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Womens Health > 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
Q

Miscarriage - what are the features of a missed (delayed) miscarriage?

A

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
Q

Miscarriage - what are the features of an inevitable miscarriage?

A

Heavy bleeding with clots

Pain

Pregnancy will not continue

Cervical os is OPEN

27
Q

Miscarriage - what are the features of an incomplete miscarriage?

A

Products of conception partially expelled

Vaginal bleeding

Pain

Cervical os is OPEN

28
Q

Miscarriage - what are the features of a complete miscarriage?

A

When all pregnancy tissue has left uterus

Vaginal bleeding may continue for several days

Cramping pain

Cervical os is CLOSED

29
Q

Miscarriage - what are recurrent miscarriages?

A

3 or more consecutive miscarriages

30
Q

Miscarriage - what are some causes of miscarriages?

A

Previous miscarriage
PCOS
Abnormality to cervix, uterus, placenta, foetal development
BV infection

31
Q

Miscarriage - what are some RFs?

A

Maternal age >30

Paternal age >45

Smoking

Alcohol/Drug abuse

Uncontrolled DM

Uterine surgery

32
Q

Miscarriage - what is the most common cause of recurrent miscarriages?

A

Antiphospholipid syndrome

33
Q

Miscarriage - what is the clinical presentation?

A

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
Q

Miscarriage - what is the gold standard investigation? What other investigation should you do?

A

Transvaginal US

Serum hCG - exclude ectopic

35
Q

Miscarriage - what are the three types of management and what do they entail?

A

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
Q

Miscarriage - expectant management is 1st line in miscarriage treatment, unless one or more of 4 factors are present, what are they?

A
  1. Increased risk of bleeding
  2. Previous adverse events in pregnancy
  3. Increased risk from effects of haemorrhage
  4. Evidence of infection

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