obs and gynae Flashcards
Define puerperium
From the delivery of the placenta to six weeks following the birth
Stages of the puerperium
Return to prepregnant state
Initiation/suppression of lactation
Transition to parenthood
Endocrine changes in puerperium
Decreased placental hormones
Increase in prolactin
Name 4 placental hormones
Human placental lactogen
Hcg
Oestrogen
Progesterone
How long does it take for progesterone and oestrogen levels to go back to prepregnant levels
7 days
What does the muscle of the uterus and genital tract do
Ischaemia, autolysis and phagocytosis
What does teh decidua of the puerperium do
Shed as lochia; rubra, serosa and alba
Where is the uterus 1 day after delivery
Umbilicus
What is lochia rubra
Day 0-4 of bleeding
- blood
- cervical discharge
- decidua
- vernix
- meconium
What is lochia serosa
Day 4-10 of bleeding -more pink WBC Exudate Cervical mucus
What is lochia alba
Day 10-28 of bleeding
- clear liquid
- cholesterol
- fat
What is Colostrum
Produced instantly.
Colostrum – is very rich in proteins, vitamin A, and sodium chloride, but contains lower amounts of carbohydrates, lipids, and potassium than mature milk.
Advantage and disadvantage of colostrum
Doesnt help with putting on weight but does contain WBC
How long does lactation suppression take if the mother isnt breast feeding
7-10 days
What hormones control lactogenesis
Prolactin (milk production)
Oxytocin (milk ejection reflex)
Insulin and cortisol
Where is prolactin secreted from
Anterior pituitary gland
Where does prolactin act on
Lactocytes
When are prolactin levels highest
More secreted at night
Peak after feed to produce milk for following
Which hormone post partum suppresses ovulation
Prolactin
Where is oxytocin released
Posterior pituitary gland
Where does oxytocin act in breast feeding
Myo epithelial cells
What stimulates oxytocin and prolactin release
Baby sucks
= sensory impulses pass from the nipple to brain
What helps oxytocin reflex
Sight, sound and smell of baby. Conditioned over time
What hinders oxytocin reflex
Anxiety, stress, pain and doubt
Advantages of breast feeding for mother
Breast cancer
Ovarian cancer
Osteoporosis
What is lactoferrin
High affinity for iron protein. High in colostrum. In breast milk too. Antibacterial qualities.
When do you use follow on milk
After 6 months
Name some minor postnatal problems
Infection PPH Fatigue Anaemia Backache urinary stress Incontinence Haemorrhoids
Name some major postnatal problems
Sepsis Severe PPH Preeclampsia Thrombosis Incontinence Breast abscess Depression
Describe PPH presentation
Sudden and profuse blood loss or persistent increased blood loss
Faintness, dizziness or palpitations/tachycardia
Describe Infection presentation
Fever, shivering, abdominal pain and/or offensive vaginal loss
What does PPH stand for
Post partum haemorrhage
What is the preeclampsia presentation
Headaches accompanied by one or more of the following symptoms within first 72hrs after birth: Visual disturbances, Nausea or vomiting
What is thromboembolism presentation
Unilateral calf pain, redness or swelling
Shortness of breath or chest pain
Postnatal care assessment tool
Modified Early Obstetric Warning Score (MEOWS)
Sepsis definition
Infection plus systemic manifestations of infection
Severe sepsis definition
Sepsis plus sepsis induced organ dysfunction of tissue hypoperfusion
SROM define
Sustained rupture of membrane
Septic shock define
The persistence of hypoperfusion despite adequate fluid replacement therapy
Rhyme for sepsis
3 Ts white with Sugar
What are the signs of infection
Temperature Tachycardia Tachypnoea WCC high or low Hyperglycaemia
How many signs of infections are needed for sepsis
2
Risk factors for sepsis
Obesity Diabetes Anaemia Amniocentesis/invasive procedures Prolonged SROM Vaginal trauma/CS Ethnicity BME
Likely causes of sepsis
Endometritis Skin and soft tissue infection Mastitis UTI Pneumonia Gastroenteritis Pharyngitis Infection related to epidural/spinal
What else should you do when looking at potentially septic woman
History or signs of a new infection or infective source
BUFALO plus two
Blood cultures Urine output Fluid restriction Antibiotics Lactate Oxygen \+ERPC \+VTE prophylaxis
Primary PPH
More than 500ml
Minor PPH
<1500mls and no clinical signs of shock
Major PPH
> 1500mls and continuing or clinical shock
Endometritis defintition
Infection of the lining of the womb
Secondary PPH define
Abnormal bleeding from birth canal from 24hrs to 12 weeks
Secondary PPH causes
Endometritis Retained products of conception (RPOC) Subinvolution of the placental implantation site Pseudoaneurysms Arteriovenous malformations
Secondary PPH investigations
Assess blood loss
Assess haemodynamic status
Bacteriological testing (HVS and endocervical swab)
Pelvic ultrasound??
What can eclampsia cause
Seizures
What increases risk of VTE
Gestational age. Just after birth (3weeks) Obesity Multiple pregnancies Genetics Smoking C section
What is given in high risk women for VTE
LMWH 6 weeks
What is given in intermediate risk women for VTE
10 day LMWH
What is given in lower risk women for VTE
Early mobilisation and avoidance of dehydration.
TED stockings
What can cause a headache post partum
Post dural puncture headache from epidural or spinal anaesthesia
Symptoms of post dural puncture headache
Headache worse on sitting or standing Starts 1-7 days after spinal/epidural sited Neck stiffness Dislike of bright lights
Treatment of post dural puncture headache
Lying flat!
Simple analgesia
Fluids and caffeine??
Epidural blood patch
What must you do to prevent urinary retention and distention
Indwelling catheter
Urinary retention risk factors
Epidural analgesia Prolonged second stage of labour Forceps or ventouse delivery Extensive perineal lacerations Poor labour bladder care
What is urinary retention treatment aiming to do
Maintain bladder function
Minimise risk of damage to UT
Prevent bladder emptying problems
Red flags for mental health
- recent significant change in mental state or emergence of new symptoms
- new thoughts or acts of violent self harm
- new and persistent expressions of incompentency as a mother or estrangement from the infant
Why is urinary retention more likely to happen
Epidurals so dont feel the sensations.
Trauma during birth
Why baby blues and common
Hormone changes
Big change
Sleep deprived
Day 3-10
Postnatal depression symptoms
Depressed Irritable Tired Sleepless Appetite changes Negative thoughts Anxiety Affects bonding
Postpartum psychosis risk factors
FHx
Bipolar diagnosis
Traumatic birth or pregancy
Postpartum psychosis symptoms
Depression Mania Psychosis. -restless -unable to sleep -unable to concentrate -experiencing psychotic symptoms
Risk factors for PTSD
Perceived lack of care
Poor communication
Perceived unsafe care
Perceived focus on outcome over experience of the mother
PTSD presentation
Anger, low mood, self-blame, suicidal ideation, isolation and dissociation
Intrusive and distressing flashbacks
PTSD consequences
Women may delay or avoid future pregnancies
Request caesarean sections to avoid vaginal delivery
Avoidance of intimate physical relationships
Impact on breastfeeding
Define Maternal death
Death within pregnancy or 42 days of termination of pregancy
- any duration
- any site
- any cause related to or aggravated by pregnancy or its management.
- not accidental or incidental causes
Direct maternal death definition
Death relating from obstetric complications of pregnancy, labour of puerperium (e.g haemorrhage, genital sepsis, suicide)
Indirect maternal death definition
Death resulting from pre-existing disease / disease that developed in pregnancy but not a direct result of obstetric causes (cardiac disease, malignancies)
Why is VTE rate the same as 80s
Older fatter mums
Prevention measures
Gonadotrophin hormones
LH, FSH, hCG
- gonadotrophs
- glycoproteins
Steroid hormones
Oestrogens
Progestins
Androgens
Cytokines
Activins
Inhibins
Describe thecal cells
Sensitive to LH
Synthesise Progesterone and Testosterone from cholesterol
Androgens (E precursors)
Describe granulosa cells
Sensitive to FSH
Converts Testosterone to E
FSH induces LH receptors
What stops LH and FSH increasing at cycle day 15.
P and E made by corpus luteum negatively feedbacks to pituitary
Which hormone causes follicle to be selected
FSH rise
LH surge is controlled by
Oestrogen. Flips from negative feedback to positive
What does LH surge cause
Ovulation
Pregnancy homrones
hCG
Progesterone
Oestrogens
What produces hCG and whats the point
Blastocyst. Stops progesterone declining as stops luteal regression.
Progesterone action
Endometrial development
Stops uterus contracting too early
Promotes fat deposition
Increases maternal ventilation
Where is oestrogen coming from
Ovary then both baby and mum
Which is the main oestrogen in pregnancy
E3
What would happen if you had no oestrogen
No progesterone would be made either
What happens to resp
Reduced inspiratory reserve
What happens to cardio
Increased HR and SV
Why should blastocyst be rejected
50% antigens from dad
Why isnt the blastocyst rejected
Differential gene expression.
Immune suppression
Failed endovascular invasion is associated with
Pre eclampsia IUGR Pre term labour Abruption Recurrent miscarriage
When is the window of implantation
20-24 days
What is decidua
Early endometrium which permits implantation
What is human implantation called
Haemochrorial placentation
Stages of implantation
- Apposition
- Interstitial implantation
- Interstitial invasion
- Endovacular invasion
Which arteries are targeted by the invasion
Spiral arteries
Define pregnancy
Pregnancy anywhere outside the uterus
Names of stages of placenta
Placenta acreta, increta, percreta
Which t cell is biased in pregnancy
Th2
Which Ig is secreted in breast milk
IgA
Which Ig crosses the placenta
IgG
Which Ig is involved in rhesus disease
IgG
Rhesus disease describe
First pregancy sensitises mother, subsequent pregnancies can result in fetal death
In rhesus disease who is rhesus positive
Father
Where is the acreta
Superficial myometrium
Where is the increta
Deeper myometrium
Where is the percreta
Penetrates uterine serosa
Effects other organs
Myometrial quiescence
Absence of uterine contractions
How is contraction prevented
G alpha S represses acto myosin ATPase activity.
What causes labour
Infection can
Surfactant proteins
Placental clock
Placental clock
ACTH = DHEA = Oestrogens increase gap junctions= increased contractility
What happens to progesterone before birth
Functional progesterone withdrawal
Which drug can be used to stop contraction
Nifedipine. Calcium blocker.
Atosiban- Oxytocin receptor anatagonist
Placental delivery mechanisms
Rpaid myometrial contraction
Physiological pressure
Immediate fibrin deposition over placental site
Drugs to inhibit uterine contraction
Beta 2 mimetics
Nifedipine
Progesterone
Atosiban
Drugs to promote uterine uterine contraction
Syntocinon
Ergometrine
Misoprostol
How is quiescence maintained
G proteins signally
K+ extrusion from myometrial myocytes
Why does K+ extrusion from myometrial myocystes reduce contractions
Hyperpolarisation
Early pregnancy glucose levels
Lower. Maternal glycogen synthesis and fat deposition
Late pregnancy glucose levels
Higher. Maternal insulin resistnace. Glucose sparing for fetus
What can maternal insulin resistnace cause
Gestational diabetes
Macrosomic infants
What can macrosomic infants cause
Shoulder dystocia
Why use contraception
Control fertility
Family spacing
Reduce teenage pregnancy
Reduce abortions
Fraser criteria
Contraception can be prescribed to a girl
under 16 yrs old if:-
-The girl understands the doctors advice
-The doctor has tried to persuade her to tell her parents or allow him to
-She will begin or continue having intercourse without contraception
-Her physical or mental health is likely to suffer if she does not receive contraceptive advice
-Her best interests require the prescriber to give contraceptive advice +/- treatment without parental consent
Assessment for contraception (history)
Age Weight BP Menstrual history Previous contraception Previous pregnancies Previous STIs PMHx FHx SHx DHx
Assessment for contraception (examination)
BP
BMI
Cervical smear
STI screen
User failure contraceptive examples
Combined OCP
Contraceptive patch
POP
Barrier methods
Non user failure contraceptive examples
Contraceptive injection Implant IUD IUS Sterilisation
Most effective contraceptive
Progesterone implant
How does COCP work
Oestrogen and progesterone. Prevents ovulation. Thickens cervival mucus. Thins lining of the womb.
COCP advantages
Reversible, reliable, regular predictable cycle. Well tolerated
Who cant have COCP
FHx of female cancers
Clotting disorders
COCP disadvantage
Lots of people cant have it. Drug interactions. Doesnt protect against STIs.
VTE and cancer risk
How does POP or mini pill work
Progesterone only. Thickens cervical mucus. Thins endometrium. Reduced tubal motility.
Progesterone only contractive advantages
Anyone.
Prevents oestrogen SE
Progesterone only contraceptive disadvantages
Less effective.
Erratic bleeding to start with.
Risk of ovarian cysts and ectopics
Condom disadvantages
Failure
Femidom advantages
Protects from STIs
Inserted any time
No lubrication
Femidom disadvantages
Loud
Messy
Higher failure rate
Diaphragm and caps advantages
Woman in control
Inserted anytime before inercourse
Diaphragm and caps disadvantages
Requires staff for fitting
Messy
Dislodged
What is natural family planning
Monitor vaginal secretions and temperature measurements. Needs periods of abstinence and montioring.
What is lactational amenorrhea method
Baby must be only on breast milk
Injectable contraception
Depo-provera Every 12 weeks. Inhibits ovulation Sayana press- self inject it. Progesterone only
Why do injectables cause weight gain
Increase appetite
Describe implants
Single rod (nexplanon). Progesterone only. Easy insertion and removal. 3 years.
IUD describe
Copper contained in plastic frame. Casues foregin body reaction within the uterus , toxic to sperm and egg significantly reducing chance of fertilization
Why do you need to do STI screen when giving a coil
Prevent PID
IUS describe
Menorrhagia, progesterone HRT. Very effective few side effects.
Very small amount of progesterone
Female sterilisation
Serious surgery, GA. No hormonal effects. Permanent.
Male sterilisation
Local anaesthetic. Surgery to vas deferens. Not reversible or immediate.
What is Emergency Contraception
EC is given after unprotected sexual intercourse to prevent pregnancy
Emergency contraceptions examples
Progesterone only (Leveonelle) pills or copper implants. Copper coil is more effective and can be used later.
Describe the latent phase of labour
irregular contractions
Show mucoid plug
Cervix is effacing and thinning
Stay at home
Treatment for latent phase of labour
Position, water, snacks, paracetamol
Length of latent phase of labour
6 hours - 2/3 days
Define presentation
The anatomical part of the fetus which presents itself first through the birth canal
Define lie
The relationship between the long axis of the fetus and the long axis of the uterus
Define attitude
Presenting part flexed or deflexed
Define engagement
Widest part of the presenting part has passed through the brim of the pelvis
Define station
Relationship between the lowest point and the ischial spines
Describe Effacement
Starts in fundus. Retraction and shortening of muscle fibres. Fetus forced down pressure on cervix
How does effacing of the cervix vary with number of previous labours
First time mothers will take longer
Active labour definition
Regular, frequent contractions which are progressive. 4cm dilated
What inhibits oxytocin
Stress and anxiety
Factors which affect labour satisfaction
- Personal expectations
- Support from caregivers
- Caregiver-paitent relationship
- Involvement in decisions
Ways to deal with pain
Psychological methods
Sensory methods
Environment
Complementary therapy
more support is associated with
Less operative births
Less analgesia
Shorter labours
Better experience
What is the official name of gas and air
Entonox
Advantage of entonox
Short half life so leaves system quickly
Disadvantage of entonox
Vomitting
Diamorphine advantage
good pain releif
Diamorphine fetal SE
Respiratory depression
Diminishes breast seeking and feeding behaviour
Diamorphine maternal SE
Euphoria and dysphoria
Nausea and vomiting
Longer 1st and 2nd stage laboru
Epidural advantage
Most effective pain relief
Epidural maternal SE
Increase length Need more oxytocin More incidents of malposition Increase instrumental rate. Less mobile, less bladder control
Epidural fetal side effects
Tachycardia due to maternal temp
Diminishes breast feeding behaviours
Can you eat during labour
Should eat and drink as normal unless c section likely
Maternal observations during labour
BP, Pulse, Temp Bladder Contractions Drugs Vaginal examination Monitoring fetal heart
What is the transition of labour
SROM- clear Irritable, anxious, distressed Start to feel pressure Contrations can stop Support and reassurance
What is second stage of labour
Full dilatation External signs- head visible Spont bearing down Can have a latent phase Progress descent
How long does it take for active phase in primigravid
3 hours
How long does it take for active phase in multiparous
2 hours
What is helpful behaviour in second stage
Beneficial, upright position, spontaneous pushing. Privacy, dignity, safety
Mechanism of labour
Descent Flexion Internal rotation Crowning Extension Restitution Internal restituion of shoulders Lateral flexion
Why is skin to skin good
Very good. Releases oxytocin
What is 3rd stage
Cut and clamp cord. Oxytocic drugs. N and V. Check placenta and membranes complete.
What is PID
Pelvic inflammatory disease
What is NSU
Non specific urethritis
Non STI GU conditions
Candidiasis Bacterial vaginosis Gential dermatoses Vulval conditions Psychosexual problems Reactive arthritis
What is candidiasis
Imbalance of pH of the vulva
Sexual health history structure
HPC Past GU PMH DH Sexual history
Questions for sexual history
3-12 months
- last intercourse
- regular/ casual partner
- male/female
- condom use
- type of SI
Sexual health history questions for females
Menstrual history
Pregnancy history
Contraception
Cervical cytology history
Sexual health history questions for males
When last voided urine
Big 4 STIs
Syphilis
Chlamydia
Gonorrhea
HIV
Genital examination for both sexes
Skin
Inguinal nodes
Pubic hair
Genital examination for women
Vulva Perineum Vagina Cervix Bimanual pelvic examination Possibly anus and ororpharynx
Genital examination for men
Penis
Scrotum
Urethral meatus
Anus and Oropharynx in MSM
Asymptomatic screening for women
Self taken vulvo vaginal swab
(for Gonorrhoea/Chlamydia NAAT)
Bloods (for STS and HIV)
What is NAAT
Nucleic Acid Amplification Test
Why must patients be off antibiotics for two weeks before STI testing
False negative
Asymptomatic screening for heterosexual male
First void urine (chlamydia/ gonorrhoea NAAT)
Bloods (STS and HIV)
MSM screening
First void urine, pharyngeal swab and rectal swab (chlamydia/ gonorrhoea NAAT)
Bloods (STS, HIV, Hep B (Hep C if indicated))
Female symptomatic presentations
Vaginal discharge Vulval discomfort/soreness, itching or pain Superficial dyspaerunia Pelvic pain Vulval lumps or ulcers Inter menstrual bleeding Post coital bleeding
Male symptomatic presentations
Pain on micturition Pain/ discomfort in urethra Urethral discharge Genital ulcers, sores or blisters Genital lumps Rash Testicular pain/ swelling
Symptomatic female screening
Vulvovaginal swab (Gono and Chlamy NAAT) High vaginal swab (BV, TV, Candida) Cervical swab (Gono) Dipstick urinalysis Bloods (STS and HIV)
Symptomatic male screening
Urethral swab (gono)
First void urine (Gono and chlam NAAT)
Dipstick urnialysis
Bloods (STS and HIV)
MSM Symptomatic screening
Asymptomatic
+ urethral and rectal slides
+ urethral, rectal, pharyngeal culture plates
Hepatitis B screening
MSM Commercial sex workers (+partners) IVDUs (+partners) High risk areas -africa, asia, eastern europe (+partners)
Why do you need to culture gonorrhea
Because gonorrhea resistance is increasing
What predisposes to preeclampsia
Younger Older Black Primigravity Multifetal pregnancies HTN Renal disease
What is chronic hypertension
- before pregnancy
- before 20th week
- during pregnancy and not resolved post partum
What is gestational hypertension
- new HTN after 20weeks
- systolic >140
- diastolic >90
- no or little proteinuria
Whats the difference between gestational hypertension and preeclampsia
Preeclampsia is where they have developed significant proteinuria
What is the difference between preeclampsia and eclampsia
Eclampsia is where they develop tonic clonic seizures
What is preeclampsia- eclampsia
- new HTN after 20 weeks
- increased BP with proteinuria
How do you take BP in pregnant women
Sitting position
Cuff at heart level
Not supine as would press on IVC
Sit for 10mins before
Classification of preeclmapsia eclampsia
Mild preeclampsia
Severe preeclampsia
Eclampsia
Clinical criteria for severe preeclampsia (one or more)
BP: >160 systolic, >110 diastolic Proteinuria: >5gm in 24 hrs, over 3+ urine dip Oliguria: < 400ml in 24 hrs CNS: Visual changes, headache, scotomata, mental status change Pulmonary Edema Epigastric or RUQ Pain Impaired Liver Function tests Thrombocytopenia: <100,000 Intrauterine Growth Restriction Oligohydramnios
Preeclampsia Superimposed Upon Chronic Hypertension
HT with or without proteinuria.
Can be thrombocytopenia and abnormal ALT/AST
How does preeclampsia effect the placenta
Failure of physiological change in spiral arteries. They dont dilate and they remain tortuous. Leading to ischaemic placenta and oxidative stress
How does preeclampsia affect the placenta
GFR and renal blood flow decrease
Raised uric acid levels
Proteinuria
Hypocalciuria; alterations in regulatory hormones
Impaired Na excretion and suppression of renin angiotensin system.
Preeclampsia affect on coagulation system
Thrombocytopenia; low antithrombin III; higher fibronectin.
Preeclampsia affect on liver
HELLP syndrome (Haemolysis, Elevated ALT and AST, and Low Platelet count).
Preeclampsia affect on CNS
Eclampsia
headache and visual disturbances
Scotomata
cortical blindness.
Symptoms fo preeclampsia
Visual disturbances. Headache similar to migraine. Epigastric pain - hepatic swelling and inflammation, stretch of liver capsule ± Oedema Rapid weight gain
Physical findings in preeclampsia
Blood Pressure
Proteinuria
Retinal vasospasm or oedema
Right upper quadrant (RUQ) abdominal tenderness
Brisk, or hyperactive, reflexes common during pregnancy
Ankle clonus is a sign of neuromuscular irritability that raises concern.
Differential diagnosis for preeclampsia
Thrombotic Thrombocytopenic Purpura
Haemolytic Uremic Syndrome
Acute Fatty Liver of Pregnancy
Lab tests for preeclampsia
Haemoglobin, platelets
Serum uric acid
Liver function tests
If 1+ protein by clean catch dip stick
Timed collection for protein and creatinine
Accurate dating and assessment of fetal growth
Preeclampsia treatment goal
prevent eclampsia and other severe complications
Palliate maternal condition to allow fetal maturation and cervical ripening.
Preeclampsia treatment
Hospitalisation
new-onset PE - to assess maternal and fetal conditions.
preterm onset of severe gestational hypertension or preeclampsia.
Ambulatory management at home or day-care unit for mild gestational hypertension
Indications for delivery in preeclampsia- maternal
Gestational age 38 wks
Platelet count < 100,000 cells/mm3
Progressive deterioration in liver and renal function
Suspected abruptio placentae
Persistent severe headaches, visual changes, nausea, epigastric pain, or vomiting
Delivery should be based on maternal and fetal conditions as well as gestational age.
Why do you give magnesium sulfate in preeclampsia
To stop fits/ eclampsia developing
Indications for delivery in preeclampsia- fetal
Severe fetal growth restriction
Nonreassuring fetal testing results
Oligohydramnios
Delivery should be based on maternal and fetal conditions as well as gestational age.
Preferrable delivery route for preeclampsia
Vaginal
Inducing can help
Which HTN drugs are used in pregnancy
Labetalol
Nifedipine
Premature definition
Before 37 weeks
Low birth weight baby definition
Less than 2.5kg
Can a baby be premature but not LBW
Yes
Can a baby be LBW but not premature
Yes
Why are more premature babies surviving
Antentatal steroids Artificial surfactant Ventilation Nutrition Antibiotics
Risk factors for pre term birth
Preterm labour PPROM Cervical weakness Amnionitis Medical/ obstetric disorders
Non recurrent risk factors for PTB
APH
Vaginal bleeding
Multiple pregnancy
Recurrent risk factors for PTB
Black race Previous preterm birth Smoking Genital infection Cervical weakness Socioeconomic
How can you prevent PTB (primary)
Smoking and STD
Planned pregnancy
Health advice
How can you prevent PTB (tertiary)
Prompt diagnosis
Drugs: Tocolytics
Anitbiotics
Corticosteroids
Diagnosis of preterm labour
Persistent uterine activity AND change in cervical dilatation and/or effacement
How can you prevent PTB (secondary)
Select increased risk for surveillance and prophylaxis
Screening for preterm labour
Transvaginal cervical ultrasound
Qualitative fetal fibronectin test
False positives for fibronectin test
Cervical manipulation
Sexual intercourse
Lubricants
Bleeding
How can you prevent PTB developing in high risk
Progesterone pessary
What increases chance of urinary incontinence
Smoking
Obesity
Multiparty
Age
Why does genital tract atrophy after menopause
Oestrogen makes cells have more glycogen and therefore water
What is the pathophysiology of overactive bladder
Involuntary bladder contractions
Define incontinence
Involuntary leakage of urine
What is the pathophysiology of stress urinary incontinence
Sphincter weakness
Is stress or urge incontinence large volume leakage
Urge
What causes fistulas
Cancers
Other than stress and urge incontinence name 5 more
Fistula Neurological Overflow Functional Mixed
Overactive bladder presentation
Urgency incontinence Frequency Nocturia Nocturnal enuresis Intercourse 'Key in door' 'Handwash'
Stress incontinence presentation
Cough Laugh Lifting Exercise Movement
Simple urinary assessments
Frequency volume chart
Urinalysis
Residual urine measurement
Questionnaire
What does Frequency volume chart tell you
Voided volume Frequency of urination Quantity and frequency of leakage Fluid intake Diurnal variation
Likely diagnosis from nitrites on MSU
Infection
Likely diagnosis from Leukocyte on MSU
Infection
Likely diagnosis from Microscopic haematuria on MSU
Glomerulonephritis, nephropathy, neoplasia, calculus, infection
Likely diagnosis from Proteinuria on MSU
Renal disease, cardiac disease
Likely diagnosis from glycosuria on MSU
Diabetes, IGT, nephropathy, reduced renal threshold
Incontinence questionnaire main categories
Urinary
Vaginal
Bowel
Sexual