Management Flashcards
Post Menopausal Bleeding
Bimanual & speculum Cervical smear if not up to date TVUS to measure endometrial thickness If >4mm or >1episode PMB: - endometrial biopsy +- hysteroscopy pipelle, hysteroscopy under paracervical LA block or under GA
Bleeding in early pregnancy
Admit if: ectopic suspected, septic miscarriage, heavy bleeding
Resuscitate if req
Remove any products in os (pain, bleeding, vasovagal shock)
If non viable + heavy bleeding: IM ergometrine
If septic: swabs + IV abx
Rhesus -ve + medical/surgical/expectant>12wks:
Threatened miscarriage I.e. Viable
90% with viable fetus detected at 8 wks will not miscarry
Bed rest, progesterone and hCG do not prevent miscarriage
Non-viable pregnancy
Expectant: if not septic
Medical: misoprostol, incomplete 600 mcg, missed 800mcg
Surgical: if heavy bleeding/septic/preferred by patient
ERPC- under anaesthetic vacuum aspiration
Complications of miscarriage management
Expectant + medical: heavy painful bleeding 24hr direct access to emergency gynae service for advice/treatment
May require surgical evacuation
Infection rates are all 3%
Surgical: uterus perforation / asherman’s syndrome if part of endometrium removed, more expensive
Symptomatic ectopic pregnancy
Admit (NBM) + fluid resus if req IV access, Hb + cross match Urine B-HCG TVUS Either: laparoscopy/otomy or medical management
Subacute ectopic pregnancy
Surgical: laparoscopy with salpingostomy/ectomy
Medical: if unruptured with no cardiac activity,
Acute PID
Urine dip, MC+S High vaginal swab, endocervical swab Abx: doxycycline + metronidazole Analgesia + Contact tracing Complications: tubo-ovarian abscess, Fitz-Hugh-Curtis synd (peri hepatitis+ adhesions), tubal infertility, ectopic preg, chronic pelvic pain
Endometriosis
Medical:
Analgesia: tranexamic acid
COCP: microgynon 30
Progestogens: medroxyprogesterone acetate
GNRH analogues: triptorelin up to 6 months
Antiandrogens
Danazol: anti-oestrogen, anti- progesterone, 3-6 months
Surgical: to improve fertility
IVF often indicated
Placenta praevia
Admit Stabilise Heavy/far from hospital admit from 30-32 wks until delivery Planned Caesarean section 38-39 wks Major haemorrhage -> emergency c section
Chorioamnionitis
Deliver without delay: oft c section
Abx for mother + baby
Paediatricians present
Pre labour SROM
No digital examination - introduces infection
Obtain sample liquor
Sterile speculum exam: visualise cervix, cough
At term: immed induction of labour or expectant management
Which should NOT exceed 96 hrs, generally induced at 48hrs post SROM
Pyelonephritis
MSU: dip, M C + S
Renal US: hydronephrosis
Uterine tightenings = risk of preterm labour + bacteraemia
Speculum as silent cervical dilation can occur
Rx: analgesia, fluids, Iv abx
UTI
Freq, dysuria, suprapubic pain, fever, tachycardia Uterine tightenings, perform speculum MSU: dipstick with M C + S Fx: cephradine, amoxicillin Recurrent UTI req further investigation
Suspected ectopic + shock
ABC!
Fluid resuscitate, urine BHCG, urgent cross match,
prep for theatre:
Urgent laparotomy
