Presentations, Differentials and Management Flashcards
What are the conservative management options for prolapse?
Weight loss Pelvic floor exercises Physiotherapy Eating high fibre - preventing constipation Drink plenty of water Stop smoking Avoid heavy lifting
What are the medical management options for prolapse?
Topical oestrogens
Pessaries
What are the surgical management options for prolapse?
Tape Sacrocolpopexy Sacrohysteropexy Sacrospinous Fixation Hysterectomy
What is the acute management of a PPH?
ABCDE approach - Call for help and activate major haemorrhage
Airway
Breathing
Circulation - 2 large bore cannula, fluid resus, blood transfusion (O neg), bolus Syntocinon or Ergometrine
Check bloods - group and save, clotting, FBC
Disability
Exposure - Catheterise, investigate for cause, rub up a contraction
Examination under anaesthetic
Surgical techniques - B-lynch sutures
Consider cell salvage, interventional radiology, second opinion
Hysterectomy is the final treatment
Differential diagnosis for PPH?
Tone: Atonic uterus - often in a nulliparous woman
Tissue: Retained placenta or membranes inside the uterus preventing the spiral arteries from constricting
Trauma: Any kind of trauma during labour or delivery such as an episiotomy which causes a bleed
Thrombus: Coagulation disorder causing bleeding - including DIC
Differential diagnosis for APH?
Placental Abruption Placenta Praevia Placenta Accreta, Percreta and Increta Vasa Praevia Ectropion Polyp Cancer STI Idiopathic Uterine rupture Inherited coagulation disorders Domestic Violence
What is the definition of Secondary PPH?
> 500mls of Blood loss occurring from 24 hours - 12 weeks after delivery
What is the definition of Secondary PPH?
> 500mls of Blood loss occurring from 24 hours - 12 weeks after delivery
What is APH?
Bleeding from the birth canal after 24 weeks gestation. to the onset of delivery
