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O&G > Gynae Procedures > Flashcards

Gynae Procedures Flashcards

1
Q

What is colposcopy?

A

A diagnostic procedure obtaining a magnified view of the cervix, the lower part of the uterus and the vagina in order to examine the transformation zone and detect malignant or premalignant changes

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2
Q

What is a cervical punch biopsy?

A

Small amount of tissue removed from the cervix

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3
Q

What are the indications for colposcopy and cervical punch biopsy?

A
  • Severe or moderate dyskaryosis
  • Borderline/mild dyskaryosis smear with HPV +ve test
  • 3x inadequate smear
  • Suspicious looking cervix
  • Glandular neoplasia on smear
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4
Q

What are the complications of colposcopy and cervical punch biopsy?

A
  • Few complications from colposcopy alone
  • Colposcopy + excisional treatments > bleeding and infection, cervical incompetence in future pregnancies
  • Biopsy – rare but include excessive bleeding for 1-week, mild cramping, vaginal soreness, dark discharge

Prognosis – 95% success rate after 1 treatment in clinic

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5
Q

What is endometrial ablation?

A

An outpatient medical procedure that is used to remove (ablate) or destroy the endometrial lining of the uterus in women who have heavy menstrual bleeding

> > Endometrial ablation should never be performed on women who wish to have children.

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6
Q

Describe the method of endometrial ablation

A
  1. Prior to procedure, woman needs endometrial sampling biopsy to exclude cancer
  2. Hormonal therapy may be given in the weeks prior to procedure (especially younger women) to shrink the endometrium
  3. Cervix open > cervix dilated
  4. Different methods used to ablate: laser beam, electricity, freezing and heating
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7
Q

What are the indications for endometrial ablation?

A
  • Menorrhagia in premenopausal or perimenopausal women with normal endometrial cavities
  • Postmenopausal bleeding of unknown origin
  • Anovulatory bleeding and bleeding secondary to fibroids (intramural or submucosal <2cm for GEA, microwave ablation for submucosal up to 3cm) – higher risk of failure as does not remove fibroids
  • No desire for future fertility but desire to retain uterus or avoid hysterectomy
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8
Q

What are the complications of endometrial ablation?

A
  • General = infection, bleeding, failure, damage to local structures (i.e. cervical os, uterus lining)
  • Minor SE = cramping, nausea, frequent urination, watery discharge mixed with blood
  • Rarely = pulmonary oedema due to fluid used to expand uterus being absorbed into blood stream
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9
Q

What is an endometrial biopsy?

A

Biopsy of the endometrium (Pipelle is the most widely used device – can be used without cervical dilatation)

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10
Q

What are the indications for endometrial biopsy?

A

Over 55 and…

  • PMB (unexplained bleeding 12+ months after LMP)
  • Unexplained discharge if its new, has thrombocytosis or reports haematuria
  • Visible haematuria and low Hb, thrombocytosis, raised blood glucose

Under 55 with unexplained bleeding 12+ months after LMP

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11
Q

What are the complications of endometrial biopsy?

A
  • General = infection, bleeding, failure, damage to local structures
  • Pipelle has poor NPV (true -ve / total -ve) > i.e. if you test -ve, the chance of that being a true negative is questionable so if the woman is high risk and negative, they will need further investigation

A lower PPV > more false positives (not as dangerous as you just test again to exclude)
A lower NPV > more false negatives (dangerous)

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12
Q

What is an epidural?

A

Regional anaesthesia performed by injecting anaesthetic into epidural space (different from a spinal)

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13
Q

What are the indications for an epidural?

A
  • Pain relief during labour
  • N.B. stop thromboprophylaxis 24 hours before epidural
  • Anaesthesia for C-section
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14
Q

What are the complications of an epidural?

A
  • General = infection, bleeding, failure, damage to local structures
  • Urinary retention, shivering, pruritus, headache (anaesthesia going to head)
  • Hypotension, epidural haematoma, epidural meningitis, respiratory depression
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15
Q

What is a gynaecological laparoscopy?

A

Endoscopic pelvic surgery

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16
Q

What are the indications for a gynaecological laparoscopy?

A
  • Diagnostic > pelvic pain, diagnose endometriosis, infertility (dye test for tubal patency)
  • Therapeutic > sterilisation, adhesiolysis, ovarian cystectomy, salpingectomy, endometrial ablation
  • Major surgery > myomectomy, hysterectomy
17
Q

What are the complications of a gynaecological laparoscopy?

A

General = infection, bleeding, failure, damage to local structures, GA complications, VTE

18
Q

What are the different approaches for a hysterectomy?

A
  • Vaginal (removed through vagina)
  • Laparoscopic-assisted vaginal
  • Laparoscopic hysterectomy
19
Q

What are the different types of hysterectomy?

A

Total → uterus and cervix

  • Cervix removed (no smears needed)

Radical → removal of structures ± BSO

  • I.E. Wertheim’s hysterectomy
  • Cervix removed (no smears needed)

Subtotal → upper part of uterus removed

  • Cervix not removed (smears needed)

Smears… if total or radical AND done due to cancer / CIN, smears are still done at 6 and 18m

20
Q

What are the indications for a hysterectomy?

A

Vaginal hysterectomy (quicker recovery):

  • Menstrual disorders with uterus <12w size
  • Microinvasive cervical carcinoma
  • Uterovaginal prolapse
  • Contraindications = malignancy, uterus 12w+ pregnancy

Abdominal hysterectomy:

  • Pfannenstiel incision (midline incision if larger masses or malignancy)
  • Uterine, ovarian, cervical, fallopian tube carcinoma
  • Pelvic pain from chronic endometriosis or chronic PID where pelvis is frozen and vaginal impossible
  • Symptomatic fibroid uterus 12w+ in size
21
Q

What are the complications of a hysterectomy?

A
  • General = infection, bleeding, failure, damage to local structures, GA complications, VTE
  • Augmentin (Co-amoxiclav) given intra-operatively
22
Q

What is a hysteroscopy?

A

Involves passing a small diameter telescope (flexible or rigid) through the cervix to inspect the uterine cavity

23
Q

What are the types of hysteroscopy?

A
  • Flexible hysteroscope can be used in OPD setting with CO2 as filling medium
  • Rigid instruments use circulating fluids so can be used to visualise uterine cavity even if the woman is bleeding
24
Q

What are the indications for a hysteroscopy?

A

Abnormal bleeding from uterus:

  • PMB, PCB, IMB
  • Menorrhagia and/or abnormal discharge
  • Suspected uterine malformations or suspected Asherman’s
25
Q

What are the complications of a hysteroscopy?

A
  • General = infection, bleeding, failure, damage to local structures (i.e. cervical os, uterus lining)
26
Q

What is LLETZ?

A

Use a small wire diathermy to cut away affected cervical tissue and seal the wound (examine cuttings for CIN)

27
Q

What are the indications for LLETZ?

A
  • High grade squamous intraepithelial lesion of the cervix (CIN 2 and 3)
  • Persistent low-grade squamous intraepithelial lesion of the cervix (CIN 1)
28
Q

What are the complications of LLETZ?

A
  • General = infection, bleeding, failure, damage to local structures (i.e. uterus lining, bladder)
  • Risk of recurrence up to 10%
  • Bleeding, discharge for 3-4 weeks (avoid tampons, sex, swimming until discharge has stopped to avoid infection)
29
Q

What is a myomectomy?

A

Surgical removal of fibroids from the uterus – prior to surgery GnRH analogues used to shrink size to reduce bleeding

The only fibroid treatment can improve pregnancy chances

30
Q

What are the indications for a myomectomy?

A
  • Hysteroscopy – fibroids on inner wall
  • Laparoscopy – removing 1 or 2 fibroids ≤ 2 inches that are growing outside the uterus
  • Open – large fibroids, many fibroids, fibroids deep into the uterine wall
31
Q

What are the complications of a myomectomy?

A
  • General = infection, bleeding, failure, damage to local structures (i.e. bladder)
  • Hysterectomy if large haemorrhage
  • Fibroids return in 10-20% of women (larger and more numerous are more likely to recur)
32
Q

What is an ovarian cystectomy?

A

Surgical excision of an ovarian cyst

33
Q

What are the indications for an ovarian cystectomy?

A
  • Diagnostic (and exclude ovarian cancer) > removal of symptomatic cysts
  • Cyst ≥7.6cm > cysts hat do not resolve after 2-3 months
  • Bilateral lesions > USS finding that deviate from simple functional cyst
34
Q

What are the complications of an ovarian cystectomy?

A

General = infection, bleeding, failure, damage to local structures (i.e. bladder, fallopian tubes)

O&G (17 decks)

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