Obstetrics Flashcards
ddx UTI
Vagina OPIUM
- vaginitis/osis
- > candida
- > trichomoniasis
- > bacterial vaginosis
- overactive bladder
- PID
- interstitial cystitis
- urethritis
- malignancy
- > urothelial
investigations UTI
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
cervical screening
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
ddx PID
CATNAPEER
- cystitis
- tubo-ovarian abscess
- torsion (ovarian)
- nephrolithiasis
- appendicits
- pyelonephritis
- ectopic
- endometriosis
- ovarian cyst rupture
Discharge
- vaginosis
- trichimoniasis
- candidiasis
Pelvic organ supports
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
pelvic organ prolapse types
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
PID risk factors
age <25
sexually active (unprotected, during menses)
multiple sex partners
sex partner with STI
previous STI/PID
instrumentation/IUD (briefly increased risk)
types of hysterectomies
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
complications hysterectomies
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
stages of labour
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
- >