Gynae and Obs - Incontinence, Ectopic Pregnancy, Miscarriages Flashcards
Incontinence - what is urgency, overactive bladder (OAB) incontinence?
Involuntary detrusor muscle bladder contractions
Incontinence - what is stress incontinence?
Sphincter weakness
Detrusor pressure > closing pressure of urethra
Incontinence - what is mixed incontinence?
Both urgency and stress incontinence
Incontinence - what is overflow incontinence?
due to bladder outlet obstruction, such as prostate enlargement
Incontinence - what is contraction of the detrusor muscle controlled by?
Controlled by muscarinic cholinergic receptors
Incontinence - risk factors
Elderly
Females
Childbirth
Family History
Hysterectomy
Incontinence - symptoms of OAB
Urgency
Frequency
Nocturia
‘Key in door’
Enuresis
Incontinence - what brings on symptoms of stress incontinence?
Coughing
Laughing
Heavy lifting
Exercise
Incontinence - what investigations can you do?
- Bladder diaries
- Vaginal exam - rule out pelvic organ prolapse
- Urine dipstick and culture - rule out DM or UTI
- Urodynamic studies
Incontinence - what is the management of urge incontinence (OAB)?
- Bladder retraining
- Bladder stabilising drugs, 1st line are antimuscarinics - OXYBUTYNIN, TOLTERODINE (both immediate release), DARIFENACIN (once daily prep)
- MIRABEGRON (Beta3 agonist) - useful if concern about anticholinergic side effects in frail patients, works by relaxing detrusor and increasing bladder capacity
- Surgery - botox, bypass, bladder drill
Incontinence - why should you not use oxybutynin in elderly, frail patients?
Increased risk of falls
Incontinence - what is the management for stress incontinence?
- Pelvic floor training, 8 contractions, 3 times a day, minimum 3 months
- DULOXETINE
- Surgery - retropubic mid-urethral tape procedures, colposuspension, surgery is aimed at restoring pressure transmission to urethra
Incontinence - (RECAP) what is 1st line treatment for both stress and urge incontinence?
Urge - Bladder retraining
Stress - pelvic floor training
Ectopic Pregnancy - what is it?
Is it the implantation of a fertilised ovum outside of the uterus
Ectopic Pregnancy - risk factors?
Smoking
History of PID
Current IUD
Previous ectopic pregnancy
Ectopic Pregnancy - when so symptoms usually start to occur?
6-8 weeks
If embryo has space to grow, symptoms may present later
Ectopic Pregnancy - what are the symptoms?
Unilateral lower abdo pain
Amenorrhea
Vaginal bleeding
Shoulder tip pain - blood in peritoneum irritates diaphragm, causing shoulder tip pain
D+V
Pelvic pain
Ectopic Pregnancy - what are the investigations?
Serum hCG testing
Transvaginal US
Vital signs
Ectopic Pregnancy - when would you do expectant management and what does expectant management entail?
Expectant management - closely monitor patient over 48h, if B-hCG levels rise again or symptoms manifest -> intervention
You would choose expectant management when:
- Size <35mm
- Unruptured, aymptomatic
- No fetal heartbeat
- Serum B-hCG <1,000IU/L
Ectopic Pregnancy - when would you do medical management and what does medical management entail?
Medical management - Methotrexate
You would do medical management when:
- Size <35mm
- Unruptured
- No fetal heartbeat
- Serum B-hCG <1,500IU/L
Can’t do medical management if there is another intrauterine pregnancy
Ectopic Pregnancy - when would you do surgical management and what does surgical management entail?
Surgical management - salpingectomy, salpingotomy
You do surgical management if:
- Size >35mm
- Can be ruptured
- Pain
- Visible fetal heartbeat
- Serum B-hCG >1,500IU/L
Miscarriage - what is it?
A miscarriage is a loss of pregnancy before 24 weeks gestation
Miscarriage - what are the 6 different types of miscarriages?
Threatened
Complete
Incomplete
Inevitable
Missed (delayed)
Recurrent
Miscarriage - what are the features of a threatened miscarriage?
Painless vaginal bleeding
Typically occurs at 6-9 weeks
Cervical os is CLOSED