Gynaeco locy

(1) Write short note on missed, threatened & incomplete miscarriage


pregnancy progress Incomplete 1-Assess ○ of bleeding 2-Resus if necessary 3-IV ergometrine 0.repeat pelvic xm if ↑ PV bleeding/abd ominal pain 4. Add:1.Luteal support: give progestron (Duphaston) till bleeding stop.5mg if no contraindica tion 4-Arrage ERPOC ↓ GA 5-give cervagerm awating OT call to soften cx Inevitable AS INCOMP.Analgesic IM pethidine 1mg/kg max 100mg 2Observation chart 3.Details management on miscarriages:Types Threatened 1-Bedrest 2-observe progress to incomplete/ Missed 3-Reassure: usually 80% progress well 4.Augmentin 1. 6) Cont IV abx for 48Htab abx for 10/7 -adjust based on C&S -at least give 1/52 *un-responsive if persist sx despite abx 48H -abx Admit .Cefoperazone 1gm BD/ Cefuroxime 750gm TDS + flagyl 500gm TDS @ 2.No spontaneous abortion within 12H give PG/oxytoxin to hasten process Missed/delayed 1) conservative Repeat USS after 2/52 (may abort spontaneous during this period) 2) present of coagulopathy/ unstable clinically -GXM 2 pints -Arrange evacuation a) Uterus < 12 weeks: Medically cervical priming with cervagerm 1mg after 2H + Surgically ERPOC via D&C ↓ GA b) Uterus > 12 week Cervagerm 1mg 4Hly 3-5 doses/day Septic 1)RESUS with fluids & blood if necessary 2) blood C+S 3)swab C+S vagina & endocervix 4) Commence IV abx 1. immediately if profuse bleed/ after 12H if min bleed.2gm TDS + gentamicin 35mg/kg/d + flagyl 500mg TDS 5) Arrage ERPOC ↓ GA by experienced Dr.

with analgesia & haematinics 1)Probable cause 2)resumptio n of coitus once bleeding stop 3)contracept ive for 3/12 4) f/up 6/52 Medical leave for 2/52 Counsel O/E D (2) Hx: 24 year old k/c/o chlamydia infection non comply with treatment presented with abdominal pain Haemodynamically stable Adnexae tenderness UPT: positive .Investigation 1)USS -viability -confirm gestation 2) TRO molar & ectopic POC for HPE 1)UPT 2)USS -CRL>7mm without fetal activity -IUGS>20mm without fetal echo→ anembryonic miscarriage 3) Screen Coag -FBC: Hb.24H after ERPOC if stable 2.Plt -Coag: PT/aPTT/INR 4)GXM 2 pints 7) W/O cx -pelvic abscess -Septic shock -Chronic PID -Uterine Synichae 1.WBC.No PV bleeding within 1224H 1)TCA stat if -↑ PV bleeding/ abdominal pain 2) to bring POC if any 1.

perfusion Appearance: consciousness.000 . Ultrasound: absent intrauterine GS correlates with β-hCG -TVS: -hCG levels between 1.1) What is the likely diagnosis . peritonism: guarding Bimanual palpation: cervical excitation. UPT: 1. hydration status. R/L or bilateral lower abdominal pain 2-PV bleeding 3-intra-abdominal haemorrhage: peritonitis/shoulder tip pain 4-collapse 2-PE 1) 2) 3) 4) Haemodynamic status : vital signs. pallor Per abdomen: pelvic tenderness. negative hCG < 5mIU/ml 2. β-hCG: Not doubling after 48H iii.000 mIU/ml able show gestational sac -Diagnosis made by ultrasound when level at least 2.2.000 -TAB: hCG levels >6500 mIU/ml .24 year old p/w haemodynamically stable ectopic pregnancy secondary to PID 2) How do you manage 1-hx 1-Pain: asx. positive > 25mIU/ml ii. adnexae tenderness/mass 3-Ix i.

haemodynamic stable.risks & when to seek emergency services 24 hour access to surgical services .5cm. USS ectopic < 3.4.Outline Mx: Expectant/Medical/ Surgical EP Asx Sx Expectant/ conservatively (<1000 IU/l) Medically (< 3000 IU/l) Unstable (?? Ruptured) Stable concentrations of β human chorionic gonadotrophin (βHCG) are falling Medical IM methotrexate f/up with serial measurements of βHCG 1’ survey. no blood/liver problems 2nd dose early pregnancy assessment units Methotrexate IM 50mg/m2 close follow-up Counseled: understand mx . RESUS + laparotomy & cornual resection / hysterectomy laparoscopy and cornual resection Asymptomatic.

Surgical: Laparotomy/laparoscopic Types remove Indications Salphingectomy tube Healthy contralateral tube Uncontrollable tube Recurrent at same site Complete family Salphingotomy Ectopic only V/V Precaution *Monitor hCG (ensure no more residua) ↓ 25% frm pre-tx by day 4 Undetectable by 4/52 Recurrence: 20% Dis advantages How to monitor βHCG Mx Repeat Expectant Medical After 48H between 4th-7th days Surgical Pre-op Post op 1) 4/7 2) 4/52 ↓ 25% disappears Expected findings ↓ < 15% Counsel after op: early booking 5-6 weeks (risk recurrence 10% nxt pregnancy) .

PID c.yolk sac Ectopic Pseudosac : Lacks echogenic ring of gestational sac Adnexal gestational sac: +/Yolk sac/fetal pole/FH Blood clot in tube Blood in POD 4) Differential diagnosis a. Peritonitis: ruptured appendicitis .3) What do you expect to see in TAB Normal intrauterine True sac: Smooth Eccentrical placed Double rim +/. Ruptured/torsion of ovarian cyst b. Tubo-ovarian cyst d.