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MRCOG Part 2 Urogynaecology > The management of urogynaecological problems in pregnancy and postpartum period TOG 2022 > Flashcards

The management of urogynaecological problems in pregnancy and postpartum period TOG 2022 Flashcards

1
Q

Why is there increase urinary frequency in pregnancy

A

Increased blood volume 50-60% and GFR

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2
Q

Why increase risk of urinary infection

A

Dilatation of urinary collecting system
Loss tone and contractility in renal pelvices/ureters
Increased tortuosity of ureters

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3
Q

Why increased risk of urinary incontience in pregnancy

A

Bladder and urethra elevated and stretched

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4
Q

Why increased risk of urinary retention in pregnancy

A

Reduced bladder tone and sensation

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5
Q

What is the most common type of UI in pregnancy? What is the prevalence?

A

SUI
19-75%, increasing with GA

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6
Q

Prevalence SUI in pregnancy
a) Already had SUI pre-preg
b) No previous SUI

A

a) 75%
b) 12%

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7
Q

1st line Tx SUI during pregnancy and PP?

A

PFMT

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8
Q

When can surgical options for SUI be considered?

A

Once family complete
If becomes pregnant after incontinence surgery, discuss risk of future surgical failure

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9
Q

What % pregnancy women experience micturition frequency?

A

41%

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10
Q

Management OAB in pregnancy

A

○ Modifying fluid intake
○ Reducing or stopping caffeine intake
○ Pelvic floor exercises
○ Bladder retraining

Can offer anticholinergics in pregnancy and breastfeeding. Safety not fully established, some lactation suppression

Intravaginal oestrogen in PP breast feeding women

Botox rarely offer in pregnancy
Percutanous nerve stimulation not offered in pregnancy

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11
Q

Difference in MOD of delivery of ongoing OAB at 6 weeks

A

Higher if vaginal delivery vs CS

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12
Q

Rate of POP in pregnancy

A

5-1%, worse in 3rd trimester and PP

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13
Q

Pregnancy-related risk factors for POP in later life?

A

Forceps
Prolonged 2nd stage
LGA baby
3rd/4th tears

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14
Q

Which pelvic floor muscle most vulnerable to injury during vaginal delivery?

A

Puborectalis

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15
Q

Consequencty of levator avulsion defect

A

Increased risk cystocele, uterine prolapse and 2 x likely POP stage 2 or above

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16
Q

How is POP managed in pregnancy

A

Altering lifestyle to reduce increased intra-abdominal pressure; for example, laxatives for constipation, cessation of smoking if a chronic cough is present, or reducing predisposing factors such as lifting heavy weights
Diet and exercise to control and lose weight
PFMT
Vaginal pessaries

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17
Q

Incidence of UTI in pregnancy and pyelonephritis in pregnancy

A

8% and 2%

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18
Q

If asymptomatic bacteraemia not treated in pregnancy, what rate UTI

A

25%

19
Q

What is asymptomatic bacteraemia?

A

bacterial growth > 100 000 colony-forming units per millitre (cfu/mL) in a urine culture in asymptomatic women

20
Q

Which bacteria are less likely to produce nitrates on urine dip

A

Gram +ve e.g. staphlococcus and enterococci

21
Q

Dx recurrent UTI outside pregnancy

A

3+ UTI in 12 months

22
Q

Risk factors recurrent UTI

A

First UTI at younger than 15 years of age
Maternal family history of UTI
Frequency of sexual intercourse
High parity
Lower socioeconomic status
Hydronephrosis (diagnosed on renal ultrasound in pregnancy)
Renal stones (diagnosed on renal ultrasound in pregnancy)

23
Q

How to manage recurrent UTI

A

USS - urinary tract abnormality

  1. Trimethoprim 100mg ON (avoid 1st T) or nitrofurantoin 50-100mg ON (avoid nr term)
  2. Amoxcillin 250mg ON or cefalexin 125mg ON

Fortnightly until 26 weeks, then weekly MSU until delivery

24
Q

Other than Abx how to prevent recurrent UTI in pregnancy

A

Hygiene
Ascorbic acid - ?efficacy
Canephron - ?efficacy
Hiprex (methenamine hippurate)
D-mannose

25
Q

What proption of women have a retroverted uterus

A

20%

26
Q

How common is a fixed retroverted uterus in pregnancy

A

1 in 3000-10,000

27
Q

Risk factors for developing fixed retroverted uterus in pregnancy

A

Pelvic adhesions
Uterine malformations
Deep sacral concavity

28
Q

When does fixed retroverted uterus in pregnancy present

A

Normally 14-16 weeks
Urinary retention as uterus grows

29
Q

Treatment urinary retention due to fixed retroverted uterus

A

Catheterisation (indwelling)
Clean intermittent self cauterisation

30
Q

Long term consequences of inefficiency bladder emptying

A

Voiding difficulties
Detrusor underactivity
Increased frequency
Nocturia

31
Q

How common is postpartum urinary retention

A

15-24%

32
Q

What is overt post partum urinary retention

A

Inability to pass urine 6 hours after vaginal delivery, or after removal of catheter after CS

33
Q

What is covert post partum urinary retention

A

Post-void residual volume >150mL after spont micturition (bladder USS or catherisation

34
Q

Risk factors for PUR

A

Epidural analgesia
Prolonged first or second stage of labour
Instrumental delivery
Episiotomy
Primiparous women
Physiological changes such as increased progesterone levels

35
Q

How long after catheter removal should a women pass urine

A

Within 4 hours, but extra 2 hours can be given, totalling 6 hours

36
Q

If women is unable to pass urine, over what volume should an indwelling Cather be inserted?

A

> 150mls

37
Q

If 150-250mls when can attempt TWOC

A

6 hours

38
Q

If 250-700ml when can attempt TWOC

A

After 24 hours

39
Q

If >700mls when can re-attempt TWOC

A

> 2 weeks

40
Q

What are voided VESSI questions

A
41
Q

If VESSI questions suggest retention?

A

In/out catheter

<250mls - review after 2nd void at 6 hours
250-700ml - retry TWOC 24 hours
>700mls - RETWOC > 2weeks

42
Q

If VESSI questions of not indicate retention?

A

In/out catheter at 6 hours
<150mls - successful two
150-700 - retwoc in 24 hours
>700 - retwoc in 2 weeks

43
Q

Draw diagram of TWOC protocol

A

MRCOG Part 2 Urogynaecology (16 decks)

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