The management of urogynaecological problems in pregnancy and postpartum period TOG 2022 Flashcards
Why is there increase urinary frequency in pregnancy
Increased blood volume 50-60% and GFR
Why increase risk of urinary infection
Dilatation of urinary collecting system
Loss tone and contractility in renal pelvices/ureters
Increased tortuosity of ureters
Why increased risk of urinary incontience in pregnancy
Bladder and urethra elevated and stretched
Why increased risk of urinary retention in pregnancy
Reduced bladder tone and sensation
What is the most common type of UI in pregnancy? What is the prevalence?
SUI
19-75%, increasing with GA
Prevalence SUI in pregnancy
a) Already had SUI pre-preg
b) No previous SUI
a) 75%
b) 12%
1st line Tx SUI during pregnancy and PP?
PFMT
When can surgical options for SUI be considered?
Once family complete
If becomes pregnant after incontinence surgery, discuss risk of future surgical failure
What % pregnancy women experience micturition frequency?
41%
Management OAB in pregnancy
○ 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
Difference in MOD of delivery of ongoing OAB at 6 weeks
Higher if vaginal delivery vs CS
Rate of POP in pregnancy
5-1%, worse in 3rd trimester and PP
Pregnancy-related risk factors for POP in later life?
Forceps
Prolonged 2nd stage
LGA baby
3rd/4th tears
Which pelvic floor muscle most vulnerable to injury during vaginal delivery?
Puborectalis
Consequencty of levator avulsion defect
Increased risk cystocele, uterine prolapse and 2 x likely POP stage 2 or above
How is POP managed in pregnancy
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
Incidence of UTI in pregnancy and pyelonephritis in pregnancy
8% and 2%
If asymptomatic bacteraemia not treated in pregnancy, what rate UTI
25%
What is asymptomatic bacteraemia?
bacterial growth > 100 000 colony-forming units per millitre (cfu/mL) in a urine culture in asymptomatic women
Which bacteria are less likely to produce nitrates on urine dip
Gram +ve e.g. staphlococcus and enterococci
Dx recurrent UTI outside pregnancy
3+ UTI in 12 months
Risk factors recurrent UTI
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)
How to manage recurrent UTI
USS - urinary tract abnormality
- Trimethoprim 100mg ON (avoid 1st T) or nitrofurantoin 50-100mg ON (avoid nr term)
- Amoxcillin 250mg ON or cefalexin 125mg ON
Fortnightly until 26 weeks, then weekly MSU until delivery
Other than Abx how to prevent recurrent UTI in pregnancy
Hygiene
Ascorbic acid - ?efficacy
Canephron - ?efficacy
Hiprex (methenamine hippurate)
D-mannose
