Operations and procedures Flashcards
When is amniocentesis and chorionic villus sampling performed?
A: after 15 weeks gestation
CVS: from 10-13+6 weeks
When are amniocentesis and CV sampling done?
- if deemed high risk from initial screening tess or previous pregnancy affected by genetic condition
- fetal cells obtained and tested for various conditions such as downs, edwards, pitaus
- fhx genetic condition
- ?congenital infection eg vzv, rubella, cmv
What are the complications of amniocentesis and CVS?
- 1% risk of miscarriage
- false assurance
- risk of infection as with most surgical procedures
- pain from procedure
- rhesus sensitisation
- increase risk club foot
- CVS: also vaginal bleeding and slightly higher risk miscarriage
What are total, sub total and radical hysterectomies?
Total: removal or uterus and cervic
Subtotal: remove uterus, leave cervix
Radical: utertus, cervoc, parametrium, vaginal cuff and part of whole of fallopian tubes, ovaries may be removed or left behind depending on pts age
What approaches can be taken for hysterectomy?
Abdominal- low transverse or midline incision, 2-5 days recovery in hospital
Vaginal: 1-2 days recovery, regional anaesthetic.
Laparoscopic: specimens removed through vagina
Give 5 indications for hysterectomy
- heavy menstrual bleeding
- pelvic pain
- uterine prolapse
- gynae malignancy
- risk reducing surgery- usually if BRCA 1/2 or lynch syndrome
- as life saving procedure in major post partum haemorrhage
Describe 5 complications specific to hysterectomy
- damage to bladder and or ureter and/ or long tern disturbance to bladder function 9uncommon)
- damage to bowel (rare)
- haemorrhage requiring transfusion (23/1000)
- return to theatre due to bleeding/ wound dehiscence
- pelvic abscess/ infection (2/1000)
- VTE (4/1000)
- death (PE or cardiac disease main causes)
- early menopause (by 1-2 yrs) even if ovaries are conserved
What is the indication for endometrial ablation?
- abnormal uterine bleeding (HMB with no specific cause)
- usually after medical management fails/ inadequate
- successful in 80-90% and 40% become amenorrheic
- need to have completed family and had reliable contraception before
- no endometrial hyperplasia or malignancy
- less effective if age <35 or where pain is major symptom or where uterus is enlarged
What techniques can be used for endometrial ablation?
- transcervical resection of endometrium (resectoscope + loop diathermy)
- balloon ablation (balloon filled w/ heated fluid sits in uterus for a number or mins then removed
- microwave energy
- bipolar mesh
Give 3 complications of endometrial ablation?
- non resectoscopic endometrial ablation has more favourable saftey profile- small risk fluid overload and electrolyte disturbances
- cervical laceration
- uterine perforation
- periop haemorrhage is rare
- bowel and bladder injury is rare
- intrauterine scarring and tissue contraction, not all areas of endometrium are equally targetted so can lead to obstructed outflow of menstrual blood which can lead to haematometra and pelvic pain
Give 5 complications of tension free vaginal tapes
- bladder perforation
- damage to pelvic blood vessels or vsicera
- voiding difficilties and urinary retention, usually only short term
- urgency and frequency
- groin suprapubic pain- usually only short term
- vaginal tape erosions
When can termination of pregnancy take place?
- within the first 24 weeks of pregnancy
- may be after 24 weeks if there is great risk of harm to mother or serious risk baby would be significantly handicapped
How can pregnancy be terminated?
Medication- mifepristone (antiprogesterone) and misoprostol (prostaglandin), also with fetocide after 22 weeks to ensure baby isnt born alive (can be done at home if <9 weeks)
Surgical- suction evaction (1st trimester) or dilation and evacuation (2nd trimester)
What are the complications of abortion?
- failure to end pregnancy (1-2%- higher if surgical and <7 weeks)
- need for further intervention (5% medical, 2% surgical)
- haemorrhage requiring transfusion (low but higher if later stage)
- uterine rupture (2nd trimester)
Surgical only: - cervical trauma
- genitral tract infections
What needs to be done before abortion can take place?
- counselling
- gestation
- blood group
- STD screening
- dicussion about future contraception
- hx and examination
- risk assesment/ safeguarding- vulnerable, domestic violence etc
- 2x drs agree
