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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
how is complete molar pregnancy treated
always needs surgical evacuation
26
how does partial molar pregnancy present
2 sperm fertilising 1 egg medical management if large fetal tissue
27
how long do you need to wait after a molar pregnancy before trying to conceive
6 months | 1 year if needed chemo
28
what are fibroids
benign tumours of myometrium
29
what is a pelvic mass in post-menopausal women until proven otherwise
cancer
30
types of fibroids
``` subserosal -under serosa outside of uterus intramural -in the muscle submucosal -in mucosa under lining - can distort the cavity ```
31
presentation of fibroids
50% asymptomatic heavy menstrual bleeding dysmenorrhoea pressure effects (frequency, retention, hydronephrosis) infertility can transform into leimyosarcoma
32
complications of fibroids
anaemia degeneration torsion if pedunculate infection
33
how are fibroids diagnosed
USS
34
management of fibroids <3cm
1st line - mirena coil 2nd line - tranexamic acid and NSAIDs ``` combined pill POP transcervical resection endometrial ablation hysterectomy ```
35
management of fibroids >3cm
tranexamic acid and NDAIDs Mirena coil uterine artery embolisation myomectomy hysterectomy
36
what medication do you give for 3 months pre-op for fibroid surgery
GnRH analogues | reduces size of uterus/fibroids by turning off hormones to them
37
Most common type of simple pre-menopausal cyst <5cm
follicular cyst
38
how do you manage a simple cyst in a premenopausal woman
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
how do you manage complex fibroids in pre-menopausal women
Ca 125 if <200 - probs benign >200 - cancer? if <40 years old do AFP, bHCG and LDG to look for germ cell tumours
40
how do you manage post menopausal ovarian cysts
always abnormal - calculate RMI calculation of cancer risk
41
how do you calculate RMI
USS X menopausal status x Ca125
42
how do you treat an ovarian cyst in a post menopausal women with an RMI of <200
if cyst <5cm and simple - repeat USS in 3 months if low risk but complex cyst - consider surgery
43
how do you manage an ovarian cyst in a post menopausal woman with an RMI of >200
CTCAP | refer to oncology MDT
44
how do you decide which cervical screening samples get cytology
only the the HPV+ ones
45
when can you diagnose menopause
if they've not had a period in >1 year
46
average age of menopause
51
47
symptoms of menopause
``` hot flushes night sweats joint and muscle pain vaginal dryness mood changes lack of interest in sex ```
48
when do you give oestrogen only HRT
only if no uterus
49
what do you give normally for HRT and why
combined oestrogen and progesterone unopposed oestrogen increases the risk of endometrium cancer
50
what is a prolapse
herniation of pelvic or abdominal organs through vaginal canal
51
types of organs
cystocele rectocele uterine prolapse vaginal vault prolapse (top of vagina prolapses after hysterectomy)
52
most common type of prolapse
51% of post menopausal women have an anterior vaginal wall prolapse
53
prolapse presentation
heaviness or dragging in the vagina urinary symptoms faecal incontinence excessive straining sexual dysfunction
54
how are prolapses graded
○ 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
management of prolapse
conservative -lifestyle advise, supervised pelvic floor exercises, vaginal oestrogen pessaries surgery - anterior repair - posterior repair - sacrospinous fixation - laparoscopic sacrohysteroplexy - colpocleisis - closing vagina
56
what is lichen sclerosis
severe itching and epidermal atrophy of the vulva of unknown aetiology
57
presentation of lichen sclerosis
``` loss of architecture fissuring figure of 8 distribution around the cliteris fusion silver white ```
58
treatment of lichen sclerosis
avoid irriants only use soap substitures dermuvate - ultrapotent steroids - in 6 week blocks 90-95% symptoms improve
59
post op Gynae complications at 0-24 hours
primary haemorrhage (tachycardia, hypotensive) - most common UTI (pyrexia >38)
60
24hrs -5 days post op complications
infection (pelvis, chest, urine) thrombosis (DVT, PE) direct injury )visceral perforation)
61
7-14 days post op complications
infection (wound, pelvis, chest, urine) thrombosis (DVT,PE) Indirect injury (diathermy injury causing necrosis)

4th Year (25 decks)

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