Acute Gynaecology Flashcards
What is an ectopic pregnancy?
Pregnancy outwit the endometrial cavity - majority are in the tube
State the risk factors for an ectopic pregnancy
Previous ectopic, tubal damage, IUD, smoking (kills microvilli), infertility/IVF (fluid can travel past the uterus and into the tubes), extremes of age and sterilisation
What investigations should be done in suspected ectopic pregnancy?
FBC, Group and save
US/FAST - donut sign due to thickening of sac, free fluid
How is an ectopic pregnancy managed?
Resuscitation, laparoscopy, better
- salpingectomy if other tube is normal
- salpingostomy if worries over fertility
Anti-D vaccine
What dictates the management in pregnancy of unknown location?
HCG - will decrease in miscarriage, normally will double but can be static
How is a pregnancy of unknown location treated medically?
Methotrexate
What surgery can be done in pregnancy of unknown location?
Diagnostic laparoscopy - uterus can be washed out simultaneously
At what size of cyst is ovarian torsion likely?
> 5cm
Is an ovarian cyst likely to be benign or malignant?
Premenopause - benign
Postmenopause - malignant
Describe the investigations in ovarian torsion
Palpable mass on examination
FBC, CRP, group and save
Ultrasound - arterial gorging
AXR - mass, calcification in dermoid cyst
What is a dermoid cyst?
Cyst with hair/teeth can have any cell from the body
How are ovarian torsions managed?
Laparoscopy, bag and take out via umbilicus (detort without bursting)
How does a cyst rupture present?
Unilateral pain often bleeding after sex/contact sport
What kind of cyst commonly ruptures?
Functional
Dermoid
Endometrioma
What investigations are done in cyst rupture?
FBC, CRP, Ultrasound - free fluid in pelvis
How is a cyst rupture managed?
Conservative
Laparoscopy - lavage and stop bleeding with diathermy
What is PID?
Pelvic Inflammatory Disease - caused by ascending infection from the endocervix
What are the causes of PID?
Endometritis Abscess Chlamydia Gonorrhoea Gardenella Anaerobes
What are the consequences of PID?
Infertility
Chronic pelvic pain
Ectopic pregnancy
State the investigations that should be carried out in PID
FBC, CRP, LFT, cervical motion tenderness, gonorrhoea and chlamydia swabs
How is PID managed?
Ceftriaxone, metronidazole and doxycycline
What are the menstrual related causes of acute bleeding?
Anovulatory
Fibroids
Anticoagulant
Van Willebrands Disease
What are the non-menstrual related causes of acute bleeding?
Miscarriage
Cervical cancer
Endometrial cancer
Vaginal trauma
What investigations should be done in acute gynae bleeding?
FBC, CRP, HCG, coagulation, GandS LFT, ferritin Endometrial/cervical biopsy Ultrasound Examine pad
How is acute gynae bleeding managed?
ABCDE
Tanexamic acid - fibrinolytic
Mefanamic acid - NSAID reduces blood supply
Norethisterone - progesterone stabilises endometrium
IUS - stabilises lining to stop period
COCP
GnRH analogue - temporary menopause
How will an infected Bartholin’s abscess present?
Painful swelling - unable to sit down
What causes bartholin’s abscess?
E.coli
Anaerobes
How can Bartholin’s abscess be treated?
Conservative
Broad Spec antibiotics
Incision and drainage with word catheter
Marsupialisation - suture backwards to drain freely
