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Emergency & Acute > Acute Gynae > Flashcards

Acute Gynae Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Early and late miscarriage

A

Early <13 weeks

Late 13-24 weeks

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2
Q

When is miscarriage most common?

A

First trimester

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3
Q

How may miscarriage present?

A

Bleeding: usually scanty, may recur over several days. Could be a large bleed
Lower abdo pain/ cramping/ back ache (usually follows bleeding)

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4
Q

What signs indicate cervical shock?

What is this?

A

Severe pain + bleeding + hypotension with bradycardia

Products of conception stuck in the cervical os

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5
Q

5 types of miscarriage

A

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

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6
Q

What is recurrent miscarriage?

A

Loss of >3 consecutive pregnancies before 24 weeks

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7
Q

Most common cause of miscarriage

A

Abnormal foetal development

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8
Q

Acne drug that can cause miscarriage

A

Isotretinoin

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9
Q

Endocrinological causes of miscarriage

A

PCOS, thyroid, DM (poorly controlled)

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10
Q

Age RFs for miscarriage

A

Increasing maternal + paternal age

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11
Q

Investigating suspected miscarriage

A

Screen for ectopic pregnancy
Vaginal exam
USS
Pregnancy test

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12
Q

Pregnancy test findings in miscarriage

A

Will be +ve for several days after foetal death

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13
Q

Management of cervical shock

A

ABCDE

Removal of contents with sponge forceps

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14
Q

Medical management of miscarriage

A

misoprostol - for incomplete/ missed to stimulate expulsion of uterine contents

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15
Q

Surgical management of miscarriage options (2)

A

Manual vacuum aspiration (LA)

Surgical (GA)

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16
Q

Where is an ectopic pregnancy most commonly found?

A

fallopian tube (95%)

17
Q

How may ectopic pregnancy present?

A 
Sudden lower abdo pain
Collapse
Amenorrhoea/ missed period - 8 weeks
Discomfort going to the toilet
Vaginal bleeding
N+V
18
Q

Where may pain in ectopic pregnancy be referred to?

A

Shoulder tip! (blood irritating the diaphragm)

19
Q

When does ectopic pregnancy most commonly present?

A

4-12 weeks

20
Q

How common is ectopic pregnancy?

A

around 1 in 100 pregnancies

21
Q

What are the 3 results of ectopic pregnancy?

A

Extrusion
Spontaneous involution of pregnancy
Rupture through tube causing pain + bleeding

22
Q

What is common about RFs for ectopic pregnancy?

A

The delay of of normal transit of fertilised ovum to uterus

23
Q

5 risk factors for ectopic pregnancy?

A 
IVF
PMH of pelvic inflammation
Adhesions (e.g. endometriosis)
ICUD (if device fails)
Progesterone-only pill
24
Q

Where is particularly dangerous for ectopic pregnancies to implant?

A

Uterine horn (may reach 10-14 weeks before rupture)

25
Q

What 2 investigations must be done in suspected ectopic?

A

Pregnancy test (ALWAYS +VE!!)

Transvaginal USS (to identify location of the pregnancy)

26
Q

What is the first line medical management for ectopic pregnancy?

A

Methotrexate

27
Q

ectopic pregnancy Mx:

<6 weeks, bleeding but no pain

A

Expectant management

28
Q

When is surgical management of ectopic required?

salpingectomy

A

In significant haemorrhage

29
Q

What is pelvic inflammatory disease?

A

Infection of the upper genital tract

30
Q

What is the most common cause of PID?

A

ALMOST ALWAYS STI!!

most commonly chlamydia

31
Q

What are RFs for PID?

A

Same as for STIs/ interruption of the cervical barriet (IUD insertion/ abortion etc)

32
Q

How is PID diagnosed?

A

Diagnosis is CLINICAL!

33
Q

Symptoms of PID

A

Bilateral lower abdo pain
Deep dyspareunia
Abnormal bleeding/ prurulent discharge
RUQ pain

34
Q

Signs of PID

A

Bilateral lower abdo tenderness
Prurulent cervical discharge
Cervical motion tenderness
Fever

35
Q

Where should women with PID be managed?

A

GUM clinic

36
Q

What are the complications of PID?

A

Tubal infertility, ectopic pregnancy, chronic pelvic pain

37
Q

How is PID managed?

A

Empiric abx

38
Q

How severe PID managed?

A

pain relief
Epiric IV abx asap!
e.g. ceftriaxone, doxycycline + metranidazole
Broad spec for C trach, N gon + anaerobes

Emergency & Acute (21 decks)

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