Emergency gynaecology

Question 1

Complications of IUD insertion?

Answer 1

• uterine perforation
• device migration through to peritoneal cavity
• PID
• expulsion of device (commonly with the next period)

Question 2

Complications of septic miscarriage?

Answer 2

• massive haemorrhage
• hysterectomy
• disseminated intravascular coagulopathy
• multisystem failure (secondary to haemorrhage or sepsis)
• death

Question 3

Which type of contraception is associated with an increased incidence of ovarian cysts?

Answer 3

progesterone-only pill

Question 4

Key initial management for suspected ruptured ectopic pregnancy?

Answer 4

• facial oxygen
• lie flat with head down
• 2 large-bore cannulae with 2L of IV fluids given immediately
• crossmatch 4 units and alert haematologist to the haemorrhage
• consent for laparotomy and salpingectomy
• transfer to theatre for salpingectomy

Question 5

Herpex simplex features:

Answer 5

Primary infection:
- general malaise
- fever
- anorexia
- lymphadenopathy
- genital blisters
- urinary retention
Recurrent (secondary) infection:
- genital blisters
- often occurs at times of stress or tiredness

Question 6

Immediate management for primary herpes simplex infection?

Answer 6

• indwelling catheter (preferably suprapubic)
• analgesia and paracetamol
• local anaesthetic gel can often relieve pain and be used until symptoms settle
• oral aciclovir started within 24h of an attack reduces severity and duration of the episode

Question 7

DDx of RIF pain?

Answer 7

gynaecological:

• adnexal/ovarian cyst torsion
• ovarian cyst rupture
• ovarian cyst haemorrhage
• ectopic pregnancy

surgical:
- appendicitis

urinary:

• UTI
• renal colic