13-24 weeks
When is miscarriage most common?
First trimester
How may miscarriage present?
Bleeding: usually scanty, may recur over several days. Could be a large bleed
Lower abdo pain/ cramping/ back ache (usually follows bleeding)
What signs indicate cervical shock?
What is this?
Severe pain + bleeding + hypotension with bradycardia
Products of conception stuck in the cervical os
5 types of miscarriage
Complete - all products expelled and bleeding stopped
Incomplete - bleeding but tissue still in the uterus
Missed (silent) -without pain or bleeding, seen on USS
Threatened - bleeding in presence of viable pregnancy
Inevitable - non-viable pregnancy. Bleeding has begun
What is recurrent miscarriage?
Loss of >3 consecutive pregnancies before 24 weeks
Most common cause of miscarriage
Abnormal foetal development
Acne drug that can cause miscarriage
Isotretinoin
Endocrinological causes of miscarriage
PCOS, thyroid, DM (poorly controlled)
Age RFs for miscarriage
Increasing maternal + paternal age
Investigating suspected miscarriage
Screen for ectopic pregnancy
Vaginal exam
USS
Pregnancy test
Pregnancy test findings in miscarriage
Will be +ve for several days after foetal death
Management of cervical shock
ABCDE
Removal of contents with sponge forceps
Medical management of miscarriage
misoprostol - for incomplete/ missed to stimulate expulsion of uterine contents
Surgical management of miscarriage options (2)
Manual vacuum aspiration (LA)
Surgical (GA)
Where is an ectopic pregnancy most commonly found?
fallopian tube (95%)
How may ectopic pregnancy present?
Sudden lower abdo pain Collapse Amenorrhoea/ missed period - 8 weeks Discomfort going to the toilet Vaginal bleeding N+V
Where may pain in ectopic pregnancy be referred to?
Shoulder tip! (blood irritating the diaphragm)
When does ectopic pregnancy most commonly present?
4-12 weeks
How common is ectopic pregnancy?
around 1 in 100 pregnancies
What are the 3 results of ectopic pregnancy?
Extrusion
Spontaneous involution of pregnancy
Rupture through tube causing pain + bleeding
What is common about RFs for ectopic pregnancy?
The delay of of normal transit of fertilised ovum to uterus
5 risk factors for ectopic pregnancy?
IVF PMH of pelvic inflammation Adhesions (e.g. endometriosis) ICUD (if device fails) Progesterone-only pill
Where is particularly dangerous for ectopic pregnancies to implant?
Uterine horn (may reach 10-14 weeks before rupture)
What 2 investigations must be done in suspected ectopic?
Pregnancy test (ALWAYS +VE!!)
Transvaginal USS (to identify location of the pregnancy)
What is the first line medical management for ectopic pregnancy?
Methotrexate
ectopic pregnancy Mx:
<6 weeks, bleeding but no pain
Expectant management
When is surgical management of ectopic required?
salpingectomy
In significant haemorrhage
What is pelvic inflammatory disease?
Infection of the upper genital tract
What is the most common cause of PID?
ALMOST ALWAYS STI!!
most commonly chlamydia
What are RFs for PID?
Same as for STIs/ interruption of the cervical barriet (IUD insertion/ abortion etc)
How is PID diagnosed?
Diagnosis is CLINICAL!
Symptoms of PID
Bilateral lower abdo pain
Deep dyspareunia
Abnormal bleeding/ prurulent discharge
RUQ pain
Signs of PID
Bilateral lower abdo tenderness
Prurulent cervical discharge
Cervical motion tenderness
Fever
Where should women with PID be managed?
GUM clinic
What are the complications of PID?
Tubal infertility, ectopic pregnancy, chronic pelvic pain
How is PID managed?
Empiric abx
How severe PID managed?
pain relief
Epiric IV abx asap!
e.g. ceftriaxone, doxycycline + metranidazole
Broad spec for C trach, N gon + anaerobes
