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4th Year > O&G Revision Lecture > Flashcards

O&G Revision Lecture Flashcards

1
Q

what is a miscarriage

A

loss of pregnancy <24 weeks

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2
Q

most common causes of miscarriage

A

trisomy (50%)
uterine anomalies
immunological
unexplained

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3
Q

when do you start investigating the cause of miscarriage

A

if they’ve had >3

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4
Q

presentation of miscarriage

A

bleeding
pain
septic

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5
Q

when can’t you diagnose a miscarriage on USS

A

can’t diagnose on 1st scan if

gestational sack <25mm
crown rump length <7

instead rescan in 7-10 days

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6
Q

what can you diagnose a miscarriage on USS

A

gestational sack >25mm
crown rump length >7

confirmed by 2 sonographers

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7
Q

what are the 3 management options for miscarriage

A

expectant
medical
surgical

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8
Q

what is expectant management of miscarriage

A

wait up to 14 days - body deals with it itself

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9
Q

medical management of miscarriage

A

misoprostol

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10
Q

surgical management of miscarriage

A

evacuation of uterus

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11
Q

when do you give anti-D in miscarriage

A

if Rh -ve and over 12 weeks or <12 weeks and had uterine instrumentation

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12
Q

what is a threatened miscarriage

A

any bleeding in pregnancy

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13
Q

what is an inevitable miscarriage

A

open os and pregnancy still inside

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14
Q

what is an ectopic pregnancy

A

pregnancy outside of uterus - most commonly in uterine tube

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15
Q

risk factors for ectopic pregnancy

A

smoking
pelvic inflammatory disease
previous tubal surgery
previous infection

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16
Q

how do you investigate a pregnancy of unknown location

A

check HCG 48 hours apart if stable or can’t see pregnancy

should have >63% rise in HCG over 48 hours

if >50% drop - likely a failing pregnancy - check urine pregnancy test in 14 days

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17
Q

Management options for ectopic pregnancy

A

Expectant
medical
surgical

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18
Q

when can you manage an ectopic pregnancy expectantly

A

HCG <1500 and dropping
no significant pain
empty uterus
mass <35mm

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19
Q

how and when do you manage an ectopic pregnancy medically

A

HCG <3000
methotrexate

monitor bloods - on day 4 theres a rise in HCG which goes by day 7

if HCG hasnt dropped then give second dose

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20
Q

what is the surgical management of ectopic pregnancy

A

salpingectomy (removal of tube) v salingotomy (just ectopic)

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21
Q

what is a molar pregnancy

A

abnormal fertilisation - entirely fetal origin

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22
Q

how does molar pregnancy present

A

expressed HCG
irregular bleeding
hyperemesis
hyperthyroidism

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23
Q

two types of molar pregnancy

A

complete - sperm fertilises empty egg

partial - two sperm fertilise one egg

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24
Q

how does a complete molar pregnancy present on USS

A

(1 sperm with empty egg)

snowstorm appearance
large intrauterine cystic mass

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25
Q

how is complete molar pregnancy treated

A

always needs surgical evacuation

26
Q

how does partial molar pregnancy present

A

2 sperm fertilising 1 egg

medical management if large fetal tissue

27
Q

how long do you need to wait after a molar pregnancy before trying to conceive

A

6 months

1 year if needed chemo

28
Q

what are fibroids

A

benign tumours of myometrium

29
Q

what is a pelvic mass in post-menopausal women until proven otherwise

A

cancer

30
Q

types of fibroids

A 
subserosal 
-under serosa outside of uterus
intramural 
-in the muscle 
submucosal 
-in mucosa under lining - can distort the cavity
31
Q

presentation of fibroids

A

50% asymptomatic

heavy menstrual bleeding

dysmenorrhoea

pressure effects (frequency, retention, hydronephrosis)

infertility

can transform into leimyosarcoma

32
Q

complications of fibroids

A

anaemia
degeneration
torsion if pedunculate
infection

33
Q

how are fibroids diagnosed

A

USS

34
Q

management of fibroids <3cm

A

1st line - mirena coil
2nd line - tranexamic acid and NSAIDs

combined pill 
POP
transcervical resection 
endometrial ablation
hysterectomy
35
Q

management of fibroids >3cm

A

tranexamic acid and NDAIDs

Mirena coil

uterine artery embolisation

myomectomy

hysterectomy

36
Q

what medication do you give for 3 months pre-op for fibroid surgery

A

GnRH analogues

reduces size of uterus/fibroids by turning off hormones to them

37
Q

Most common type of simple pre-menopausal cyst <5cm

A

follicular cyst

38
Q

how do you manage a simple cyst in a premenopausal woman

A

no need for Ca125

if asymptomatic and <5cm discharge

if 5-7cm repeat scan in 12 months

if >7cm offer surgery - risk of ovarian torsion if it gets too big

39
Q

how do you manage complex fibroids in pre-menopausal women

A

Ca 125

if <200 - probs benign
>200 - cancer?

if <40 years old do AFP, bHCG and LDG to look for germ cell tumours

40
Q

how do you manage post menopausal ovarian cysts

A

always abnormal - calculate RMI calculation of cancer risk

41
Q

how do you calculate RMI

A

USS X menopausal status x Ca125

42
Q

how do you treat an ovarian cyst in a post menopausal women with an RMI of <200

A

if cyst <5cm and simple - repeat USS in 3 months

if low risk but complex cyst - consider surgery

43
Q

how do you manage an ovarian cyst in a post menopausal woman with an RMI of >200

A

CTCAP

refer to oncology MDT

44
Q

how do you decide which cervical screening samples get cytology

A

only the the HPV+ ones

45
Q

when can you diagnose menopause

A

if they’ve not had a period in >1 year

46
Q

average age of menopause

A

51

47
Q

symptoms of menopause

A 
hot flushes
night sweats
joint and muscle pain 
vaginal dryness 
mood changes
lack of interest in sex
48
Q

when do you give oestrogen only HRT

A

only if no uterus

49
Q

what do you give normally for HRT and why

A

combined oestrogen and progesterone

unopposed oestrogen increases the risk of endometrium cancer

50
Q

what is a prolapse

A

herniation of pelvic or abdominal organs through vaginal canal

51
Q

types of organs

A

cystocele
rectocele
uterine prolapse
vaginal vault prolapse (top of vagina prolapses after hysterectomy)

52
Q

most common type of prolapse

A

51% of post menopausal women have an anterior vaginal wall prolapse

53
Q

prolapse presentation

A

heaviness or dragging in the vagina

urinary symptoms

faecal incontinence

excessive straining

sexual dysfunction

54
Q

how are prolapses graded

A

○ Classify prolapse - in relation to hymen
§ Stage 0 - no prolapse
§ Stage 1- leading edge is -1cm or above
§ Stage 2 - leading edge is between -1 and +1cm
§ Stage 3- Leading edge is +1cm or below but without complete eversion
Stage 4- complete vaginal eversion

55
Q

management of prolapse

A

conservative
-lifestyle advise, supervised pelvic floor exercises, vaginal oestrogen

pessaries

surgery

  • anterior repair
  • posterior repair
  • sacrospinous fixation
  • laparoscopic sacrohysteroplexy
  • colpocleisis - closing vagina
56
Q

what is lichen sclerosis

A

severe itching and epidermal atrophy of the vulva of unknown aetiology

57
Q

presentation of lichen sclerosis

A 
loss of architecture
fissuring 
figure of 8 distribution around the cliteris 
fusion 
silver white
58
Q

treatment of lichen sclerosis

A

avoid irriants
only use soap substitures
dermuvate - ultrapotent steroids - in 6 week blocks

90-95% symptoms improve

59
Q

post op Gynae complications at 0-24 hours

A

primary haemorrhage (tachycardia, hypotensive) - most common

UTI (pyrexia >38)

60
Q

24hrs -5 days post op complications

A

infection (pelvis, chest, urine)

thrombosis (DVT, PE)

direct injury )visceral perforation)

61
Q

7-14 days post op complications

A

infection (wound, pelvis, chest, urine)

thrombosis (DVT,PE)

Indirect injury (diathermy injury causing necrosis)

4th Year (25 decks)

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