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Finals Revision Flashcards > Gynae and Obs - Incontinence, Ectopic Pregnancy, Miscarriages > Flashcards

Gynae and Obs - Incontinence, Ectopic Pregnancy, Miscarriages Flashcards

1
Q

Incontinence - what is urgency, overactive bladder (OAB) incontinence?

A

Involuntary detrusor muscle bladder contractions

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2
Q

Incontinence - what is stress incontinence?

A

Sphincter weakness

Detrusor pressure > closing pressure of urethra

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3
Q

Incontinence - what is mixed incontinence?

A

Both urgency and stress incontinence

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4
Q

Incontinence - what is overflow incontinence?

A

due to bladder outlet obstruction, such as prostate enlargement

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5
Q

Incontinence - what is contraction of the detrusor muscle controlled by?

A

Controlled by muscarinic cholinergic receptors

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6
Q

Incontinence - risk factors

A

Elderly

Females

Childbirth

Family History

Hysterectomy

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7
Q

Incontinence - symptoms of OAB

A

Urgency

Frequency

Nocturia

‘Key in door’

Enuresis

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8
Q

Incontinence - what brings on symptoms of stress incontinence?

A

Coughing

Laughing

Heavy lifting

Exercise

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9
Q

Incontinence - what investigations can you do?

A
  1. Bladder diaries
  2. Vaginal exam - rule out pelvic organ prolapse
  3. Urine dipstick and culture - rule out DM or UTI
  4. Urodynamic studies
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10
Q

Incontinence - what is the management of urge incontinence (OAB)?

A
  1. Bladder retraining
  2. Bladder stabilising drugs, 1st line are antimuscarinics - OXYBUTYNIN, TOLTERODINE (both immediate release), DARIFENACIN (once daily prep)
  3. MIRABEGRON (Beta3 agonist) - useful if concern about anticholinergic side effects in frail patients, works by relaxing detrusor and increasing bladder capacity
  4. Surgery - botox, bypass, bladder drill
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11
Q

Incontinence - why should you not use oxybutynin in elderly, frail patients?

A

Increased risk of falls

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12
Q

Incontinence - what is the management for stress incontinence?

A
  1. Pelvic floor training, 8 contractions, 3 times a day, minimum 3 months
  2. DULOXETINE
  3. Surgery - retropubic mid-urethral tape procedures, colposuspension, surgery is aimed at restoring pressure transmission to urethra
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13
Q

Incontinence - (RECAP) what is 1st line treatment for both stress and urge incontinence?

A

Urge - Bladder retraining

Stress - pelvic floor training

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14
Q

Ectopic Pregnancy - what is it?

A

Is it the implantation of a fertilised ovum outside of the uterus

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15
Q

Ectopic Pregnancy - risk factors?

A

Smoking
History of PID
Current IUD
Previous ectopic pregnancy

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16
Q

Ectopic Pregnancy - when so symptoms usually start to occur?

A

6-8 weeks

If embryo has space to grow, symptoms may present later

17
Q

Ectopic Pregnancy - what are the symptoms?

A

Unilateral lower abdo pain

Amenorrhea

Vaginal bleeding

Shoulder tip pain - blood in peritoneum irritates diaphragm, causing shoulder tip pain

D+V

Pelvic pain

18
Q

Ectopic Pregnancy - what are the investigations?

A

Serum hCG testing

Transvaginal US

Vital signs

19
Q

Ectopic Pregnancy - when would you do expectant management and what does expectant management entail?

A

Expectant management - closely monitor patient over 48h, if B-hCG levels rise again or symptoms manifest -> intervention

You would choose expectant management when:

  1. Size <35mm
  2. Unruptured, aymptomatic
  3. No fetal heartbeat
  4. Serum B-hCG <1,000IU/L
20
Q

Ectopic Pregnancy - when would you do medical management and what does medical management entail?

A

Medical management - Methotrexate

You would do medical management when:

  1. Size <35mm
  2. Unruptured
  3. No fetal heartbeat
  4. Serum B-hCG <1,500IU/L

Can’t do medical management if there is another intrauterine pregnancy

21
Q

Ectopic Pregnancy - when would you do surgical management and what does surgical management entail?

A

Surgical management - salpingectomy, salpingotomy

You do surgical management if:

  1. Size >35mm
  2. Can be ruptured
  3. Pain
  4. Visible fetal heartbeat
  5. Serum B-hCG >1,500IU/L
22
Q

Miscarriage - what is it?

A

A miscarriage is a loss of pregnancy before 24 weeks gestation

23
Q

Miscarriage - what are the 6 different types of miscarriages?

A

Threatened

Complete

Incomplete

Inevitable

Missed (delayed)

Recurrent

24
Q

Miscarriage - what are the features of a threatened miscarriage?

A

Painless vaginal bleeding

Typically occurs at 6-9 weeks

Cervical os is CLOSED

25
Miscarriage - what are the features of a missed (delayed) miscarriage?
Gestational sac contains dead foetus before 20 weeks, but is retained Light vaginal bleeding/discharge Pain not usually a feature Cervical os is CLOSED
26
Miscarriage - what are the features of an inevitable miscarriage?
Heavy bleeding with clots Pain Pregnancy will not continue Cervical os is OPEN
27
Miscarriage - what are the features of an incomplete miscarriage?
Products of conception partially expelled Vaginal bleeding Pain Cervical os is OPEN
28
Miscarriage - what are the features of a complete miscarriage?
When all pregnancy tissue has left uterus Vaginal bleeding may continue for several days Cramping pain Cervical os is CLOSED
29
Miscarriage - what are recurrent miscarriages?
3 or more consecutive miscarriages
30
Miscarriage - what are some causes of miscarriages?
Previous miscarriage PCOS Abnormality to cervix, uterus, placenta, foetal development BV infection
31
Miscarriage - what are some RFs?
Maternal age >30 Paternal age >45 Smoking Alcohol/Drug abuse Uncontrolled DM Uterine surgery
32
Miscarriage - what is the most common cause of recurrent miscarriages?
Antiphospholipid syndrome
33
Miscarriage - what is the clinical presentation?
Vaginal bleeding with/without abdo pain Cervical os big enough to admit 1 finger Uterine size small for dates Products of conception being expelled
34
Miscarriage - what is the gold standard investigation? What other investigation should you do?
Transvaginal US Serum hCG - exclude ectopic
35
Miscarriage - what are the three types of management and what do they entail?
Expectant management: 1. Waiting for spontaneous miscarriage 2. 1ST LINE. involves waiting 7-14 days for miscarriage to complete spontaneously 3. Unsuccessful - medical or surgical Medical management: 1. Vaginal Misoprostol - prostaglandin analogue, binds to myometrial cells, cause strong myometrial contractions to expel tissue 2. Give antiemetics and pain relief too Surgical management: 1. Vacuum aspiration (suction curettage)
36
Miscarriage - expectant management is 1st line in miscarriage treatment, unless one or more of 4 factors are present, what are they?
1. Increased risk of bleeding 2. Previous adverse events in pregnancy 3. Increased risk from effects of haemorrhage 4. Evidence of infection

Finals Revision Flashcards (49 decks)

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