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MB3 Obstetrics and Gynaecology > Acute gynaecology and early pregnancy complication > Flashcards

Acute gynaecology and early pregnancy complication Flashcards

1
Q

investigations of ectopic pregnancy

A

FBC
HCG
G&S
Transvaginal/FAST USS

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2
Q

location of ectopic pregnancy and most common?

A 
98% in tube 
c/s scar
cervix
corunal 
ovary 
peritoneum 
liver
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3
Q

what is a heterotopic ectopic pregancy

A

twins

one has a normal birth and the other is ectopic

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4
Q

risk factors for ectopic

A 
smoking 
previous ectopic 
infertility 
infertility treatment 
extremes of age 
tubal damage, infection, endometriosis or surgery 
IUD/IUS
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5
Q

management of ectopic pregnancy

A

resus
laparoscopy/laparotomy
salphingectomy/salphingotomy
anti-D

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6
Q

what would you expect to find in PUL and how would you manage

A

static HCG in clincially well patient

watchful waiting or medical management with methotrexate

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7
Q

investigations of ovarian torsion

A

FBC, CRP, G&S
Transvaginal USS
Examination - palpable ovary and pain

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8
Q

what increases risk of ovarian torsion

A

cyst >5cm

usually benign premenopause and malignant postmenopause

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9
Q

management of ovarian torsion

A 
resus 
laparoscopy/laparotomy 
detorsion and look for blood supply 
cystectomy 
oophorectomy
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10
Q

causes of cyst accident

A

spontaneous

traumatic - sexual intercourse, contact sport

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11
Q

investigation for cyst accident

A

FBC, CRP, G&S
check for peritonism
USS

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12
Q

management of cyst accident

A 
Resus 
conservative if limited free fluid 
lararoscopy, lavage 
stop bleed 
oophorectomy
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13
Q

investigation of PID

A

Genital swabs x2

FBC, CRP, LFTs (FHCs)

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14
Q

examination finding of PID on cervical exam

A

cervical motion tenderness

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15
Q

causes of PID

A

chlamydia
gonorrhoea
gardenella
anaerobes

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16
Q

possible consequences of PID

A

ectopic pregnancy
infertility
chronic pelvic pain

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17
Q

management of PID

A 
14 days metronidazole/doxy 
consider IV for 24hr 
remove IUD 
laparoscopy to drain an abscess 
barrier contraception and contact tracing
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18
Q

what is PID and what can it cause

A

ascending infection from endocervix
endometritis
salphingitis
tubo-ovarian abscess

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19
Q

menstrual causes acute bleed

A

anovulatory
fibroids
anticoagulant
von-willebrands

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20
Q

non-menstrual causes acute bleed

A

miscarriage
cervical or endometrial cancer
vaginal trauma

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21
Q

investigation of acute bleeding

A 
FBC, LFT, CRP, Coag, G&S
HCG
Ferritin
endometrial biopsy 
cervical biopsy 
USS
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22
Q

management of acute gynae bleed

A 
resus 
tranexamic acid and mefanemic acid 
norehistheorne 
IUS 
COCP
GnRH analogue
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23
Q

features of HSV infection

A 
pain
ulceration 
discharge 
dysuria 
urine retention
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24
Q

investigation of HSV infection

A

viral swabs

examine for lymphadenopathy

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25
Q

management of HSV infection

A

local anaesthetic
aciclovir
catheter??

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26
Q

features of bartholins gland infection

A

swelling, pain of bartholins gland at 5/7 oclock

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27
Q

management of bartholins abscess

A

conservative
broad spec abx
incise and drain if not working with word catheter
marsupialisation if nothing else

28
Q

what are the clinical features of miscarriage

A

+ve UPT
bleeding and cramping
period type cramps
passed products

29
Q

investigation of miscarriage

A

USS transabdo or transvaginal ±foetal heartbeat

speculum exam

30
Q

what is cervical shock

A

cramping, N&V, sweating, fainting
resolves if products removed from cervix
resus with IVI, uterotonics

31
Q

open os with products sited at cervix is a?

A

inevitable miscarriage

32
Q

closed os with no products sites is a?

A

threatened miscarriage

33
Q

closed os with products in vagina is a?

A

complete miscarriage

34
Q

what is a threatened miscarriage

A

risk to pregnancy

35
Q

what is an inevitable miscarriage

A

pregnancy cannot be saved

36
Q

what is an incomplete miscarriage

A

part of pregnancy lost

37
Q

what is a complete miscarriage

A

all pregnancy lost and uterus empty

38
Q

what is a NCP and how can it be seen on USS

A

pregnancy in situ, stagnating HCG, mean sac diameter >25mm and foetal pole >7mm

39
Q

what is an anembryonic pregnancy

A

no foetus and empty sac

40
Q

causes of miscarriage

A 
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
41
Q

what is a recurrent miscarriage and possible causes

A 
>3 miscarriages 
APLS
thrombophilia 
balanced translocation 
uterine abnormality 
age and previous risk
42
Q

how may recurrent miscarriage be managed

A

LDA and fragmin in APLS

progesterone pessay in unexplained cases if >35 and >2 losses

43
Q

investigation of miscarriage

A

assess haemodynamic stability

FBC, G&S, hCG, USS, histology

44
Q

management of miscarriage

A

conservative vs medical vs surgical
consider admitting
manual vacuum aspiration
anti-D if surgical options needed

45
Q

features of PUL

A

amenorrhoea and abdo pain
no evidence of pregnancy in uterus, fallopian tube, cervix, c/s scar, abdomen
level of hCG confirms pregnancy

46
Q

how may PUL be managed

A

methotrexate

47
Q

what is a molar pregnancy

A

fertilisation of a non viable egg

leads to overgrowth of placental tissue with swollen chorionic villi

48
Q

true/false - partial mole increases risk of choriocarcinoma

A

false - complete mole does

49
Q

what is a complete molar pregnancy

A

egg has no DNA and 1/2 sperm fertilise to result in paternal only DNA
no foetus and overgrown placental tissue

50
Q

what is a partial molar pregnancy

A

haploid egg
1 sperm with replicated DNA or two sperm fertilise egg leading to triploidy
can have foetus but overgrown placenta

51
Q

management of molar pregnancy

A

surgical uterine evacuation and tissue for histology

medical management possible

52
Q

issues associated with molar pregnancy leading to diagnosis

A 
hyperemesis 
hyperthyroid 
early onset pre-eclampsia 
varied bleed, grapelike tissue 
SOB due to lung embolisation or seizure due to brain mets
53
Q

USS appearance of molar pregnancy

A

snowstorm

54
Q

what is implantation bleeding and how is it managed

A 
egg implanting into endometrial lining 
10 days post ovulation 
light brown bleed, self limiting 
signs of pregnancy emerge 
can be mistaken as pregnancy
55
Q

what is a chorionic haematoma, what symptoms does it cause and management

A

pooling of blood between endometrium and embryo
bleed, cramp, threatened miscarriage
usually self limited, large haematoma can be source infection, miscarriage
surveillance

56
Q

cervical causes of bleeding in early pregnancy

A

ectopy
infection, chlamydia, gonorrhoea, other bacteria
polyp
malignancy

57
Q

vaginal causes of bleeding early pregnancy

A 
trichomoniasis 
BV 
chlamydia 
malignancy 
ulcers 
forgotten tampon
58
Q

management of BV

A

metronidazole

59
Q

management of chlamydia in pregnancy

A

erythromycin

amoxicillin

60
Q

what causes of bleeding may be missed as part of early pregnancy

A

urinary

bowel

61
Q

when is anti-D injection advised

A

follwowing surgical procedure with rh-ve mother

62
Q

what is hyperemesis gravidarum

A

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

63
Q

other possible differentials to consider instead of HG

A 
UTI
gastritis 
PUD 
viral hep 
pancreatitis
64
Q

management of HG

A 
rehydrate and replace electrolytes 
IV antiemitic 
nutrition 
thiamine 
NG/PTN feed
steroid - pred
VTE prophylaxis
65
Q

antiemitics to use in HG

A

1st line is cyclizine or prochlorperazine

2nd line is metclopramide

MB3 Obstetrics and Gynaecology (12 decks)

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