S11C109 - Complications of Gyne Procedures

Question 1

Post-op gyne infxn: eg. vaginal cuff cellulitis/abscess

Answer 1

-tx: cover for gm-, gm+ and anaerobes
-amipicillin 2g IV q6h
plus gentamycin 1mg/kg/IV loading dose then 1mg/kg IV q8h
plus clindamycin 900mg IV q6h

Question 2

Septic pelvic thrombophlebitis

Answer 2

• ovarian veing thrombosis causes fever and abdo pain w/in 7 post-op
• deep septic pelvic thrombophlebitis presents with fevers w/in a few days post-op that persist despite Abx
• negative CT/MRI does not exclude it
• tx: heparin + Abx (clinda), long-term AC not needed

Question 3

Ovarian hyperstimulation syndrome

Answer 3

• complication of 1-2% of IVF
• mild: abdo distension, ovarian enlargement, wt gian
• sever: rapid wt gian, tense ascites (From 3rd spacing), pleural effusion, tachypnea, orthostatic HoTN, tachy, oliguria, lyte abnormalities, increased coagulability
• DO NOT DO bimanual (fragile ovaries can rupture)
• tx: fluid resusc

Question 4

Complications of IVF:

Answer 4

• ovarian hyperstimulation syndrome
• infection
• intrperitoneal bleeding
• adnexal torsion

Question 5

Postembolization syndrome

Answer 5

• procedure for fibroids
• pelvic pain and fever 2-10d post -op
• mild-severe pain
• ddx: infection/endometritis
• may see vaginal d/c and fibroid expulsion
• may require hysto.