Acute gynae EMERGENCY presentations: Miscarriage, AUB - Dr USAMA BW3 Flashcards
OSCE need to know
Learning objectives:
Focussed Gynae history:
Emergency case:
Onset pain 6 hours ago- hsarp and graduallly wosening
Quantify bleeding? Pads/tampons/goes through clothes/ clots/changing pads?
When was your last period? How do you know? Beta hcg
Sexual hx? STIs? Previous chlamydia- treated - PID - increase risk of ectopic (any tubal surgery) Infection increases ectopic, endometriosis- Blocks off tube (in tube)- its an inflammatory condition
- Torsion ovarian
- Rupture
- Ectopic prgancy (need to rule out ectopic)
In theratre:
Case: In theartre: big tense angry abdomen,
ECTOPIC pregnany- Mnagement
DRABCDE
Lets- Tell supervisor - This is a gynae emergency- i think this is an ectopic
She is speaking in sentence- Her airways secrure
Check oxygen+ RR - Bretahing -
C- Circulation- 2 IVx cannulas- IV fluids 16g- Take - Give Bolus - 1L Stat Hartmans
D-
E-
Perform Salpingectomy - rupture-
Methotrexate- cannot fall pregnant for 6 months
Definition: Ectopic pregnancy?
Epidemiology?
Risk factors: List 6
Clinical presentation: List 4 features:
Investigations:List 6 critical
treatment: Medical/surgical
Pregnancy of unknown location: What is it?
How high does beta HCG to see something intrabdominally?
beta hcg- 1500
Case 2: Miscarriage:
Hx?
Exam?
Ix?
Management?
hx: PMHX, bleeding, pain hx, obs gynae hx, CST, M and surgical hx
exam: general appearance, VS, Abdo examination, Guarding rigidity, pelvic examination (products of pregnancy)
On examination: Case 2:
POC in cervix: How do you manage this?
DRABCDE-
This is a gynae emergency-
What is a miscarriage?
What is a threatened miscarriage?
Incomplete miscarriage?
Missed miscarriage?
Septic miscarriage?
bHCG: Role? What is the minimum increase?
Should i?
Bloods? HCG? DO USS? Depends?
Management of stable miscarriage:
Management principles: Basic?
Dilatation +curretage???
- Complications include bleeding, infection, or perforation of the uterus (when the tip of an instrument passes through the wall of the uterus). Problems related to the anesthesia used also can occur. These complications are rare.
- In rare cases, after a D&C has been performed after a miscarriage, bands of scar tissue, or adhesions, may form inside the uterus. This is called Asherman syndrome. These adhesions may cause infertility and changes in menstrual flow. Asherman syndrome often can be treated successfully with surgery
Case 3: 22 yo nulliparous women, presents with sudden onset RIF
- Post coital pain
- Sudden sharp
- Associated symptoms
- Cysts ruputure
- Ovarain Torsion!!!!!!! (no 1)
Ovarian torsion:
On examination:?
Investigations?
Impression?
Management?
Surgical maanagement of ovarian torsion:
