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Phase 2 > Gynae > Flashcards

Gynae Flashcards

1
Q

What are the special components of a gynae history?

A 
Menstrual history
Contraception
Cervical smear
Obstetric history
Previous gynae history
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2
Q

What are the important things to note for a gynae history?

A

Age
Parity
Date of LMP
Date of last smear

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3
Q

How do you take a menstrual history?

A 
Menarche / menopause
Duration of bleeding
Cyclicity - interval from first to first day
Any change in amount or duration
Pain
Date of LMP
Contraception use
Intermenstrual / Post-coital bleeding
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4
Q

How do you denote cycles?

A

5/28

Duration of bleeding / days between first day of bleeding

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5
Q

How do you denote an obstetric history?

A 
Parity = number of births (live or still) after 24weeks gestation
Gravidity = total number of pregnancies including current one
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6
Q

When is colposcopy done?

A

Women with smears suggestive of CIN or with an abnormal-looking cervix

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7
Q

What happens at colposcopy?

A

Done in OP
Microscope allows visualisation of cervical epithelium
Cusco’s speculum allows passage of scope
Any abnormal looking areas are biopsied
If histology shows severe cellular changes, abnormal areas should be removed using laser treatment

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8
Q

What do cervical smears identify?

A

Cytological cellular dyskaryosis

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9
Q

What do cervical biopsies identify?

A

Histological cellular dysplasia

CIN I, II, III or invasive disease

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10
Q

When is TVUS done?

A

Early pregnancy

Empty bladder

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11
Q

What USS is used in PMB and why?

A

Transabdominal
Measure endometrial thickness
>5cm in post menopausal women then proceed to biopsy

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12
Q

What is the purpose of an early pregnancy USS?

A

Check fetal heartbeart (present by 6weeks’ amenorrhoea)
Number of fetuses
CRL to calculate gestation

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13
Q

What is HSG and what is it used for?

A

Hysterosalpingography
To assess uterine cavity and patency of tubes
Catheter into cervix, radiocontrast medium injected into uterine cavity and X-rays taken

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14
Q

What is the gold-standard investigation for abnormal uterine bleeding?

A

Hysteroscopy + pipellle Biopsy

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15
Q

What are the complications (+ rates) of laparoscopy?

A

Bowel injury 0.6 per 100
Bladder injury 0.3
Ureteric injury 0.3
Vascular injury 0.1

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16
Q

What are the different types of hysterectomy and how do you decide which is done?

A

Vaginal
Abdominal
Laparoscopic
Depends on uterine findings

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17
Q

What is a subtotal hysterectomy?

A

Cervix left behind

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18
Q

When is total abdominal hysterectomy used?

A

Large uterus
Multiple large fibroids
Adenomyosis
Endometriosis

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19
Q

What are the complications of hysterectomy?

A 
Short-term: fever, haemorrhage
Ureteric damage 1 in 200
Bladder 1 in 100
Bowel 1 in 200
Long-term: pain, regret, pelvic floor laxity, prolapse, premature ovarian failure, bladder and bowel dysfunction
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20
Q

What is cystometry?

A

Measures bladder pressure during filling and voiding

Detects detrusor instability

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21
Q

What are the components of a gynae examination?

A

General
Abdo
Pelvic: speculum then bimanual

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22
Q

How do you determine / compare uterine size?

A

Level at which fund us can be palpated
12 weeks = symphysis pubis
20 weeks = umbilicus
36 weeks = xiphisternum

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23
Q

What do you look for on external inspection of the vulva?

A 
Abnormal discharge
Anatomy
Inflammation
Ulceration
Swellings
Atrophic changes
Scars
Prolapse (with and without patient bearing down)
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24
Q

How do you examine for prolapse?

A

With and without patient bearing down
Cough: may show SUI
Sims speculum with patient in left lateral position

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25
Q

What do you use Cusco speculum to examine for?

A

Visualise cervix

Look at anterior and posterior vaginal walls

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26
Q

Describe what you are examining for on bimanual palpation

A

Vaginal walls for scarring, cysts and tumours
Vaginal fornices for scarring, thickening and swelling
Cervix: size, shape, position, angle, mobility. Cervical motion tenderness
Uterus: ante- or retroverted
Adnexa: put fingers in one of lateral fornices. Ovaries and F.tubes not normally palpable

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27
Q

Define infertility

A

Inability of a couple to conceive after 1-2 yrs of unprotected intercourse
Or 6 months if over 35yo

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28
Q

What is infecundity?

A

The inability of a couple to produce a live birth

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29
Q

Why does fertility decline with age?

A

Women born with discrete supply of oocytes, the number of which declines with age
Only 500 mature oocytes are released during reproductive life
Decline in fertility directly related to declining oocytes popn and the egg’s inherent quality

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30
Q

What are the most common causes of infertility?

A

Ovulation defects
Male factor
Tubal disease
Unexplained

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31
Q

What male factors may contribute to infertility?

A

Sperm count and function
Ejaculate characteristics and immunology
Anatomic anomalies

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32
Q

What are the causes of ovulatory dysfunction?

A 
Chronic systemic illness
Eating disorders
PCOS
Hyperprolactinaemia
Hypo or hyperthyroidism
Cannabis used
NSAIDs
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33
Q

What tubal factors can cause infertility?

A

PID
Previous tubal surgery
Previous ectopic pregnancy
Endometriosis

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34
Q

What things do you examine for in a woman with history of infertility?

A 
BMI
Body hair distribution
Galactorrhoea
Secondary sexual characteristics
Pelvis structural abnormalities, fixed or tender uterus
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35
Q

What are the baseline female investigations for infertility?

A

Follicular phase LH, FSH
Luteal phase progesterone (day 21)
Rubella status
HSG or diagnostic laparoscopy + due to test tubal patency

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36
Q

Describe normal semen analysis

A

Volume >2ml
Concentration >20
Initial forward motility >50%
Normal morphology >30%

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37
Q

How do you treat anovulation?

A

Clomiphene
Gonadotrophins / pulsatile LHRH
Dopamine agonists (hyperprolactinaemia)
Weight loss / gain

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38
Q

How does clomiphene work?

A

Anti-oestrogen
Occupies receptors in hypothalamus to increase GnRH release
Leads to increased release of LH/FSH inducing follicular development and ovulation

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39
Q

How do you manage tubal disease?

A

Surgery or IVF

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40
Q

How can you manage male factor infertility?

A 
IUI
IVF
Intracytoplasmic sperm injection (ICSI)
Donor insemination
Donor sperm
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41
Q

What are the stages of IVF?

A
  1. Follicle aspiration
  2. Fertilisation
  3. Embryo transfer
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42
Q

What is dyspareunia?

A

Painful sexual intercourse

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43
Q

What are the differentials of chronic pelvic pain?

A 
Adenomyosis
Endometriosis
Adhesions
Gynae malignancy
GI pathology
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44
Q

What are the differentials for acute pelvic pain?

A 
PID
Tubo-ovarian abscess
Early pregnancy complications
Gynae malignancy
Ovarian cyst: rupture, haem, torsion
Fibroid necrosis
Ovulation pain
Abscess
UTI / renal calculi
Appendicitis
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45
Q

What specific questions should you ask in a history of pelvic pain?

A 
Relationship to menstrual cycle
Bowel habit
N&V
Vaginal discharge 
LMP
Dyspareunia
Smears
STI, sexual history
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46
Q

How does ovarian cyst torsion present?

A

Acute pain worse on one side, radiates to upper thighs

Associated nausea and vomiting

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47
Q

What is Mittelschmerz?

A

Acute pain associated with ovulation

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48
Q

What is pelvic pain associated with endometriosis like?

A

Pain begins up to 2 weeks before period
Usually relieved when bleeding starts
Deep dyspareunia

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49
Q

What are the causes of dyspareunia?

A 
Adhesions / fibrosis
Atrophic changes 
Vulval dystrophy
PID
Endometriosis
Fibroids
Ovarian mass
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50
Q

What are fibroids?

A

Benign tumours of the myometrium

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51
Q

What are the symptoms of fibroids?

A

Menstrual abnormalities: normally heavy periods. Can also cause IMB or PMB
Abdominopelvic mass
Pain
Subfertility
Pressure symptoms: frequency, nocturia, urgency

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52
Q

What are the potential complications of fibroids?

A 
Degeneration
Torsion
Malignancy
Infertility
Obstructed labour
Risk of PPH
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53
Q

What is the medical management of fibroids?

A

GnRH analogues - cause temporary reversible menopause
Reduce fibroids volume by 50%
Used prior to surgery, up to 6 months

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54
Q

What are the surgical options for fibroids?

A

Transcervical resection of fibroids
Myomectomy
Hysterectomy
Uterine artery embolisation

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55
Q

What are the complications of myomectomy?

A

Haemorrhage

Hysterectomy

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56
Q

What is endometriosis?

A

Tissue resembling the endometrium lying outside the endometrial cavity
Responds to cyclical hormonal changes, so bleeds at menstruation

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57
Q

What is adenomyosis?

A

Presence of endometrial tissue within the myometrium

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58
Q

What are the most common sites for endometriosis?

A

Ovaries
Pouch of Douglas
Uterosacral ligaments

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59
Q

What are the clinical features of endometriosis?

A 
Secondary dysmenorrhea 
Heavy periods
Dyspareunia
Lower abdo pain
Infertility
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60
Q

What are the potential differential diagnoses for endometriosis?

A 
PID
Pelvic pain syndrome
Sub mucous fibroids
Ovarian accident
Adhesions
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61
Q

How is endometriosis diagnosed?

A

Diagnostic laparoscopy

Shows powder-burn spots and chocolate cysts

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62
Q

What are the complications of endometriosis?

A

Often due to fibrosis and scarring

Rupture of an endometrioma and release of irritant material can cause peritonism

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63
Q

What are the aims of treatment in endometriosis?

A

Alleviate symptoms
Stop progression of disease and development of complications
Improve fertility

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64
Q

What medical therapies are used in endometriosis?

A 
COCP
Progestogen
Mirena coil
GnRH analogues
Mefenamic of tranexamic acid
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65
Q

How do hormonal therapies help in endometriosis?

A

Suppress ovulation

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66
Q

What conservative surgery may be performed in endometriosis?

A

Division of adhesions with diathermy or laser

Removal of endometriomas

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67
Q

What radical surgery may be used in endometriosis?

A

Total abdominal hysterectomy + bilateral salpingo-oophorectomy

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68
Q

How do you diagnose PCOS?

A

2 of 3 of…

  1. Infrequent or no ovulation
  2. Clinical or biochem signs of hyperandrogenism: hirsutism, acne, male pattern alopecia, elevated free testosterone
  3. Polycystic ovaries on USS
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69
Q

What are the other features of PCOS?

A

Evidence of insulin resistance:
Obesity
Acanthosis nigricans: dry rough skin with grey-brown pigmentation

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70
Q

What are the diagnostic investigations used in PCOS?

A

Total testosterone
Sex-hormone binding globulin
Calculate free androgen index

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71
Q

What other causes of oligo/amenorrhoea should be ruled out when considering PCOS?

A

Premature ovarian failure
Hypothyroidism
Hyperprolactinaemia

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72
Q

What are the 5 key hormones in the menstrual cycle?

A

GnRH
FSH and LH
Oestrogen
Progesterone

73
Q

What happens in the follicular phase of the menstrual cycle?

A

FSH and LH levels rise causing a follicle to mature
Granulosa cells in the follicle secrete oestrogen
Oestrogen levels rise
Negative feedback so FSH falls

74
Q

What happens at ovulation?

A

Oestrogen causes LH surge (anterior pituitary)
LH surge promotes
Maturation of oocyte, rupture of follicle and ovulation

75
Q

What is the luteal phase?

A

Follicle becomes the corpus luteum
CL secretes progesterone
Negative feedback suppresses FSH and prevents recruitment of another follicle

76
Q

What happens to the corpus luteum?

A

If pregnancy occurs, hCG maintains progesterone synthesis

No pregnancy then corpus luteum involutes and progesterone levels decline

77
Q

What triggers menstruation?

A

Progesterone levels falling

78
Q

What are the different phases of the endometrium?

A

Proliferative phase
Secretory phase
Progesterone falls

79
Q

What is the proliferative phase of the endometrium?

A

Corresponds to follicular phase
Driven by oestrogen
Increased thickness of endometrium and proliferation of glands

80
Q

What happens in the secretory phase of the endometrium?

A

Progesterone effect

Glands become tortuous and secretory

81
Q

Define amenorrhoea

A

Temporary or permanent absence of menstruation

82
Q

Define primary amenorrhoea

A

No periods by age 14 in the absence of secondary sexual characteristics
Or age 16 regardless of normal development

83
Q

Define secondary amenorrhoea

A

Absence of periods for 6 months in a woman who has previously been menstruating

84
Q

Define oligomenorrhoea

A

Interval >35 days between periods

85
Q

What are the hypothalamic causes of amenorrhoea?

A

Weight loss

Intensive exercise

86
Q

What are the reproductive organ causes of amenorrhoea?

A

Imperforate hymen
Cervical stenosis
PCOS
Turner’s syndrome

87
Q

What are the pituitary causes of amenorrhoea?

A

Hyperprolactinaemia
Hypopituitarism
Sheehan’s syndrome

88
Q

What are the systemic causes of amenorrhoea?

A

Chronic illness
Weight loss
Thyroid disease
Cushing’s

89
Q

What is dysmenorrhea?

A

Pain during menstruation

90
Q

What is primary dysmenorrhea?

A

No pelvic pathology
Crampy, radiates to lower back or thighs
Cause is myometrium hyperactivity and increased uterine production of prostaglandin

91
Q

What is secondary dysmenorrhea?

A

Pelvic pathology

Associated dyspareunia

92
Q

What are the causes of secondary dysmenorrhea?

A

Endometriosis
Adenomyosis
PID
Obstruction to menstrual flow

93
Q

What is the average blood loss during menstruation?

A

35 ml per cycle

94
Q

What is defined as excessive menstrual blood loss and why?

A

> 80ml

Leads to anaemia as unable to compensate between cycles

95
Q

Define menorrhagia

A

Excessive menstrual blood loss that interferes with a woman’s physical, social and material quality of life

96
Q

How do you assess menorrhagia?

A

Subjective
Pictorial blood loss assessment charts
Objective assessment

97
Q

What are the common gynae causes of menorrhagia?

A 
Fibroids
Polyps
Endometriosis
PID
Endometrial cancer
Cervical cancer
98
Q

What are the systemic causes of menorrhagia?

A 
Hypothyroidism
Von Willebrand's disease
ITP
Factor II, V, VII, XI deficiency
Liver or renal disease
99
Q

What clinical examinations should you do in a history of menorrhagia?

A

General: anaemia, thyroid, clotting
Speculum: discharge, cervical pathology
Bimanual: enlarged uterus (fibroids), pelvic tenderness (endometriosis/PID), adnexal masses

100
Q

What are the classes of medical therapy that may be used to treat menorrhagia?

A 
Tranexamic acid (antifibrinolytic)
Mefenamic acid (prostaglandin inhibitor)
Hormonal therapy
101
Q

How does the mirena coil treat menorrhagia?

A

Intrauterine progestogen
Prevents endometrial proliferation
Decreases MBL by 90%

102
Q

What are the side effects of the mirena coil?

A

Breast tenderness
Acne
Headache

103
Q

How does the COCP help in menorrhagia?

A

Acts on HPovarian axis to suppress ovulation

Decreases MBL by 45%

104
Q

What other hormone treatments may be used to treat menorrhagia?

A

Cyclical progesterone

GnRH analogue

105
Q

How do GnRH analogues reduce menstrual blood loss?

A

Suppresses pituitary release of FSH and LH

106
Q

What is a subtotal hysterectomy?

A

Cervix left behind

107
Q

What are the complications of a hysterectomy?

A

Short-term: fever, haemorrhage
Damage to bowel, urinary tract
Long-term: pain, regret, pelvic floor laxity

108
Q

What are fibroids?

A

Benign tumour of the myometrium (leiomyoma)

Hormonally-dependent

109
Q

Why do you get heavy bleeding with fibroids?

A

Enlarged uterine cavity to increase surface area of endometrium from which menstruation occurs

110
Q

What is a myomectomy?

A

Removal of fibroids

111
Q

What is the most common cause of menorrhagia?

A

DUB

112
Q

What are the cervical causes of intermenstrual or post coital bleeding?

A

Ectopy
Polyps
Malignancy
Cervicitis

113
Q

What are the intrauterine causes of intermenstrual or postcoital bleeding?

A 
Polyps
Fibroids
Endometrial hyperplasia
Endometrial malignancy
Endometritis
114
Q

Define postmenopausal bleeding

A

Vaginal bleeding occurring more than 12 months after the menopause

115
Q

What needs to be excluded in a woman with PMB?

A

Endometrial, ovarian or cervical cancer

116
Q

What proportion of those presenting with PMB are found to have a malignancy?

A

9%

117
Q

What is the most common cause of PMB?

A

Atrophic changes to the genital tract, due to oestrogen deficiency

118
Q

What are the clinical features of atrophic changes to the female genital tract?

A

Small amounts of bleeding
Local symptoms of vaginal dryness, soreness
Superficial dyspareunia

119
Q

What examination should you do in a woman presenting with PMB?

A

Abdo: ascites or masses

Vulva, vagina and cervix

120
Q

What investigations are done in a woman with PMB?

A

USS of pelvis: ?endometrial thickness
Hysteroscopy
Endometrial biopsy

121
Q

How do you treat atrophic vaginitis?

A

Oestrogen replacement to prevent recurrence of PMB and other symptoms of oestrogen-deficiency eg dyspareunia
Topical oestrogen
Systemic HRT given in combination with progesterone in women with a uterus

122
Q

What is the average age of menopause?

A

51

123
Q

What leads to cessation of menstruation at menopause?

A

Depletion of oocytes and their increased resistance to FSH and LH

124
Q

What is there increased risk of during the peri-menopausal stage and why?

A

Endometrial hyperplasia

Oestrogen secretion continues without the progesterone opposition required to protect the endometrium

125
Q

What should you ask about in a woman presenting with ?menopause?

A 
Vasomotor symptoms  and mood changes
LMP
Pattern of menses in the past few years
Cervical smear
Family history
126
Q

What are the symptoms of menopause?

A

Hot flushes and night sweats
Mood disturbance
Atrophy of vaginal tissue: dyspareunia and bleeding
Atrophy of urethra: dysuria, frequency, incontinence

127
Q

What are the long-term consequences of menopause?

A

Osteoporosis

Cardiovascular disease risk increases markedly compared with pre-menopause

128
Q

What investigations should be done in ?menopause?

A

Serum FSH levels confirm diagnosis

Others should be tailored to symptoms

129
Q

What treatments are available for menopause?

A

Lifestyle factors: exercise, smoking cessation
HRT
Bisphosphonates

130
Q

What are the components of HRT and why?

A

Oestrogen and progesterone

Progesterone protects the endometrium

131
Q

What are the side effects of HRT?

A 
Nausea
Fluid retention
Hirsutism
Leg cramps
Breast discomfort
132
Q

What are the contraindications to HRT?

A 
Endometrial carcinoma
Breast carcinoma
Undiagnosed vaginal bleeding
Undiagnosed breast lumps
Severe liver disease
Pregnancy
History of VTE
133
Q

What are the risks of HRT?

A

Increased risk of breast cancer

Increased CVS and stroke risk in older patients

134
Q

What is the contraceptive advice for women around the menopause?

A

Continue contraception for 1 year after LMP if they are over 50, or for 2 years if under 50

135
Q

How is osteoporosis managed?

A

Cons: smoking cessation, weight-bearing exercises
Calcium and vit D
HRT if under 50
Bisphosphonates

136
Q

What is premature ovarian failure?

A

Premature menopause

Under 40 with secondary amenorrhoea and high FSH on 2 occasions

137
Q

What are the causes of premature ovarian failure?

A

Chemotherapy
Radiotherapy
Viral infections eg mumps

138
Q

How is premature menopause managed?

A

HRT
Dietary advice to avoid osteoporosis
Counselling about IVF

139
Q

What muscles are involved in maintaining continence?

A

Detrusor
External urethral sphincter
Internal urethral sphincter
Pelvic floor

140
Q

Define urinary frequency

A

More than 8 voids per day

141
Q

Define nocturia

A

More than 2 voids per night

142
Q

How do you measure severity of incontinence?

A

Amount of leakage
Pads - size and number
Lifestyle modifications

143
Q

What examination should you do in a history of incontinence?

A 
Obesity
Scars
Abdo or pelvic masses
Visible incontinence
Prolapse
Pelvic floor tone
CNS - neuro disorders?
144
Q

What is cystometry?

A

Functional test of bladder function
Type of urodynamic study
Assesses capacity, flow rate and voiding function

145
Q

What is the main cause of incontinence?

A

Urodynamic stress incontinence

146
Q

What are the causes of stress incontinence?

A

Incomplete urethral sphincter (childbirth, menopause, prolapse, chronic cough)
Positional displacement
Intrinsic weakness

147
Q

Why is stress incontinence associated with prolapse?

A

If the proximal urethra is below the pelvic floor
Means the raised intra-abdo pressure is no longer transmitted to the proximal urethra
Positive pressure gradient is lost

148
Q

What factors are associated with stress incontinence?

A 
Increasing age / parity
Obesity
Genital prolapse
Postmenopausal 
Constipation
Smoking / chronic cough
149
Q

How do you examine for stress incontinence?

A

Ask patient to cough while standing with a moderately full bladder
Examine vaginal walls with sims speculum in left lateral position

150
Q

What is detrusor overactivity?

A

Urethra functions normally
But if uninhibited detrusor activity increases bladder pressure above normal max urethral closure pressure, urinary leakage occurs

151
Q

What is detrusor overactivity associated with?

A

Increasing age
History of nocturnal enuresis
Exacerbated by diuretics

152
Q

What is the conservative management of incontinence?

A

Weight loss
Reduce caffeine intake
Smoking cessation
Treat constipation or chronic cough

153
Q

What is the management of stress incontinence?

A

Cons: pelvic floor exercises
Medical: Duloxetine, oestrogen replacement
Surgery: TVT or colposuspension

154
Q

How does Duloxetine work in stress incontinence?

A

Increases tone of urethral sphincter

155
Q

What types of surgery are used for stress incontinence?

A

Tension free vaginal tape (TVT)

Colposuspension - paravaginal fascia attached to Cooper’s ligament to hold it in place

156
Q

What are the complications of surgery for stress incontinence?

A

Voiding difficulty
Detrusor instability
Enterocoele formation

157
Q

How is detrusor overactivity managed?

A

Behaviour: bladder retraining

Antimuscarinics eg oxybutynin or tolterodine

158
Q

How do antimuscarinics work in incontinence?

A

Delay initial desire to void

Decrease frequency and strength of detrusor contractions

159
Q

What drug regimes may be used for incontinence?

A

Oxybutynin 2.5 mg BD

Tolterodine 2 mg BD

160
Q

What are the side effects of antimuscarinics?

A 
Dry mouth
Reduced visual accommodation
Constipation
Glaucoma
Confusion
161
Q

What is CISC?

A

Clean intermittent self-catheterisation

162
Q

When is CISC indicated?

A

Voiding dysfunction after suspension operation

Postpartum / post op retention

163
Q

What are the problems with in dwelling catheters?

A 
Urethral erosion
Stone formation
Blockage
Chronic bacteriuria
Risk of pyelonephritis
164
Q

Define prolapse

A

Protrusion of an organ or structure beyond its normal anatomical site

165
Q

What is the most common type of prolapse?

A

Cystourethrocoele

- bladder and urethra prolapse

166
Q

What is the 2nd most common type of prolapse?

A

Uterine descent

167
Q

How is uterine descent graded?

A

According to position of cervix on vaginal examination
1st degree - within vagina
2nd - to introitus
3rd - outside introitus (procidentia)

168
Q

Name the pelvic floor muscles

A

Levator ani - pubococcygeus and iliococcygeus
Internal obturator and piriform
Superficial and deep perineal muscles

169
Q

What are the pelvic ligaments?

A

Transverse cervical or cardinal
Uterosacral
Round ligaments

170
Q

What are the risk factors for prolapse?

A

Obstetric factors
Postmenopausal atrophy
Chronically raised intra-abdo pressure (tumour, cough, constipation)
Iatrogenic: hysterectomy, colposuspension

171
Q

What are the symptoms of prolapse?

A 
Local discomfort / feeling something coming down
Worse with standing, straining
Interference with sexual function
Urinary symptoms: frequency, SUI
Bowel symptoms: incomplete emptying
172
Q

How can you prevent prolapse?

A

Minimise damage to supporting structures during labour - avoid prolonged 1st and 2nd stages and do postnatal pelvic floor exercises

173
Q

How is prolapse managed conservatively?

A

Weight loss
Smoking cessation
Treat constipation
Pelvic floor exercises

174
Q

How do vaginal pessaries work?

A

Sits behind pubic bone and in the posterior fornix of the vagina
Encloses cervix

175
Q

What are the indications for use of vaginal pessaries?

A

Patient hasn’t completed her family
Conservative management preferred
Medically unfit for surgery

176
Q

What are the complications of vaginal pessaries?

A

Vaginal discharge or bleeding
Granulation tissue incarcerating pessary
Discomfort if too large

177
Q

What is an important factor when considering prolapse surgery?

A

Are they sexually active: vagina may be shortened and narrowed by surgery leading to dyspareunia

178
Q

What types of surgery are available for prolapse?

A

Anterior colporrhapy (anterior repair)
Posterior repair
Vaginal hysterectomy
Manchester repair (Fothergill procedure)

179
Q

What are the complications of prolapse surgery?

A 
Recurrent prolapse
Haemorrhage and vault haematoma
Vault infection
DVT
New incontinence
Ureteric or bladder injury

Phase 2 (21 decks)

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