Obs and Gynae Peer Teaching Flashcards
1
Q
What gestation is normal labour
A
37 to 42 weeks
2
Q
Role of prostaglandin in labour
A
Reduces cervical resistance (cervical ripening) and increased release of oxytocin from posterior pituitary
3
Q
Role of oxytocin in labour
A
Stimulates uterine contraction
4
Q
2 things needed for diagnosis of labour
A
Painful, regular, progressive uterine contractions
Cervical dilatation and effacement
5
Q
Describe the latent first phase of labour
A
Cervix efface and dilate up to 4cm
6
Q
Describe the active first phase of labour
A
Progressive cervical dilatation from 4-10cm. Regular painful contractions
7
Q
Describe the second stage of labour
A
Full cervical dilatation until birth of baby
8
Q
Describe the third stage of labour
A
Delivery of baby to delivery of placenta
9
Q
How long is latent phase
A
18hr first, then 12 hour for second baby
10
Q
What makes you suspect fialure to progress
A
Less than 2cm dilatation in 2 hours. Arrested descent/ slowing of progress in multips
11
Q
Causes of abnormal first stage of labour
A
Inefficient uterine contractions
Cephalopelvic disproportion
12
Q
Who most commonly gets inefficient uterine contractions in labour and what is the management
A
Nulliparous.
Amniotomoy and syntocin
13
Q
Who most commonly gets cephalopelvic disproportion, what are the signs and whats the management
A
Multiparous women
Caput and moulding are the signs. Secondary arrest (previously good progress).
Do a c section
14
Q
What counts as a prolonged 2nd stage of labour
A
2hr of active pushing in nulliparous, 1hr of active pushing in multiparous
15
Q
What is the management of prolonged 2nd stage
A
Assisted vaginal delivery or c section
16
Q
What is a 1st degree tear
A
Laceration of vaginal epithelium or perineal skin only
17
Q
What is a 2nd degree tear
A
Involvement of the perineal muscles but not the sphincter
18
Q
What is a 3rd degree tear
A
Disruption of the anal sphincter muscles
19
Q
What is a 4th degree tear
A
Disruption of the anal epithelium as well
20
Q
What is physiological management of 3rd stage
A
No Syntometrine or syntocin
Cord stops pulsating before clamping
Maternal effort to deliver placenta
21
Q
When do you change to active 3rd stage of labour management
A
Haemorrhage or placenta not delivered by 1hr. Reduces risk of PPH
22
Q
What is the active management of the 3rd stage of labour
A
IM syntocin
Deferred clamping and cutting of cord
Controlled cord traction
23
Q
Definition of gestational diabetes
A
Carbohydrate intolerance which is diagnosed in pregnancy
24
Q
Why does gestational diabetes happen
A
Reduced glucose tolerance due to change in carbohydrate metabolism
Antagonistic effect of human placental lactogen, progesterone and cortisol
25
Risk factors for gestational diabetes
Maternal obesity (BMI>30)
Previous macrosomic baby
Previosu GDM
1st degree relative with DM
26
Effects of pregnancy on diabetes
Increased DKA and hypo risk
| Increased retinopathy and nephropathy risk
27
Effects of diabetes on pregnancy anagram
SMASH
28
SMASH anagram of diabetes effects on pregnancy
```
Shoulder dystocia
Macrosomnia
Amniotic fluid excess
Still birth
HTN, Hypoglycaemia
```
29
What can shoulder dystocia cause
Erbs palsy
30
Which circumference is bigger in a GDM baby
AC bigger than HC on USS
31
What is the name for amniotic fluid excess
Polyhydramnios
32
Why will a GDM baby get hypoglycaemia
Hyperinsulinaemia
33
How do you diagnose GDM
Oral glucose tolerance test
2hr, 75g oral glucose
Done at booking then repeated at 24-28 weeks if normal
34
What is the threshold for OGTT and Fasting glucose of GDM
7. 8mmol/L OGTT
| 5. 6mmol/L Fastin
35
Counselling for mums who are already diabetic
Achieve optimal control
Screen complications
Alter meds
Folic Acid
36
What medications need to be stopped in pregnancy
ACEis, Statins, all other hypoglycaemics
37
Why does folic acid need to be given especially to GDM mums
Increased risk of neural tube defects
38
Steps of GDM treatment
Diet/exercise
Metformin
Insulin
Glibenclamide
39
Fetal monitoring for GDM
```
Serial USS (size and amnio)
Fetal echo at 20-24wks (CHD)
```
40
GDM labour
Delivery before 41wks
Induce by 39
Vaginal delivery and continued monitoring preferred
If >4kg then elective CS
IV dextrose and sliding scale insulin given
41
Post birth GDM advice baby
Breastfeeding
| Monitor fetal BG as risk of hypoglycaemia
42
Post partum GDM advice mum
Stop insulin and arrange OGTT at 6 weeks postpartum
43
What is rhesus disease
Maternal antibody response mounted against fetal red cells
44
What combination of rhesus parents leads to rhesus disease
Rhesus negative mum, rhesus positive dad
45
How does sensitisation work in rhesus disease work
During first pregnancy, fetal blood crosses into maternal circulation. Maternal immune response to Rh D+ve antigens on foetal RBCs
46
Why isnt the first rhesus pregnancy at risk
Initially IgM can not cross the placenta
47
How does rhesus disease happen in the second pregnancy
Memory B cells produce rapid immune response (IgG) which crosses into the foetal circulation causing haemolytic anaemia (foetal hydrops if severe
48
Sensitising events for rhesus
```
surgery after miscarriage
Ectopic pregnancy
Blunt abdo trauma
Amniocentesis
Intrauterine death
Delivery
```
49
Management of rhesus disease
All mums checked at booking visit, 28 and 34 weeks.
50
How do you assess and treat fetal anaemia
```
MCA doppler (increased flow velocity)
Prevention= antiD immunoglobulin
Kleihauer test
```
51
What is kleihauer test
Tests for foetal maternal haemorrhage
52
Define chronic hypertension (obs and gynae)
HTN before pregnancy (also includes HTN before 20 weeks)
53
Define pregnancy induced hypertension
Gestational non proteinuric HTN
| New persistent hypertension after 20 weeks gestation without evidence of preeclampsia
54
Threshold of hypertension in pregnancy
140/90
55
Define preeclampsia
HTN and proteinurina, specific to pregnancy and puerperium
56
Preeclampsia risk factors acronym
NOPE 2 FAT
57
NOPE 2 FAT preeclampsia risk factors
Nulliparity
Obesity
Previous Hx
Extremes of age
2- twins
Family History
Autoimmune (anitphospholipids)
Twins
58
Pathophysiology of preeclampsia
Failure of trophoblastic endovascular remodelling. Spiral arteries remain high resistance (coil and not dilated). Causes placental ischaemia
59
Presentation of preeclampsia
Most asymptomatic.
Headache, visual disturbances, epigastric/ RUQ pain.
Nausea and vomitting
Rapid oedema (esp. face)
60
Preeclampsia on examination
```
Hypertension
Proteinuria
Facial oedema
Epigastric/ RUQ pain
Brisk hyperreflexia/ ankle clonus
```
61
Preeclampsia kidney complications
Reduced renal blood flow and GFR
| Increased uric acid/ urea/ creatinine and proteinuria
62
Preeclampsia liver complications
HELLP syndrome
| Coagulation system changes
63
What is HELLP syndrome
Happens to the liver in preeclampsia (haemolysis, high ALT, high AST, low platelets)
64
What haemolytic changes happen to the liver in preeclampsia
Thrombocytopenia, Low antithrombin III, increased fibronectin
65
What is eclampsia
Generalised tonic clonic seizures
66
What CNS changes happen in preeclampsia
Eclampsia
Headaches
Visual disturbances
67
Severe complications of preeclampsia
```
Eclampsia
HELLP
Stroke
Renal failure
Placental abruption
```
68
Foetal complications of preeclampsia
IUGR (placental insufficiency)
Preterm
Oligohydramnios
IUFD
69
Preeclampsia diagnosis
New persistent raised BP (>140/90 at 20+ weeks) AND Proteinuria 300mg+ in 24hr collection or 2+ on dipstick
70
Mild and moderate preeclampsia classification
BP less than 160/110 with significant proteinuria and no complications
71
Severe preeclampsia classification
BP >160/110
Proteinuria over 1g/24hr or 2++
Maternal complications occur
72
What is the only cure of preeclampsia
Delivery of placenta
73
Preferred delivery route for preeclampsia
Induction of labour and vaginal
74
If pregnancy at risk which drug do you give from 12 weeks in preeclampsia
Low dose aspirin
75
Which drug do you give if preeclampsia is moderate/severe at 34 weeks
Steroids- bethametasone
76
Which drug do you give to treat eclampsia but then must deliver
IV Magnesium Sulphate
77
Which drug is used to treat acute severe preeclampsia and what do you give if asthmatic or CHF
PO Labetalol (methyldopa if asthmatic/CHF)
78
What is the definition of antepartum haemorrhage
Bleeding from genital tract after 24 weeks gestation and prior to the onset of labour
79
How much is minor APH
Less than 50mL
80
How much is major APH
50-1000mL
81
How much is massive APH
>1000mL and or signs of shock
82
Uterine differentials of APH
Placental abruption
| Placenta praevia, vasa praevia
83
Cervical differentials of APH
Show (loss of mucus plug)
Cervical cancer/ polyps
Cervical ectropian
84
Vaginal differentials of APH
Trauma
| Infection
85
Velamentuous placenta
Umbilical vessels go within the membranes before placental insertion
86
Placenta accreta
chorionic villi attach to the myometrium, rather than being restricted within the decidua basalis.
87
Placenta increta
chorionic villi invade into the myometrium.
88
Placenta percreta
chorionic villi invade through the perimetrium
89
Risk factors for placenta accreta
Previous accreta
C-section
uterine surgery
90
Investigations for placenta crreta
Ultrasound scan (MRI can complement)
91
Management for placenta accreta
Aim to deliver in 35th week.
C section hysteretomy with placenta in situ
Uterine preserving surgery
92
Placenta praevia definition
Implantation of placenta, wholly or in part, in the lower segment of the uterus
93
What happens to 90% of low lying placentas at 20 weeks
Resolve as the pregnancy progresses and lower uterine segment grows
94
Risk factors for placenta praevia
Multiparity, smoking, mulitple pregnancy, advanced age, previous PP, previous c section
95
Define marginal placenta praevia
Placenta in lower segment of uterus, close to the internal OS
96
Define major placenta praevia
Placenta lies over the OS (cervical effacement and dilatation= catastrophic bleeding)
97
placenta praevia symptoms
Intermittent painless bright red bleeds, which increase in frequence and severity over the weeks
98
Placenta praevia on physical examination
Soft uterus
Foetal malpresentation
Foetal head not engaged and high
99
Investigations of placenta praevia
Diagnostic USS if low lying at 2nd trimester, repat at 32.
100
Management of placenta praevia
Avoid sex, dont do a vaginal examination. If previously bled and major, monitor till delivery.
Elective C section 37-39wks.
Single steroid course at 35 weeks
101
Placenta abruption definition
Premature seperation of a normally sited placenta from the uterine side wall
102
Whats the difference between a revealed abruption and a concealed abruption
Revealed has visible bleeding, concealed doesnt
103
Risk factors for placenta abruption
```
Previous abruption
Preeclampsia
IUGR
Abnormal placentation
Rapid uterine decompression
```
104
Symptoms of placenta abruption
Abdominal pain and bleeding. Sudden onset severe constant bleeding. Contraction leads to blood clot which irritates and promotes contraction
105
Placental abruption on examination
Tender, contracting WOODY HARD uterus. Maternal shock and foetal distress
106
Investigations for placental abruption
Diagnosis on clinical grounds. Foetal CTG, USS, Maternal FBC, clotting, Xmatch, U+E
107
Management of placental abruption
Immediate delivery
| Usually CS and resus simultaneously
108
Vasa praevia definition
Foetal vessels run in membrane below presenting foetal part
109
Triad of vasa praevia symptoms
ROM
APH
Foetal distress
110
Order of presentation of vasa praevia
Rupture of membranes then painless PV bleed then rapid foetal distress and bradycardia
111
Minor PPH
500-1000mL
112
Major PPH
More than 1000mL
113
Define primary PPH
Loss of more than 500mL of blood from genital tract within 24h of the birth of the baby
114
Define secondary PPH
Abnormal/excessive bleeding from the genital tract between 24hr and 6 weeks post partum
115
What can cause secondary PPH
Infection (endometritis) or retained placental products
116
Causes of primary PPH (4Ts)
Tone- uterine atony
Trauma- perineal/ vaginal lacerations
Tissue- retained placenta
Thrombin- coagulopathy
117
How can uterine atopy lead to primary PPH
Lack of contractions after delivery means uterine vessels dont clamp down.
118
Risk factors for uterine atony
Prolonged labour, nulliparity, gran multiparity, overdistended uterus, previous PPH
119
How can retained placenta lead to primary PPH
Partial seperation means uterus cant contract properly
120
How can coagulopathy lead to primary PPH
haemophilia, anticoagulant or DIC means bleeding problem
121
PPH symptoms
Prolonged and worsening vaginal bleeding after delivery delivery. PV bleeding/ clots. Abdominal/ pelvic pain
122
PPH signs
Pyrexia, tachycardia, tachypnoea, hypotension, reduced level of consciousness, pallor
123
Complications of PPH
Shock, DIC
124
Management of minor PPH without clinical signs of shock
IV fluids, cross match blood, regular clinical monitoring and obs
125
How do you treat major PPH
Resuscitate- ABC
| Treat and stop cause of bleeding
126
Treatment of lacerations causing PPH
Suture
127
Treatment of retained placenta causing PPH
Manual evacuation
128
Treatment of uterine atony causing PPH
Bimanual uterine compression
Ergometrine IV
Oxytocin
infusion
129
What is second line for PPH after oxytocin infusion if bleeding doesnt stop
Misoprostol
| Carboprost
130
Surgical treatment of PPH caused by uterine atony
Uterine tamponade with Rusch balloon, B lynch suture, UAE, hysterectomy
131
Name 4 types of incontinence
Stress incontinence
Urge incontinence
Mixed urinary incontinence
Neurogenic bladder
132
Define stress incontinence
Involuntary leakage of urine on effort or exertion, or on sneezing or coughing
133
What is the cause of stress incontinence
Urethral sphincter weakness (detrusor pressure is greater than closing pressure of urethra)
134
What are the key risk factors for stress incontinence
```
Pregnancy
Vaginal delivery
Instrumental delivery
Oestrogen deficiency
Pelvic trauma/irradiation
Congenital weakness
Increased age and obesity
```
135
What happens to the pressures in stress incontinence
Bladder neck slips below pelvic floor because of weak supports. Bladder neck not compressed. Bladder neck pressure is therefore less than the bladder pressure leading to incontinence
136
Clinical features of stress incontinence
Incontinence on coughing, sneezing, laughter or other stressors.
Frequency
Urgency
137
Investigations of stress incontinence
exclude UTI
Frequency volume chart
Bladder diaries
Urodynamics
138
What are urodynamics and do you do them before starting management
Function tests of the bladder at OPCs. You can start conservative management first
139
First line treatment for stress incontinence
Atleast 3 months of pelvic floor muscle training
140
Treatment of stress incontinence
Lifestyle (weight loss, avoid excessive drinking)
Pelvic floor muscle training.
Surgery (synthetic mid urethral sling; burch colposuspenision)
Duloxetine (last line)
141
Describe duloxetine as a treatment for stress incontinence
Only if not suitable for surgery. Side effects: nausea, dyspepsia, dry mouth, diziness, insomnia, drowsiness
142
Define urge incontinence
Involuntary leakage of urine accompanied by urgency
143
Define overactive bladder
Urgency (+- urge incontinence, with frequency or nocturia in the absence of UTI
144
What causes urge incontinence
Detrusor overactivity
145
What are risk factors for urge incontinence
Secondary to pelvic floor or incontinence surgery
UTI
Neurogenic (spastic bladder)
146
Clinical features of urge incontinence
Urgency
Frequency
Stress incontinence too
147
How do you exclude UTI
Urine dipstick and MSU for MC&S
148
Investigations for overactive bladder
Exclude uti
Frequency volume chart
Urodynamics
149
First line treatment for urge incontinence
Anticholinergics- oxybutynin
150
Anticholinergic side effects
Dry mouth
Constipation
Nausea
151
Management of urge incontinence
Conservative (fluids, caffeine, weight, pelvic floor)
Bladder training
Anticholinergics
152
Anticholinergics alternatives for urge incontinence
Beta 3 agonists, mirabegron, botox (botulinum toxin type A); sacral nerve stimulation
Surgery last resort
153
Which incontinence if surgery before meds
Stress incontinence
154
Anterior wall prolapses
Cystocele
Urethrocele
Cystourethrocele
155
Cystocele
Bladder
156
Urethrocele
Urethra
157
Cystourethrocele
Bladder and urethra
158
Posterior wall prolapses
Enterocele
| Rectocele
159
Enterocele
Small bowel
160
Rectocele
Rectum
161
Apical prolapses
Uterovaginal
| Vault
162
Uterovaginal prolapse
Uterine descent w/ inversion of vaginal apex
163
Vault prolapse
Post hysterectomy- inversion of vaginal apex
164
What causes prolapse
Pelvic floor weakness
165
Name 4 categories of causes of prolapse
```
Vaginal delivery and process of pregnancy
Congenital
Menopause
Chronic predisposing factors
Iatrogenic factors
```
166
How can vaginal delivery and process of pregnancy cause prolapse
Big baby delivery, prolonged second stage, instrumental delivery
167
How can congenital problems lead to prolapse
Abnormal collagen metabolism
168
How can menopause and age lead to prolapse
Deterioration of collagenous connective tissue with oestrogen withdrawal
169
How can chronic predisposing factors lead to prolapse
Deterioration of collagenous connective tissue with oestrogen withdrawal
170
How can iatrogenic factors lead to prolapse
Any chronic increase increase in intraabdominal pressure (obesity, chronic cough, constipation, heavy lifting, pelvic mass)
171
Clinical features of prolapse
Asymptomatic
| Dragging sensation, discomfort, heaviness within pevlic. Dyspareunia
172
How would anterior prolapse prevent
Urinary symptoms.
| Dragging sensation, discomfort, heaviness
173
How would posterior prolapse present
Constipation, difficulty with defaecation.
| Dragging sensation, discomfort, heaviness
174
How does severe prolapse present
Increased distressing symptoms (incontinence, heaviness, pain, dyspareunia)
175
Prevention of prolapse
Weight reduction, smoking cessation, treat chronic triggers, pelvic floor exercises
176
Treatment for prolapse
Surgery (if symptomatic or severe)
| Pessaries
177
Which pessary is best for prolapse
Ring pessary, common, easy to use, sexual intercouse not affected
178
Can you have a kid after manchester repair
no
179
surgery for uterine prolapse if wanting children
Sacrospinous hysteropexy with sutures
180
surgery for uterine prolapse if not wanting children
Vaginal hysterectomy
181
surgery for anterior or posterior wall prolapse
Anterior/ posterior repair without mesh
182
surgery for vault prolapse
Sacrospinous fixation
| Colpocleisis
183
Define endometriosis
Presence of endometrial tissue outside the uterus
184
Risk factors for endometriosis
Women in 20s, after menarche, nulliparous
185
Whats the theory about how endometriosis happens
Reflux and implantation of viable endometrial tissue during menstruation
186
What is endometriosis dependent on
Oestrogen. Regresses after menopause and during pregnancy
187
What is frozen pelvis
Where severe adhesions for because of menstrual blood causing progressive fibrosis and adhesions
188
What is a chocolate cyst
Accumulated dark brown blood in ovaries, can rupture
189
Do PID and ectopic pregnancy cause endometriosis
No
190
Symptoms of endometriosis
Chronic cyclical pelvic pain (during periods, deep dyspareunia and backache); infertility
191
How do you diagnose endometriosis
Laparoscopy and biopsy (visualisation of lesions and histology of biopsy specimen)
192
What is stage 1 endometriosis
Minimal, superficial
193
What is stage 2 endometriosis
Mild
| Some deep
194
What is stage 3 endometriosis
Moderate
| some endometriomas and adhesions
195
What is stage 4 endometriosis
Large endometriomas and adhesions. Reduced egg reserve and chance of live birth
196
First line treatment of endometriosis
NSAIDS, reduce pain and menstrual flow
197
Medical treatment of endometriosis
Continous COCP and NSAIDs
| GnRH agonist
198
Surgical treatment of endometriosis which preserves fertility
Laparoscopic surgery (laser ablation +- adhesiolysis)
199
Radical surgical treatment for endometriosis
Hysterectomy and bilateral salpingoophectomy
200
Define fibroid
Benign neoplasm of smooth muscle in myometrium
201
Risk factors for fibroids
Near menopause, afrocarribean population
202
What are fibroids dependent on
Oestrogen.
| Increase in size with pregnancy, pills, clomifene. Regress after menopause
203
Symptoms of fibroids
Menorrhagia and IMB
Dysmenorrhoea
Subfertility
Pressure effects- bladder retention and constipation
204
What is red degeneration of fibroids
Where during pregnancy they grow too big causing acute severe pain and fever
205
How do fibroids reduce fertility
Submucosal fibroids prevent fertility
206
Investigations of fibroids
Examination VE and Abdo, pelvis USS
207
When do you treat fibroids
If they have distressive symptoms, excessive bleeding or concern of sarcoma
208
Name an IUS
Mirena
209
Name a progestogen
Norethisterone
210
Name medical managements of fibroids
Tranexamic acid, NSAIDs, Progestogens, IUS, COCP
211
Non invasive surgery for fibroids
Uterine artery embolization
212
Surgical treatment of fibroids to preserve fertility
Hysteroscopic resection if small, laparoscopic myomectomy if large
213
Surgical treatment of fibroids if family completed
Hysterectomy/ endometrial ablation
214
Polycystic ovary definition
Transvaginal USS appearance of multiple (12+) small (2-8mm) follicles in an enlarge (>10mL volume) ovary
215
Three things needed for an ovary to be classic as polycystic
12+ follicles
2-8mm follicles
>10mL ovary
216
What criteria are used for PCOS
Rotterdam criteria (2/3 needed)
217
What are the rotterdam criteria
1) PCO on USS
2) Oligoovulation and/or anovulation
3) evidence of hyperadnrogenism
218
What is evidence of hyperandrogenism
Acne, hirsutism
| Raised serum testosterone
219
Clinical features of PCOS
```
Obese
Acne
Hirsuitism
Oligo/amenorrhoea
Subfertility
Miscarriage
```
220
What can PCOS lead to later in life
Type 2 diabetes
| Gestational diabetes
221
What is a relevant blood test finding in PCOS
LH:FSH ratio is high (3:1) as LH high.
222
Blood tests for PCOS
```
FSH
LH
Antimullerian hormone
Prolactin
Oestrogens
Serum testosterone
```
223
What blood test would you do for cushings
Cortisol
224
What blood test would you do for acromegaly
IGF-1
225
What blood test for congenital adrenal hyperplasia
DHEAs
226
What investigations would you do for PCOS
Lots of blood tests and USS
227
PCOS management
Conservative
Improve menstrual regularity
Control symptoms
Treat subfertility
228
Conservative management in PCOS
Lose weight
Exercise and diet advice
Smoking cessation
229
How would you improve menstrual regularity in PCOS
COCP
| Metformin (reduces androgen levels)
230
How do you control symptoms of PCOS
Anti androgens- dont give during conception or pregnancy. Cyproterone acetate, spironolactone, vaniqa face cream
231
Treatment for subfertility in PCOS
```
Weight loss
Antioestrogens
Gonadotrophins
Laparoscopic ovarian diathermy
IVF
```
232
Name an antioestrogen for PCOS and subfertility
Clomid- clomifene citrate (safe and cheap)
233
What is an increased risk with gonadotrophins
Increased risk of multiple pregnancy and ovarian hyperstimulation syndrome
234
Define pelvic inflammatory disease
Clinical syndrome characterised by inflammation of the upper genital tract
235
What is endometritis
Inflammation of the endometrium
236
What is salpingitis
Inflammation of the fallopian tubes
237
What causes PID
Ascending infection from endocervix (chlamydia). Uterine instrumentation, childbirth or miscarriage
238
Name examples of surgical instrumentation
Surgical termination of pregnancy, evacuation of retained products of conception, Lap and dye test, IUD
239
PID presenation
Pelvic pain, deep dyspareunia, vaginal discharge (dysmenorrhoea, IMB, Fever)
240
Complications of PID
Ectopic pregnancy
Infertility
Adhesions
Fitz Hugh Curtis Syndrome
241
PID on examination
Tachycardia
Fever
Abdominal tenderness, bilateral adnexal tenderness, cervical excitation
242
Investigations for PID
FBC, Triple STI swab screen, urine pregnancy test, pelvic/TVUSS, laparoscopy
243
Gold standard investigation for PID
Laparoscopy
244
Management of PID
IM ceftriaxone + PO doxycycline+ PO Metronidazole
245
Examples of ovarian cyst accident
Torsion, rupture, haemorrhage
246
Symptoms of ovarian cyst accident
Sharp unilateral pain following sex or strenuous exercise.
Tender abdomen.
Severe may cause syncope
247
Investigation for ovarian cyst accident
USS shows free fluid in pelvic cavity
248
Treatment of ovarian cyst accident
ABCDE
249
What is adnexal torsion
Twisting of the ovary and sometimes fallopian tube
250
Who gets adnexal torsion
Adolescent and reproductive age women
251
Symptoms fo adnexal torsion
Unilateral sharp, waxing and waning pelvic pain. Nausea and vomitting
252
Adnexal torsion on examination
Tender palpable mass on bimanual
253
Ultrasound scan of adnexal torsion
Whirlpool sign.
Enlarge oedematous ovary with impaired blood flow
254
Define ectopic pregnancy
Implantation of a conceptuous outside the uterine cavity
255
Where are most ectopic pregnancies
Tubal (ampulla then isthmus(prone to rupture))
256
Risk factors for ectopic pregnancy
Previous EP
IUCD
Pelvic surgery
Assisted reproduction
257
Triad of ectopic pregnancy
Amenorrhoea
Lower abdominal pain
PV bleeding
258
Describe the pain in ectopic
lower abdo, Unilateral, initially colicky then constant
259
Describe the bleeding in ectopic
Small amount PV
260
What symptoms are produced by intraperitoneal blood loss
D and V, lightheadedness
| Shoulder tip pain (haemoperitoneum)
261
Assessment of ectopic pregnancy
Peritonism
Obs and vitals
Adnexal mass
262
Ectopic pregnancy on VE
Cervical excitation, adnexal tenderness, OS closed
263
Gold standard investigation of ectopic pregnancy
Laparoscopy
264
Investigations for ectopic pregnancy
Pregnancy test
Serial serum hCG
Pelvic TVUSS
LAPAROSCOPY
265
How does IUP and EP hCG differ
Rapid rise in IUP. Falling or rising slowly suggests EP
266
What is expectant management of EP
Serial serum hCG until repeated fall in levels
267
What is the medical management of ectopic pregnancy
IM Methotrexate and monitor serum hCG
268
What is surgical management of ectopic
Laparoscopy
| Salpingectomy
