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Obs and gynae > Operations and procedures > Flashcards

Operations and procedures Flashcards

1
Q

What is amniocentesis

A

Sample amniotic fluid from around fetus

Used after 15 weeks

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2
Q

How is amniocentesis performed

A

Ultrasound guidance

Needle through abdominal wall, into amniotic sac

Avoid passing through placenta

Fetal cells for karyotyping/PCR

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3
Q

What are the indications for amniocentesis

A

High risk result from 1st trimester screening test

Genetic condition in previous pregnancy

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4
Q

What are the complications of amniocentesis

A

1% risk of miscarriage

False reassurance

Risk of infection

Pain

Rhesus sensitisation

Increased risk of club foot

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5
Q

What is chorionic villus sampling

A

Invasive prenatal diagnostic procedure

Performed between 11 and 14 weeks

Biopsy of placental villi

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6
Q

How is chorionic villus sampling performed

A

Transabdominal/transvaginal

Ultrasound guided

Cannula aspiration/biopsy forceps

Send sample for chromosomal analysis

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7
Q

What are the indications for chorionic villus sampling

A

High risk from antenatal screening

Previous child with chromosomal/genetic abnormalities

Known carrier for a genetic condition

Family history of a genetic condition

Ultrasound evidence of abnormality

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8
Q

What are the complications of chorionic villus sampling

A

1% risk of miscarriage

Vaginal bleeding

Pain

Infection

Amniotic fluid leakage

Rhesus sensitisation

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9
Q

What is a hysterectomy

A

Surgical removal of uterus

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10
Q

What are the 4 types of hysterectomy

A

Total

Subtotal

Total with bilateral salpingo-oophorectomy

Radical

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11
Q

What is a total hysterectomy

A

Removal of uterus and cervix

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12
Q

What is a sub-total hysterectomy

A

Removal of body of uterus

Cervix left behind

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13
Q

What is a total hysterectomy with bilateral salpingo-oophorectomy

A

Removal of uterus, cervix, fallopian tubes, and ovaries

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14
Q

What is a radical hysterectomy

A

Removal of uterus, cervix, parametrium, vaginal cuff, and fallopian tubes

Can leave ovaries behind (depending on patient age)

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15
Q

How can a hysterectomy procedure be performed

A

Abdominally

Vaginally

Laparoscopically

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16
Q

What are the indications for hysterectomy

A

Heavy menstrual bleeding

Pelvic pain

Uterine prolapse

Gynaecological malignancy

Risk-reducing surgery

Management of major PPH

17
Q

What are the complications of hysterectomy

A

Haemorrhage

Infection

Pain

Damaged bladder/uterus/bowel

Wound dehiscence

Pelvic abscess/infection

VTE

Early menopause (change in blood supply to ovary)

18
Q

When is endometrial ablation usually used

A

In heavy menstrual bleeding

19
Q

What are the 4 main techniques of endometrial ablation

A

Transcervical resection of endometrium (TCRE - uses diathermy)

Balloon ablation (balloon filled with heated fluid)

Microwave energy

Bipolar mesh

20
Q

Who can not have endometrial ablation

A

Women who still want to have children

Life-threatening complications if pregnancy does occur

21
Q

What are the contraindications for endometrial ablation

A

Women who want to retain fertility

Endometrial hyperplasia

Large uterus

22
Q

What are the complications of endometrial ablation

A

Fluid overload

Electrolyte disturbances

Cervical laceration

Uterine perforation

Intrauterine scarring

Haematometra

Pelvic pain

23
Q

What is tension-free vaginal tape

A

Synthetic tape, makes a sling around urethra

Used for stress incontinence

24
Q

What are the complications of tension-free vaginal tape

A

Bladder perforation

Damage to pelvic blood vessels/viscera

Short term voiding difficulties

Urgency

Frequency

Groin/supra-pubic pain

Erosion of tape

25
Q

What are the alternatives to tension-free vaginal tape

A

Mid-urethral tape

Open colposuspension

Autologous rectus fascial sling

Anterior vaginal repair

Bulking agent injection into bladder neck

Creation of artificial sphincter around bladder neck

26
Q

How long after insertion is an implant effective

A

First 5 days of cycle - effective immediately

Other points in cycle - in 7 days

27
Q

What are the contraindications for implant insertion

A

Already pregnant

Taking certain medications (got HIV/TB/epilepsy)

History of: arterial disease, liver disease, breast cancer, unexplained vaginal bleeding

Obs and gynae (6 decks)

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