Obstetrics Flashcards

1
Q

ddx UTI

A

Vagina OPIUM

  • vaginitis/osis
  • > candida
  • > trichomoniasis
  • > bacterial vaginosis
  • overactive bladder
  • PID
  • interstitial cystitis
  • urethritis
  • malignancy
  • > urothelial
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2
Q

investigations UTI

A

FBC
-raised WCC
EUC
-eGFR

urinalysis

  • dipstick
  • > leuks and nitrites
  • > haematuria
  • microscopy
  • > follow up for haematuria -> haem or RCCs?
  • > diagnostic = 100 CFU/mL of typical organism
  • culture
  • > growth >10^5 CFU/mL
  • > gram stain
  • > sensitivity

consider

  • CT KUB
  • > protracted illness, treatment resistance, upper tract signs
  • renal ultrasound
  • > hydronephrosis
  • > stones
  • > scarring
  • cystoscopy
  • > suspicion of lower tract pathology
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3
Q

cervical screening

A

Demographic

  • asymptomatic
  • women over 25 (up to 75)
  • every 5 years

Test

  • cervical cell HPV testing (DNA PCR)
  • partial genotyping (16/18)

Pathway

  • positive result = liquid based cytology
  • positive HPV with 16/18 -> colposcopy
  • positive HPV not 16/18 -> triaged by LBC results
  • > negative/pLSIL/LSIL = repeat HPV test 12 months
  • > pHSIL/HSIL = colposcopy
  • all adeno referred for colposcopy
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4
Q

ddx PID

A

CATNAPEER

  • cystitis
  • tubo-ovarian abscess
  • torsion (ovarian)
  • nephrolithiasis
  • appendicits
  • pyelonephritis
  • ectopic
  • endometriosis
  • ovarian cyst rupture

Discharge

  • vaginosis
  • trichimoniasis
  • candidiasis
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5
Q

Pelvic organ supports

A

Support provided by interaction between muscles of pelvic floor and connective tissue attachment to bony pelvis

a system of three integrated levels of support was described by DeLancey

Level 1

  • uterosacral + cardinal ligaments
  • suspends uterus plus upper vagina to sacran and pelvic side wall

Level 2
attachments along the length of vagina to
-superior fascia of levator ani
-tendinous arch

Level 3 
support of distal third of vagina by 
-perineal body
-superficial and deep transverse perineal muscles
-perineal membrane
-bulbospongiosis
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6
Q

pelvic organ prolapse types

A

anterior compartment

  • hernia of anterior wall
  • associated with descent of bladder (cystocele)

posterior compartment

  • hernia of posterior wall
  • associated with descent of rectum (rectocele)

enterocele
-hernia of intestines through vaginal wall

apical compartment prolapse
-descent of apex of vagina/cervix/uterus into lower vagina

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7
Q

PID risk factors

A

age <25
sexually active (unprotected, during menses)
multiple sex partners
sex partner with STI
previous STI/PID
instrumentation/IUD (briefly increased risk)

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8
Q

types of hysterectomies

A

vaginal

  • preferred method
  • faster return to activities/shorter hospital stay
  • faster surgery

laparoscopic

  • second option
  • longer surgery time
  • increased risk of damage to urinary tract
  • compared with abdominal
  • > faster
  • > shorter hospital stay
  • > fewer infections

single port and robot assisted laparoscopy
-neither have improved outcome over conventional laparoscopy and are technically difficult

abdominal
-default when laparoscopy is insufficient

Variations

  • supracerivcal (subtotal) hysterectomy
  • > no difference in major outcomes (eg. continence or sexual function)
  • > continued need for cancer screening, cyclic bleeding
  • may include oophorectomy and salpingectomy depending on indication
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9
Q

complications hysterectomies

A

haemorrhage

Structures

  • ureters
  • bladder
  • bowel
  • femoral nerve (placement of retractors lateral to psoas)

UTI

Urinary incontinence

Pelvic organ fistulae

Pelvic organ prolapse

  • risk is controversial
  • loss or damage to level 1 supports
  • prophylactic apical suspension is recommended
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10
Q

stages of labour

A

Stage 1

  • start
  • > contracts every 3-5mins every hour
  • end
  • > full (10cm) cervical dilation
  • process
  • > stretching cervix stimulates posterior pituitary
  • > release of oxytocin causes contraction
  • > contractions release prostaglandins from placenta
  • > prostaglandins strengthen contractions
  • > contractions stimulate stretch cervix
  • substage
  • > latent = slow progress until approx 5-6cm
  • > active = more rapid effacement
  • > inflection point less clear in nullips
  • median progression time
  • > approx 1.5hrs/cm until inflection
  • > approx 0.5hrs/cm after inflection
  • 95th centile progression time
  • > approx 6hrs for 4-5cm
  • > approx 3hrs for 5-6cm
  • > approx 1.5hrs/cm after inflection

Stage 2

  • start
  • > complete dilatation
  • end
  • > delivery
  • process
  • >

Stage 3

  • start
  • > fetal expulsion
  • end
  • > placental expulsion
  • process
  • >
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