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3a Women's health > Gynaecology emergencies > Flashcards

Gynaecology emergencies Flashcards

1
Q

What is an ectopic pregnancy

A

Pregnancy that occurs when the fertilised egg implants outside of the uterus

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2
Q

Where is the most common location of an ectopic pregnancy

A

fallopian tube - 90%

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3
Q

Give 5 RFs for an ectopic pregnancy

A
  • Previous ectopic
  • previous STI/ PID
  • endometriosis
  • age >35
  • IUD (coils etc)
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4
Q

What investigations would you do when suspecting ectopic pregnancy

A
  • Urine pregnancy test (hcg)
  • BHCG
  • transvaginal ultrasound
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5
Q

Give 5 ways an ectopic pregnancy may present

A
  • PV bleeding
  • unilateral low abdominal pain
  • shoulder tip pain (peritonitis)
  • dizziness
  • missed period
  • cervical excitation
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6
Q

What are the possible findings of an ectopic pregnancy on an ultrasound

A
  • adnexal mass moving separately to the ovary comprising of gestational sac +/- fetal pole
  • free fluid may be seen
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7
Q

State the 3 options for terminating an ectopic pregnancy

A
  • Expectant management - natural termination
  • Medical management
  • Surgical management
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8
Q

Describe expectant management for an ectopic pregnancy

A
  • Repeat BHCG on day 2,4 and 7
  • If BHCG reduced by 15% each 48h then can repeat weekly until <20iu
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9
Q

What is the criteria for expectant management of an ectopic pregnancy

A
  • clinically stable pt w no significant pain
  • unruptured ectopic
  • adnexal mass < 35mm with no fetal pole
  • BHCG < 1000iu
  • pt able to return for follow up
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10
Q

What drug is used in the medical management of an ectopic pregnancy

A

IM methotrexate

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11
Q

What is the criteria for medical management of an ectopic pregnancy

A
  • no significant pain + clinically stable
  • unruptured ectopic <35mm
  • confirmed absence of intrauterine pregnancy
  • can return for follow up
  • BHCG < 1500iu
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12
Q

What are the two options for surgical management of ectopic pregnancy

A
  • laparoscopic salpingectomy (1st line) - whole tube w ectopic
  • laparoscopic salpingostomy - just ectopic removed
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13
Q

When is surgical management first line for an ectopic pregnancy

A
  • significant pain
  • adnexal mass > 35mm
  • live/ ruptured ectopic
  • HCG >5000iu
  • haemodynamically unstable
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14
Q

When should salpingostomy be considered over salpingectomy for removing an ectopic and why

A

Salpingostomy should be considered for women with contralateral tube damage, as this is a risk factor for infertility

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15
Q

What is a miscarriage

A

Involuntary, spontaneous loss of a fetus before 24 weeks

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16
Q

Describe a complete miscarriage (presentation, cervical Os, USS findings)

A
  • PV bleeding and passing of products of conception
  • Open/ closed cervical Os depending on stage
  • USS: empty uterus
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17
Q

Describe an incomplete miscarriage (presentation, cervical Os, USS findings)

A
  • Heavy bleeding inc some passing of products
  • Os: open
  • USS: retained tissues
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18
Q

Describe a threatened miscarriage (presentation, cervical Os, USS findings)

A
  • mild PV bleeding, some abdo pain, intact membranes
  • Os: closed
  • USS: viable intrauterine pregnancy detected
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19
Q

Describe a missed miscarriage (presentation, cervical Os, USS findings)

A
  • asymptomatic
  • Os: closed
  • USS: nonviable pregnancy, retained products with no fetal heartbeat or empty gestational sac
20
Q

Describe an inevitable miscarriage (presentation, cervical Os, USS findings)

A
  • Pv bleeding and abdo pain +/- intact membranes
  • Os: open
  • USS: gestational sac in the uterus without fetal HB or other signs of a non-viable pregnancy.
21
Q

How is a miscarriage managed conservatively

A
  • allow miscarriage to occur spontaneously
  • bHCG - decrease of >50% in 48h indicates early pregnancy loss
  • repeat UPT in 3 weeks to confirm miscarriage is complete
  • follow up USS (1w) for threatened/ inevitable miscarriages
22
Q

Describe the medical management of a miscarriage

A
  • Mifepristone followed by misoprostol 48h later for missed miscarriage
  • single dose oral/ vaginal misoprostol for others
  • analgesia
  • anti-emetics
  • UPT after 3w to confirm
23
Q

What are the two types of surgical management for a miscarriage

A
  • Manual vacuum aspiration under local anaesthetic
  • Electric vacuum aspiration under general anaesthetic
24
Q

Why is infection more common in an incomplete miscarriage

A

retained products of conception create a risk of infection
treat with abx

25
Q

What are molar pregnancies

A
  • chromosomally abnormal pregnancies that have the potential to become malignant (gestational trophoblastic neoplasia)
26
Q

What is a complete mole

A

occurs when a single sperm (90%) or two sperm cells fertilise an egg that has lost its DNA (“empty ovum”)

27
Q

What is a partial mole

A
  • occurs when two sperm cells fertilise a normal ovum (has DNA) at the same time
  • new cell now has three sets of chromosomes
28
Q

How is a molar pregnancy diagnosed, give findings

A
  • Pelvic ultrasound - irregular echobright area containing multiple cysts (snowstorm appearance)
  • serum hCG - significantly elevated for gestational age
29
Q

How does a molar pregnancy typically present

A
  • vaginal bleeding
  • uterus size greater than expected for gestational age
30
Q

How is a molar pregnancy managed

A
  • send POC for histology urgently to confirm
  • surgery - suction evacuation of uterus to remove mole
31
Q

Molar pregnancies are at an increased risk of developing into which cancer

A

choriocarcinoma - part of the gestational trophoblastic tumours

32
Q

What is ovarian torsion

A

Twisting of the ovary and/ or fallopian tube on its vascular and ligamentous supports

33
Q

Why is ovarian torsion an issue

A

It can block adequate blood flow to the ovary

34
Q

Give 3 ways ovarian torsion may present

A
  • severe pelvic/ abdo pain
  • N+V
  • diarrhoea
    (non- specific)
35
Q

What imaging should be done for a suspected ovarian torsion

A
  • urgent transvaginal ultrasound - enlarged ovary, free fluid, whirlpool sign
  • abdo/ transrectal USS for children/ pt who haven’t been sexually active
36
Q

How is ovarian torsion managed

A

laproscopic surgery
* immediate surgical detorsion
* salpingo-oophrectomy if ovary is non-viable

37
Q

What is the definitive diagnostic tool for ovarian torsion

A

Surgical visualisation

38
Q

What is pelvic inflammatory disease

A

Infection within the female reproductive system
* inc: endometrium, fallopian tubes, ovaries, uterus

39
Q

How might PID present

A
  • abnormal cervical/ vaginal discharge
  • lower abdo pain
  • dyspareunia
40
Q

PID can be diagnosed by clinical exam. Give 3 findings on pelvic examination.

A
  • uterine tenderness
  • cervical motion tenderness
  • adnexal tenderness (endometritis)
41
Q

Give 4 RFs of PID

A
  • unprotected sex
  • previous chlamydia, gonorrhoea or PID
  • Multiple sexual partners
  • IUD use
41
Q

How is PID investigated

A
  • STI screen
  • pregnancy test - exclude ectopic
  • CRP/ ESR - raised = support diagnosis
42
Q

What typically causes PID

A

Bacterial infection - mc STI
* Gonorrhoea
* chlamydia (mc)

43
Q

How is PID managed

A
  • Swabs to confirm causative agent
  • single dose IM ceftriaxone + PO doxycycline and metronidazole for 14 days
  • contact tracing
  • advice: avoid sex until patient and partner complete treatment
44
Q

What bacteria does each antibiotic cover in the treatment of PID

A
  • Ceftriaxone - gonorrhoea
  • doxycycline - chlamydia and mycoplasma genitalium
  • metronidazole - anaerobes eg. gardnerella vaginalis (bv)

3a Women's health (12 decks)

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