Gynae Emergencies

Question 1

What is an Ectopic Pregnancy?

Answer 1

Fertilised egg implants outside uterus e.g. within fallopian tube

Question 2

What are the main symptoms of Ectopy?

Answer 2

PV bleeding
Abdominal pain, typically one side
Shoulder tip pain
Dizziness

Question 3

How are Ectopy diagnosed?

Answer 3

USS +/- bHCG
Detect adnexal mass moving separately to ovary with gestational sac/foetal pole or yolk sac (Sensitivity 87-99%)

Question 4

What is the most common site of implant in Ectopy?

Answer 4

Ampulla

Question 5

What are the 3 types of management for Ectopy?

Answer 5

Surgical, Medical, Conservative

Question 6

What does Conservative management involve?

Answer 6

Pt must be clinically stable/pain free, Tubal ectopic pregnancy <35mm, serum hCG <1000 iu/l, Patient can return for followup. Repeat hCG on day 2,4,7

Question 7

What does Medical management involve?

Answer 7

Offer systemic methotrexate! If:
- No sig pain, unruptured tubal ectopic with adnexal mass. Serum hCG <1500, no IU preg and can return for follow up

Question 8

What should patients be told not to do after methotrexate?

Answer 8

Not get pregnant within 3 months

Question 9

What does surgical management of ectopy include?

Answer 9

Salpingectomy: First line unless RF for infertility
Salpingotomy: Alternative for RF for infertility, contralateral tubal damage, should perform hCG day 7 and weekly until negative

Question 10

What occurs in Complete Miscarriage?

Answer 10

Present after PV bleeding, could remove products of conception and USS shows empty uterus. Will need a bHCG monitoring follow up

Question 11

What are the odds of miscarriage in UK?

Answer 11

1/4 end during birth or pregnancy in loss

Question 12

What happens in incomplete miscarriage?

Answer 12

Diagnosed on USS, see mixed echoes within uterine cavity and may need serial bHCG monitoring.
(If <35mm can expect medical or surgical, whereas >35mm surgical under GA)

Question 13

What happens in Delayed Miscarriage?

Answer 13

Diagnosed on transvag scan, needs visualisation of gestation sac, yolk and foetal pole at 12 weeks.
If <54mm is surgical
If >54mm is medical

Question 14

Define a Molar pregnancy?

Answer 14

Complete: Single sperm fertilises egg with no DNA (Sometimes 2x sperm) - Can get choriocarcinoma and fluid filled water sacs
Partial: Pregnancy when father supplies 2x chromosome sets

Question 15

How is Molar pregnancy managed?

Answer 15

Diagnosed by USS of cysts (Grape Sign)
- Surgical Management only with increased risk of bleeding

Question 16

What does Ovarian Torsion present with?

Answer 16

• Severe Abdo pain, N&V, non specific
• Enlarged ovary on USS
  Normally surgical definitive management –> Oophorectomy if bad

Question 17

Define Ovarian Torsion

Answer 17

Ovary and FT twists on vascular and ligamentous suports –>Block blood flow to ovaries (Surgical emergency)

Question 18

What is a Cyst Accident?

Answer 18

Rupture, Haemorrhage and Torsion, Self limiting but laparoscopy someimes required if diagnosis uncertain or haemodynamically unstable pt.

Question 19

What are symptoms of PID?

Answer 19

Pelvic pain, Dyspareuinia, Dysuria, IMB/PCB and discharge change

Question 20

What are causes and RF?

Answer 20

RF: UPSI, IUS/IUD, Multiple partners
C: Bac infection e.g. STI chlam, gon,
Treat: 14 days Abx IM Ceftriaxone, single dose plus PO doxy/Metro