Gynae Management Basics

Question 1

What is the primary aim when assessing bleeding/pain in early pregnancy?

Answer 1

Rule out an ectopic and ensure viable intrauterine pregnancy

Question 2

2 main differentials for early pregnancy bleeding/pain, and rarer causes?

Answer 2

Ectopic
Miscarriage
Rarely - molar pregnancy, gynae causes incl malignancy

Question 3

What initial management and investigation approach should be taken to bleeding in early pregnancy?

Answer 3

Abc resus if necessary
Pregnancy test
USS (TV if

Question 4

What management can be taken for a threatened miscarriage with only light bleeding?

Answer 4

Allow home

Question 5

What management could be considered for a missed miscarriage?

Answer 5

ERCP, medical or conservative management

Question 6

What management should be done for inevitable or incomplete miscarriage with heavy bleeding?

Answer 6

IM ergometrine and ERPC

Question 7

What management should be done for inevitable/incomplete miscarriage with light bleeding?

Answer 7

Consider medical management or conservative

Question 8

What management should be done for complete miscarriage?

Answer 8

Allow home

Question 9

What management should be done for molar pregnancy?

Answer 9

Admit, ERPC, send products for histology and monitor hCG

Question 10

What management should be done for a certain ectopic pregnancy?

Answer 10

Methotrexate if criteria met

Laparoscopy otherwise

Question 11

What management should be done for a possible ectopic pregnancy?

Answer 11

Admit gain IV access and test BhCG
If >1000 do lap
If less than 1000 repeat after 48 hours, if risen by less than 66% do lap and then USS 1 week later

Question 12

What steps should be taken in the management of any ectopic or miscarriage?

Answer 12

Anti D if rhesus negative

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