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