Acute gynaecology and early pregnancy complication Flashcards
investigations of ectopic pregnancy
FBC
HCG
G&S
Transvaginal/FAST USS
location of ectopic pregnancy and most common?
98% in tube c/s scar cervix corunal ovary peritoneum liver
what is a heterotopic ectopic pregancy
twins
one has a normal birth and the other is ectopic
risk factors for ectopic
smoking previous ectopic infertility infertility treatment extremes of age tubal damage, infection, endometriosis or surgery IUD/IUS
management of ectopic pregnancy
resus
laparoscopy/laparotomy
salphingectomy/salphingotomy
anti-D
what would you expect to find in PUL and how would you manage
static HCG in clincially well patient
watchful waiting or medical management with methotrexate
investigations of ovarian torsion
FBC, CRP, G&S
Transvaginal USS
Examination - palpable ovary and pain
what increases risk of ovarian torsion
cyst >5cm
usually benign premenopause and malignant postmenopause
management of ovarian torsion
resus laparoscopy/laparotomy detorsion and look for blood supply cystectomy oophorectomy
causes of cyst accident
spontaneous
traumatic - sexual intercourse, contact sport
investigation for cyst accident
FBC, CRP, G&S
check for peritonism
USS
management of cyst accident
Resus conservative if limited free fluid lararoscopy, lavage stop bleed oophorectomy
investigation of PID
Genital swabs x2
FBC, CRP, LFTs (FHCs)
examination finding of PID on cervical exam
cervical motion tenderness
causes of PID
chlamydia
gonorrhoea
gardenella
anaerobes
possible consequences of PID
ectopic pregnancy
infertility
chronic pelvic pain
management of PID
14 days metronidazole/doxy consider IV for 24hr remove IUD laparoscopy to drain an abscess barrier contraception and contact tracing
what is PID and what can it cause
ascending infection from endocervix
endometritis
salphingitis
tubo-ovarian abscess
menstrual causes acute bleed
anovulatory
fibroids
anticoagulant
von-willebrands
non-menstrual causes acute bleed
miscarriage
cervical or endometrial cancer
vaginal trauma
investigation of acute bleeding
FBC, LFT, CRP, Coag, G&S HCG Ferritin endometrial biopsy cervical biopsy USS
management of acute gynae bleed
resus tranexamic acid and mefanemic acid norehistheorne IUS COCP GnRH analogue
features of HSV infection
pain ulceration discharge dysuria urine retention
investigation of HSV infection
viral swabs
examine for lymphadenopathy
management of HSV infection
local anaesthetic
aciclovir
catheter??
features of bartholins gland infection
swelling, pain of bartholins gland at 5/7 oclock
management of bartholins abscess
conservative
broad spec abx
incise and drain if not working with word catheter
marsupialisation if nothing else
what are the clinical features of miscarriage
+ve UPT
bleeding and cramping
period type cramps
passed products
investigation of miscarriage
USS transabdo or transvaginal ±foetal heartbeat
speculum exam
what is cervical shock
cramping, N&V, sweating, fainting
resolves if products removed from cervix
resus with IVI, uterotonics
open os with products sited at cervix is a?
inevitable miscarriage
closed os with no products sites is a?
threatened miscarriage
closed os with products in vagina is a?
complete miscarriage
what is a threatened miscarriage
risk to pregnancy
what is an inevitable miscarriage
pregnancy cannot be saved
what is an incomplete miscarriage
part of pregnancy lost
what is a complete miscarriage
all pregnancy lost and uterus empty
what is a NCP and how can it be seen on USS
pregnancy in situ, stagnating HCG, mean sac diameter >25mm and foetal pole >7mm
what is an anembryonic pregnancy
no foetus and empty sac
causes of miscarriage
chromosome issue APLS CMV, rubella, toxoplasma, listeria severe upset or stress iatrogenic - CVS heavy smoking, alcohol or cocaine diabetes bleeding from placental bed of chorion leading to hypoxia
what is a recurrent miscarriage and possible causes
>3 miscarriages APLS thrombophilia balanced translocation uterine abnormality age and previous risk
how may recurrent miscarriage be managed
LDA and fragmin in APLS
progesterone pessay in unexplained cases if >35 and >2 losses
investigation of miscarriage
assess haemodynamic stability
FBC, G&S, hCG, USS, histology
management of miscarriage
conservative vs medical vs surgical
consider admitting
manual vacuum aspiration
anti-D if surgical options needed
features of PUL
amenorrhoea and abdo pain
no evidence of pregnancy in uterus, fallopian tube, cervix, c/s scar, abdomen
level of hCG confirms pregnancy
how may PUL be managed
methotrexate
what is a molar pregnancy
fertilisation of a non viable egg
leads to overgrowth of placental tissue with swollen chorionic villi
true/false - partial mole increases risk of choriocarcinoma
false - complete mole does
what is a complete molar pregnancy
egg has no DNA and 1/2 sperm fertilise to result in paternal only DNA
no foetus and overgrown placental tissue
what is a partial molar pregnancy
haploid egg
1 sperm with replicated DNA or two sperm fertilise egg leading to triploidy
can have foetus but overgrown placenta
management of molar pregnancy
surgical uterine evacuation and tissue for histology
medical management possible
issues associated with molar pregnancy leading to diagnosis
hyperemesis hyperthyroid early onset pre-eclampsia varied bleed, grapelike tissue SOB due to lung embolisation or seizure due to brain mets
USS appearance of molar pregnancy
snowstorm
what is implantation bleeding and how is it managed
egg implanting into endometrial lining 10 days post ovulation light brown bleed, self limiting signs of pregnancy emerge can be mistaken as pregnancy
what is a chorionic haematoma, what symptoms does it cause and management
pooling of blood between endometrium and embryo
bleed, cramp, threatened miscarriage
usually self limited, large haematoma can be source infection, miscarriage
surveillance
cervical causes of bleeding in early pregnancy
ectopy
infection, chlamydia, gonorrhoea, other bacteria
polyp
malignancy
vaginal causes of bleeding early pregnancy
trichomoniasis BV chlamydia malignancy ulcers forgotten tampon
management of BV
metronidazole
management of chlamydia in pregnancy
erythromycin
amoxicillin
what causes of bleeding may be missed as part of early pregnancy
urinary
bowel
when is anti-D injection advised
follwowing surgical procedure with rh-ve mother
what is hyperemesis gravidarum
vomiting in 1st trimester, excessive, protracted and altering quality of life
can lead to weight loss, altered liver function, malnutrition, instability, anxiety, dehydration, ketosis, electrolyte imbalance
other possible differentials to consider instead of HG
UTI gastritis PUD viral hep pancreatitis
management of HG
rehydrate and replace electrolytes IV antiemitic nutrition thiamine NG/PTN feed steroid - pred VTE prophylaxis
antiemitics to use in HG
1st line is cyclizine or prochlorperazine
2nd line is metclopramide
