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Gynaecological Investigations - Coggle Diagram
Gynaecological Investigations
Urine
Urine Dipstick Analysis
Check expiry date
Wash hands
Sample urine with dipsyick
Allow to develop for required time - up to 2min
Assess the colour of each tets against the container chart
Document results
Dispose of urine sample and equipment
Urine Pregnancy Test
Add 3 drops to well
Allow 5 min to deveop
Line must develop in C - control space
Line in T - Positive test
Radiological
Ultrasound
Transvaginal Ultrasound Scan T(TVUSS)
Use
Assessment of endometrium . uterus, fallopian tuves, ovaries
Early pregnancy assessment
Advantages
Can be performed in clinic / bedside
Avoids impendance of view associated with TA US
Obesity / bowel
No ionising radiation
Consent
C/I
Not tolerated
No previous penetration of vagina
Transabdominal Ultrasouns
Use
Pelvic masses
Bladder voiding
CT
Use
Assessment of large pelvic masses
Gynaecological malignancy
Evalualtion of post op complications - pelvic collection
CT TAP
Cancer staging
Pre-operative surgical planning
Disadvantage
Ionising radiation
MRI
Use
Staging of endometrial cancer
Staging of cervical cancer
Assessment of ovarian lesions
Assessment of infiltrative endometriosis
Special Investigations
Hysterosalpingogram (HyCoSy)
Use
Assessment of uterine cavity
Assessment of tubal patency for fertility
Endoscopic
Hysteroscopy
Setting
Outpatient
Smaller diameter hysteroscopes
Without cervical dilation / GA
Non-touch vaginoscopic approach - less pain
High success rate - 95%
High rate of detection of pathology (more than 50%)
Low morbidity
Advantages
GA not required
↓ Cost
↓ Time off work
Avoids GA risks
High patient acceptance and satisfaction
Potentiall for procedures
Polypectomy
Adhesiolysis
Resection of some submucous fibroids
Localisation / removal of IUCD
Difficulties
Nulliparous women
Postmenopausal women
Cervical stenosis
Severe pt anxiety
Pre-existing pelvic pain
Extreme retroversion
Inpatient / Daycase
Use
Diagnostic
Operative
Indications
Abnormal menstruation age >45
Post menopausal bleeding
Fibroids, polyps, endometrial pathology
Abnoral pelvic US findings
Endometrial polyps
Submucous fibroids
Subfertility
Recurrent misscarriage
Congenital uterine anomaly
Contraindications
Pelvic infection
Pregnancy
Cervical cancer
Heavy uterine bleeding - obsured view
Findings
Normal
Fibroid
Polyp
Adherman's syndrome
Septum resection
Unhealthy endometriu
Consent Process
Confirm ICE
Explain options including no treatment
3 Supply info
Success rates
Benefits
Risks
Trade-offs
Check understanding
Councelling RIsks
Serious risks
Overall risk of serious risks 2/1000 - uncommon
Damage to uterus - uncommon
Damage to bowel, bladder, major vessels - rare
Failure to gain entry to uterine cavity and complete proceedure - uncommon
Infertility - rare
Death 8 / 100,000 - rare
Frequent risks
Infection
Bleeding
Extra procedures
Laparoscopy / laparotomy in event of perforation
Cystoscopy
Laparoscopy
Councelling Risks
Frequent
Usually mild and self limiting
Bruising
Shoulder tip pain (referred from phrenic)
Wound gaping
Infection
Serious Risks 2:1000
Damage to bowel, bladder, ureters, uterus, major blood vessles
Would require immediate repair by laparoscopy / laparotomy (open surgery is rare)
15% bowel injuries not diagnosed at time of laparoscopy
Hernia at site of entry (uncommon)
Thromboembolic complications (rare/ very rare)
Death from complications 3-8/ 100,000
Failure to gain entry / complete procedure / gain diagnosis
Extra procedures
Laparotomy
Repaire of bowel (+/- stoma)
Repair of bladder, uterus, blood vessles
Blood transfusion
Consent
Definition
The giving of permission or agreement for an intervention, reciept or use of a service or participation in research following a process of communication about the proposed intervention
Ongoing process rather than once-off
Valid consent
Received sufficient
information
in a comprehensible manner about nature, purpose, benefits and risks of an intervention or service
Be acting
voluntarily
- not under undu pressure or duress from anyone
Have the mental
capacity
to make a particular decision at that time
Information
Diagnosis
Prognosis
Options including not to treat
Purpose + what is in involved
Benefits, risks, likelihood of success
Alternatives
Risks / Side Effect Information
Side effects or complications of an intervention
Failure of an intervention to achieve aim
Risk of no action / alternative approach
