Week 4 part 3 Flashcards
When does bleeding in early pregnancy occur?
less than 24 weeks
Bleeding from the genital tract after 24 weeks gestation?
Antepartum haemorrhage
Are preeclampsia and hypertension risk factors for placental abruption?
Yes
Name a cause of couvelaire uterus?
Placental abruption
Uterine tenderness/wooden hard?
Placental abruption
Sudden-onset abdominal pain, vaginal bleeding, and uterine tenderness. Also abnormally freuqent contractions and uterine hypertonus?
Abruption
Placenta is partially or totally implanted in lower uterine segment?
Placenta previa
Painless, ‘causeless’ recurrent 3rd trimester bleeding? Uterus is soft and non tender
Placenta previa
How do you diagnose placenta oprevuia?
Ultrasound (20 week scan) - do not perform vaginal exam until you exclude it
Placenta invades myometrium?
Placenta accreta - percreta (placenta has reached serosa). Associated with sever ebleeding, PPH and may end up with hysterectomy
With placenta praevia - if ther has been prior bleeding in pregnancy or suspected/confirmed placenta accreta how is baby delivered?
Caesarea section at 37 weeks
With placenta preavia are steroids given?
Yes - promote fetal lung surfactant production (e.g. betamethasone)
Greater than 500ml blood loss post partum?
PPH
4 t’S OF pph?
Tone - 70%
Trauma - 20%
Tissue -10%
Thrombin - <1%
What is the initial management of PPH?
- Uterine massage
- 5 units IV syntocinon stat
- 40 units syntocinon in 500ml Hartmanns
Management of persistent PPH
Catheter
500microg ergometrine IV
Deepest layer of pelvic floor?
Pelvic diaphragm
What two muscle groups make up pelvic diapgrahm?
Levator ani
+
Coccygeus
Forms most of pelvic diaphragm?
Levator ani
What are three muscles making up levator ani/
- Iliococcygeus
- Pubococcygeus
- Puborectalis
Name 4 pelvic ligaments?
- Uterosacral
- Transverse cervical
- Lateral ligament of bladder
- Lateral rectal ligaments
What lies below fascia covering inferior aspect of pelvic diaphragm, and lies above perineal membrane?
Deep perineal pouch - conatains part of urethra, bulbourethral glands, NVB for penis/clitoris, extensions of ischioanal fat pads and muscles
What in males, contains bulb - corpus spongiosim, crura - corpus cavernosum. associated muscles - bulbospongiosus and ischiocavernosus?
Superficial perineal pouch - male
What in females, contains female erectile tissue and associated muscles: clitoris and crura - corpus cavernosum, bulbs of vestibule - paired, associated muscles - bulbospongiosus and ischiocavernosus
superficial perineal pouch - female
Lump in vaginal wall?
Prolapse - vaginal
Dragging sensation, feeling of lump, urinary incontinence?
Uterine prolapse
Predominant locations and role of muscarinic receptor subtypes: M1
Brain (cortex, hippocampus); salivary glands
Cognitive functioning and memory; saliva secretion
Predominant locations and role of muscarinic receptor subtypes: M2
Heart, brain, smooth muscle
Regulation of heart rate and heart rate flexibility; behavioural flexibility
Predominant locations and role of muscarinic receptor subtypes: M3
Smooth muscle, glands, eye
Smooth muscle contraction; gland secretion; iris contraction
Predominant locations and role of muscarinic receptor subtypes: M4
Brain (forebrain, striatum)
Modulation of several important dopamine-dependent behaviours
Predominant locations and role of muscarinic receptor subtypes: M5
Brain (substantia nigra); eye
Regulation of striatal dopamine release
Stress urinary incontinence?
leakage of urine during raised intra-abdominal pressure
leakage associated with urgency, usually with detrusor activity
Overactive bladder
What test is useful to differentiate between stress urinary incontinence and overactive bladder in patients whom surgery considered?
Urodynamics
a method by which the pressure/volume relationship of the bladder is measured during filling, provocation and during voiding
Cystometry
Drug for stress urinary incontinence
Duloxetine
Drug for overactive bladder?
Oxybutynin
1st degree uterine descent?
In vagina
2ND degree uterine descent?
In interiotus
3rd degree uterine descent?
Procidentia (entiryl outside vagina)
What has prolapsed if it is an enterocele prolapse?
Pouvh of douglas cobtaining small bowel
What type of prlapse: stress urinary incontinence, urinary retention, recurrent UTI?
Cystourethrocele
What typeof prolapse? Backache, ulceration if procidentia/everted?
Uterine/vault prolapse
What type of prolapse - constipation, dyschezia?
Rectal
When is the nadir reached in pregnancy for BP/
22-24 weeks
What are the two stages in pathogenesis of preeclampsia?
- aBNORMAL placental perfusion
2. Maternal syndrome
What can be used to predict pre-eclampsia?
Maternal Uterine Artery Doppler 20-24 weeks
Treatment of hypertension in pregnancy: METHYLdopa contraindication?
Depression
Treatment of hypertension in pregnancy: labetalol contraindication?
Asthma
Tonic-clonic (grand mal) seizure occuring with features of pre-eclampsia
Eclampsia - most common post partum 44%, more common in teenagers
What hypertensives are given for eclampsia?
IV Labetalol
IV hydralazine
How are seizures treated in eclampsia?
Magnesium sulphate
What is main cause of death in eclampsia?
Pulmomary oedema
whats is given in low dose to high risk woemn for preeclampsia?
Aspirin- commence before12 weeks
