Urogical Problems In Pregnancy Flashcards
What bladder changes occurs during pregnancy
Displaced
Hyperaemic
Hypertrophy due to oestrogen so Increased capacity
What changes occur to ureters in pregnancy
Reduced peristalsis
List some of the risk factors for bacteriuria in pregnancy
Low SES.
Multiparous
Sickle cell trait
List some of the complications of bacteriuria in pregnancy
Prematurity
LBW
Prenatal mortality
Maternal anaemia
Which antibiotics do you use to treat UTIs in pregnancy
Penicillins- Amoxicillin
Cephalosporins- ceftriaxone
Nitrofurantoin: safe 1st and 2nd Trimesters. NOT in pt with G6PD-deficiency
Course -3days
Which antibiotics are contraindicated in pregnancy for tx of UTI
Fluoroquinolones- ciprofloxacin
Bactrim- sulfamethaxozole
Erythromycin
Chloramphenicol
How would you manage pyelonephritis in pregnancy
Hospitalise
IV antibiotics:
Ampicillin and Aminoglycoside OR Cephalosporin
Oral antibiotics to continue X 14 DAYS
NB then prophylaxis low dose: Amoxicillin, Cephalosporin or Nitrofurantoin
Discuss management of urolithiasis in pregnancy
Most stones will pass spontaneously (rarely complications)
Surgical treatment required: temporary measures until pregnancy completed:
DJ stent
Percutaneous nephrostomy
What investigations would you do to confirm urolithiasis
US
One shot IVP/ AXR
List some of the indications for renal imaging
Visible haematuria,
Non-visible haematuria & one episode of hypotension,
A history of rapid deceleration injury and/or significant associated injuries,
Penetrating trauma,
Clinical signs suggesting renal trauma e.g. flank pain, abrasions, fractured ribs, abdominal distension,
Mass & tenderness.
How would you confirm presence of contralateral kidney
One shot IVP 2ml/kg if radiographing contrast
Palpate it
What are the diagnostic tests for urological trauma
CT IPV
Retrograde pyelogram (optimal standard for confirmation)
What are the principles of surgical repair of urethral injury
Debridement of necrotic tissue.
Spatulation of ureteral ends.
Watertight mucosa-to-mucosa anastomosis with absorbable sutures.
Internal stenting.
External drain.
Isolation of injury with peritoneum or omentum.
What are the contraindications to a suprapubic catheter
•Empty/small capacity bladder
•Previous lower abdominal surgery
-Bowel injury risk
•Macroscopic haematuria
-May have bladder tumour
-Tract seeding a concern
•Skin disease in supra-pubic area
•Gross obesity
-Trocar too short
List the indications of suprapubic Catheter
*Urinary retention with failed urethral catheterisation
•Suspected urethral injury
•Blood at the meatus pelvic fracture
•Necrotising fasciitis of perineum/ Fournier’s gangrene
-Diverts urine
•Temporary diversion of urine following urological surgery
•Selected neuropathic bladder patients
-Clean intermittent self-catheterisation not possible
•Epididymitis due to indwelling urethral catheter
