Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

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

A

Age
Parity
Date of LMP
Date of last smear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How do you denote cycles?

A

5/28

Duration of bleeding / days between first day of bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When is colposcopy done?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What do cervical smears identify?

A

Cytological cellular dyskaryosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What do cervical biopsies identify?

A

Histological cellular dysplasia

CIN I, II, III or invasive disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When is TVUS done?

A

Early pregnancy

Empty bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What USS is used in PMB and why?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

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

A

Hysteroscopy + pipellle Biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is a subtotal hysterectomy?

A

Cervix left behind

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When is total abdominal hysterectomy used?

A

Large uterus
Multiple large fibroids
Adenomyosis
Endometriosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is cystometry?

A

Measures bladder pressure during filling and voiding

Detects detrusor instability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the components of a gynae examination?

A

General
Abdo
Pelvic: speculum then bimanual

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What do you use Cusco speculum to examine for?
Visualise cervix | Look at anterior and posterior vaginal walls
26
Describe what you are examining for on bimanual palpation
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
27
Define infertility
Inability of a couple to conceive after 1-2 yrs of unprotected intercourse Or 6 months if over 35yo
28
What is infecundity?
The inability of a couple to produce a live birth
29
Why does fertility decline with age?
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
30
What are the most common causes of infertility?
Ovulation defects Male factor Tubal disease Unexplained
31
What male factors may contribute to infertility?
Sperm count and function Ejaculate characteristics and immunology Anatomic anomalies
32
What are the causes of ovulatory dysfunction?
``` Chronic systemic illness Eating disorders PCOS Hyperprolactinaemia Hypo or hyperthyroidism Cannabis used NSAIDs ```
33
What tubal factors can cause infertility?
PID Previous tubal surgery Previous ectopic pregnancy Endometriosis
34
What things do you examine for in a woman with history of infertility?
``` BMI Body hair distribution Galactorrhoea Secondary sexual characteristics Pelvis structural abnormalities, fixed or tender uterus ```
35
What are the baseline female investigations for infertility?
Follicular phase LH, FSH Luteal phase progesterone (day 21) Rubella status HSG or diagnostic laparoscopy + due to test tubal patency
36
Describe normal semen analysis
Volume >2ml Concentration >20 Initial forward motility >50% Normal morphology >30%
37
How do you treat anovulation?
Clomiphene Gonadotrophins / pulsatile LHRH Dopamine agonists (hyperprolactinaemia) Weight loss / gain
38
How does clomiphene work?
Anti-oestrogen Occupies receptors in hypothalamus to increase GnRH release Leads to increased release of LH/FSH inducing follicular development and ovulation
39
How do you manage tubal disease?
Surgery or IVF
40
How can you manage male factor infertility?
``` IUI IVF Intracytoplasmic sperm injection (ICSI) Donor insemination Donor sperm ```
41
What are the stages of IVF?
1. Follicle aspiration 2. Fertilisation 3. Embryo transfer
42
What is dyspareunia?
Painful sexual intercourse
43
What are the differentials of chronic pelvic pain?
``` Adenomyosis Endometriosis Adhesions Gynae malignancy GI pathology ```
44
What are the differentials for acute pelvic pain?
``` PID Tubo-ovarian abscess Early pregnancy complications Gynae malignancy Ovarian cyst: rupture, haem, torsion Fibroid necrosis Ovulation pain Abscess UTI / renal calculi Appendicitis ```
45
What specific questions should you ask in a history of pelvic pain?
``` Relationship to menstrual cycle Bowel habit N&V Vaginal discharge LMP Dyspareunia Smears STI, sexual history ```
46
How does ovarian cyst torsion present?
Acute pain worse on one side, radiates to upper thighs | Associated nausea and vomiting
47
What is Mittelschmerz?
Acute pain associated with ovulation
48
What is pelvic pain associated with endometriosis like?
Pain begins up to 2 weeks before period Usually relieved when bleeding starts Deep dyspareunia
49
What are the causes of dyspareunia?
``` Adhesions / fibrosis Atrophic changes Vulval dystrophy PID Endometriosis Fibroids Ovarian mass ```
50
What are fibroids?
Benign tumours of the myometrium
51
What are the symptoms of fibroids?
Menstrual abnormalities: normally heavy periods. Can also cause IMB or PMB Abdominopelvic mass Pain Subfertility Pressure symptoms: frequency, nocturia, urgency
52
What are the potential complications of fibroids?
``` Degeneration Torsion Malignancy Infertility Obstructed labour Risk of PPH ```
53
What is the medical management of fibroids?
GnRH analogues - cause temporary reversible menopause Reduce fibroids volume by 50% Used prior to surgery, up to 6 months
54
What are the surgical options for fibroids?
Transcervical resection of fibroids Myomectomy Hysterectomy Uterine artery embolisation
55
What are the complications of myomectomy?
Haemorrhage | Hysterectomy
56
What is endometriosis?
Tissue resembling the endometrium lying outside the endometrial cavity Responds to cyclical hormonal changes, so bleeds at menstruation
57
What is adenomyosis?
Presence of endometrial tissue within the myometrium
58
What are the most common sites for endometriosis?
Ovaries Pouch of Douglas Uterosacral ligaments
59
What are the clinical features of endometriosis?
``` Secondary dysmenorrhea Heavy periods Dyspareunia Lower abdo pain Infertility ```
60
What are the potential differential diagnoses for endometriosis?
``` PID Pelvic pain syndrome Sub mucous fibroids Ovarian accident Adhesions ```
61
How is endometriosis diagnosed?
Diagnostic laparoscopy | Shows powder-burn spots and chocolate cysts
62
What are the complications of endometriosis?
Often due to fibrosis and scarring | Rupture of an endometrioma and release of irritant material can cause peritonism
63
What are the aims of treatment in endometriosis?
Alleviate symptoms Stop progression of disease and development of complications Improve fertility
64
What medical therapies are used in endometriosis?
``` COCP Progestogen Mirena coil GnRH analogues Mefenamic of tranexamic acid ```
65
How do hormonal therapies help in endometriosis?
Suppress ovulation
66
What conservative surgery may be performed in endometriosis?
Division of adhesions with diathermy or laser | Removal of endometriomas
67
What radical surgery may be used in endometriosis?
Total abdominal hysterectomy + bilateral salpingo-oophorectomy
68
How do you diagnose PCOS?
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
69
What are the other features of PCOS?
Evidence of insulin resistance: Obesity Acanthosis nigricans: dry rough skin with grey-brown pigmentation
70
What are the diagnostic investigations used in PCOS?
Total testosterone Sex-hormone binding globulin Calculate free androgen index
71
What other causes of oligo/amenorrhoea should be ruled out when considering PCOS?
Premature ovarian failure Hypothyroidism Hyperprolactinaemia
72
What are the 5 key hormones in the menstrual cycle?
GnRH FSH and LH Oestrogen Progesterone
73
What happens in the follicular phase of the menstrual cycle?
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
What happens at ovulation?
Oestrogen causes LH surge (anterior pituitary) LH surge promotes Maturation of oocyte, rupture of follicle and ovulation
75
What is the luteal phase?
Follicle becomes the corpus luteum CL secretes progesterone Negative feedback suppresses FSH and prevents recruitment of another follicle
76
What happens to the corpus luteum?
If pregnancy occurs, hCG maintains progesterone synthesis | No pregnancy then corpus luteum involutes and progesterone levels decline
77
What triggers menstruation?
Progesterone levels falling
78
What are the different phases of the endometrium?
Proliferative phase Secretory phase Progesterone falls
79
What is the proliferative phase of the endometrium?
Corresponds to follicular phase Driven by oestrogen Increased thickness of endometrium and proliferation of glands
80
What happens in the secretory phase of the endometrium?
Progesterone effect | Glands become tortuous and secretory
81
Define amenorrhoea
Temporary or permanent absence of menstruation
82
Define primary amenorrhoea
No periods by age 14 in the absence of secondary sexual characteristics Or age 16 regardless of normal development
83
Define secondary amenorrhoea
Absence of periods for 6 months in a woman who has previously been menstruating
84
Define oligomenorrhoea
Interval >35 days between periods
85
What are the hypothalamic causes of amenorrhoea?
Weight loss | Intensive exercise
86
What are the reproductive organ causes of amenorrhoea?
Imperforate hymen Cervical stenosis PCOS Turner's syndrome
87
What are the pituitary causes of amenorrhoea?
Hyperprolactinaemia Hypopituitarism Sheehan's syndrome
88
What are the systemic causes of amenorrhoea?
Chronic illness Weight loss Thyroid disease Cushing's
89
What is dysmenorrhea?
Pain during menstruation
90
What is primary dysmenorrhea?
No pelvic pathology Crampy, radiates to lower back or thighs Cause is myometrium hyperactivity and increased uterine production of prostaglandin
91
What is secondary dysmenorrhea?
Pelvic pathology | Associated dyspareunia
92
What are the causes of secondary dysmenorrhea?
Endometriosis Adenomyosis PID Obstruction to menstrual flow
93
What is the average blood loss during menstruation?
35 ml per cycle
94
What is defined as excessive menstrual blood loss and why?
>80ml | Leads to anaemia as unable to compensate between cycles
95
Define menorrhagia
Excessive menstrual blood loss that interferes with a woman's physical, social and material quality of life
96
How do you assess menorrhagia?
Subjective Pictorial blood loss assessment charts Objective assessment
97
What are the common gynae causes of menorrhagia?
``` Fibroids Polyps Endometriosis PID Endometrial cancer Cervical cancer ```
98
What are the systemic causes of menorrhagia?
``` Hypothyroidism Von Willebrand's disease ITP Factor II, V, VII, XI deficiency Liver or renal disease ```
99
What clinical examinations should you do in a history of menorrhagia?
General: anaemia, thyroid, clotting Speculum: discharge, cervical pathology Bimanual: enlarged uterus (fibroids), pelvic tenderness (endometriosis/PID), adnexal masses
100
What are the classes of medical therapy that may be used to treat menorrhagia?
``` Tranexamic acid (antifibrinolytic) Mefenamic acid (prostaglandin inhibitor) Hormonal therapy ```
101
How does the mirena coil treat menorrhagia?
Intrauterine progestogen Prevents endometrial proliferation Decreases MBL by 90%
102
What are the side effects of the mirena coil?
Breast tenderness Acne Headache
103
How does the COCP help in menorrhagia?
Acts on HPovarian axis to suppress ovulation | Decreases MBL by 45%
104
What other hormone treatments may be used to treat menorrhagia?
Cyclical progesterone | GnRH analogue
105
How do GnRH analogues reduce menstrual blood loss?
Suppresses pituitary release of FSH and LH
106
What is a subtotal hysterectomy?
Cervix left behind
107
What are the complications of a hysterectomy?
Short-term: fever, haemorrhage Damage to bowel, urinary tract Long-term: pain, regret, pelvic floor laxity
108
What are fibroids?
Benign tumour of the myometrium (leiomyoma) | Hormonally-dependent
109
Why do you get heavy bleeding with fibroids?
Enlarged uterine cavity to increase surface area of endometrium from which menstruation occurs
110
What is a myomectomy?
Removal of fibroids
111
What is the most common cause of menorrhagia?
DUB
112
What are the cervical causes of intermenstrual or post coital bleeding?
Ectopy Polyps Malignancy Cervicitis
113
What are the intrauterine causes of intermenstrual or postcoital bleeding?
``` Polyps Fibroids Endometrial hyperplasia Endometrial malignancy Endometritis ```
114
Define postmenopausal bleeding
Vaginal bleeding occurring more than 12 months after the menopause
115
What needs to be excluded in a woman with PMB?
Endometrial, ovarian or cervical cancer
116
What proportion of those presenting with PMB are found to have a malignancy?
9%
117
What is the most common cause of PMB?
Atrophic changes to the genital tract, due to oestrogen deficiency
118
What are the clinical features of atrophic changes to the female genital tract?
Small amounts of bleeding Local symptoms of vaginal dryness, soreness Superficial dyspareunia
119
What examination should you do in a woman presenting with PMB?
Abdo: ascites or masses | Vulva, vagina and cervix
120
What investigations are done in a woman with PMB?
USS of pelvis: ?endometrial thickness Hysteroscopy Endometrial biopsy
121
How do you treat atrophic vaginitis?
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
What is the average age of menopause?
51
123
What leads to cessation of menstruation at menopause?
Depletion of oocytes and their increased resistance to FSH and LH
124
What is there increased risk of during the peri-menopausal stage and why?
Endometrial hyperplasia | Oestrogen secretion continues without the progesterone opposition required to protect the endometrium
125
What should you ask about in a woman presenting with ?menopause?
``` Vasomotor symptoms and mood changes LMP Pattern of menses in the past few years Cervical smear Family history ```
126
What are the symptoms of menopause?
Hot flushes and night sweats Mood disturbance Atrophy of vaginal tissue: dyspareunia and bleeding Atrophy of urethra: dysuria, frequency, incontinence
127
What are the long-term consequences of menopause?
Osteoporosis | Cardiovascular disease risk increases markedly compared with pre-menopause
128
What investigations should be done in ?menopause?
Serum FSH levels confirm diagnosis | Others should be tailored to symptoms
129
What treatments are available for menopause?
Lifestyle factors: exercise, smoking cessation HRT Bisphosphonates
130
What are the components of HRT and why?
Oestrogen and progesterone | Progesterone protects the endometrium
131
What are the side effects of HRT?
``` Nausea Fluid retention Hirsutism Leg cramps Breast discomfort ```
132
What are the contraindications to HRT?
``` Endometrial carcinoma Breast carcinoma Undiagnosed vaginal bleeding Undiagnosed breast lumps Severe liver disease Pregnancy History of VTE ```
133
What are the risks of HRT?
Increased risk of breast cancer | Increased CVS and stroke risk in older patients
134
What is the contraceptive advice for women around the menopause?
Continue contraception for 1 year after LMP if they are over 50, or for 2 years if under 50
135
How is osteoporosis managed?
Cons: smoking cessation, weight-bearing exercises Calcium and vit D HRT if under 50 Bisphosphonates
136
What is premature ovarian failure?
Premature menopause | Under 40 with secondary amenorrhoea and high FSH on 2 occasions
137
What are the causes of premature ovarian failure?
Chemotherapy Radiotherapy Viral infections eg mumps
138
How is premature menopause managed?
HRT Dietary advice to avoid osteoporosis Counselling about IVF
139
What muscles are involved in maintaining continence?
Detrusor External urethral sphincter Internal urethral sphincter Pelvic floor
140
Define urinary frequency
More than 8 voids per day
141
Define nocturia
More than 2 voids per night
142
How do you measure severity of incontinence?
Amount of leakage Pads - size and number Lifestyle modifications
143
What examination should you do in a history of incontinence?
``` Obesity Scars Abdo or pelvic masses Visible incontinence Prolapse Pelvic floor tone CNS - neuro disorders? ```
144
What is cystometry?
Functional test of bladder function Type of urodynamic study Assesses capacity, flow rate and voiding function
145
What is the main cause of incontinence?
Urodynamic stress incontinence
146
What are the causes of stress incontinence?
Incomplete urethral sphincter (childbirth, menopause, prolapse, chronic cough) Positional displacement Intrinsic weakness
147
Why is stress incontinence associated with prolapse?
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
What factors are associated with stress incontinence?
``` Increasing age / parity Obesity Genital prolapse Postmenopausal Constipation Smoking / chronic cough ```
149
How do you examine for stress incontinence?
Ask patient to cough while standing with a moderately full bladder Examine vaginal walls with sims speculum in left lateral position
150
What is detrusor overactivity?
Urethra functions normally But if uninhibited detrusor activity increases bladder pressure above normal max urethral closure pressure, urinary leakage occurs
151
What is detrusor overactivity associated with?
Increasing age History of nocturnal enuresis Exacerbated by diuretics
152
What is the conservative management of incontinence?
Weight loss Reduce caffeine intake Smoking cessation Treat constipation or chronic cough
153
What is the management of stress incontinence?
Cons: pelvic floor exercises Medical: Duloxetine, oestrogen replacement Surgery: TVT or colposuspension
154
How does Duloxetine work in stress incontinence?
Increases tone of urethral sphincter
155
What types of surgery are used for stress incontinence?
Tension free vaginal tape (TVT) | Colposuspension - paravaginal fascia attached to Cooper's ligament to hold it in place
156
What are the complications of surgery for stress incontinence?
Voiding difficulty Detrusor instability Enterocoele formation
157
How is detrusor overactivity managed?
Behaviour: bladder retraining | Antimuscarinics eg oxybutynin or tolterodine
158
How do antimuscarinics work in incontinence?
Delay initial desire to void | Decrease frequency and strength of detrusor contractions
159
What drug regimes may be used for incontinence?
Oxybutynin 2.5 mg BD | Tolterodine 2 mg BD
160
What are the side effects of antimuscarinics?
``` Dry mouth Reduced visual accommodation Constipation Glaucoma Confusion ```
161
What is CISC?
Clean intermittent self-catheterisation
162
When is CISC indicated?
Voiding dysfunction after suspension operation | Postpartum / post op retention
163
What are the problems with in dwelling catheters?
``` Urethral erosion Stone formation Blockage Chronic bacteriuria Risk of pyelonephritis ```
164
Define prolapse
Protrusion of an organ or structure beyond its normal anatomical site
165
What is the most common type of prolapse?
Cystourethrocoele | - bladder and urethra prolapse
166
What is the 2nd most common type of prolapse?
Uterine descent
167
How is uterine descent graded?
According to position of cervix on vaginal examination 1st degree - within vagina 2nd - to introitus 3rd - outside introitus (procidentia)
168
Name the pelvic floor muscles
Levator ani - pubococcygeus and iliococcygeus Internal obturator and piriform Superficial and deep perineal muscles
169
What are the pelvic ligaments?
Transverse cervical or cardinal Uterosacral Round ligaments
170
What are the risk factors for prolapse?
Obstetric factors Postmenopausal atrophy Chronically raised intra-abdo pressure (tumour, cough, constipation) Iatrogenic: hysterectomy, colposuspension
171
What are the symptoms of prolapse?
``` Local discomfort / feeling something coming down Worse with standing, straining Interference with sexual function Urinary symptoms: frequency, SUI Bowel symptoms: incomplete emptying ```
172
How can you prevent prolapse?
Minimise damage to supporting structures during labour - avoid prolonged 1st and 2nd stages and do postnatal pelvic floor exercises
173
How is prolapse managed conservatively?
Weight loss Smoking cessation Treat constipation Pelvic floor exercises
174
How do vaginal pessaries work?
Sits behind pubic bone and in the posterior fornix of the vagina Encloses cervix
175
What are the indications for use of vaginal pessaries?
Patient hasn't completed her family Conservative management preferred Medically unfit for surgery
176
What are the complications of vaginal pessaries?
Vaginal discharge or bleeding Granulation tissue incarcerating pessary Discomfort if too large
177
What is an important factor when considering prolapse surgery?
Are they sexually active: vagina may be shortened and narrowed by surgery leading to dyspareunia
178
What types of surgery are available for prolapse?
Anterior colporrhapy (anterior repair) Posterior repair Vaginal hysterectomy Manchester repair (Fothergill procedure)
179
What are the complications of prolapse surgery?
``` Recurrent prolapse Haemorrhage and vault haematoma Vault infection DVT New incontinence Ureteric or bladder injury ```

Phase 2 (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions