Week 4 Flashcards Preview

Mattias - Reproduction > Week 4 > Flashcards

Flashcards in Week 4 Deck (272):
1

Which nerve type fiber carry out pain from the ovaries and fallopian tube

Visceral afferent

2

Which nerve type fiber carry out pain from the uterus

Visceral afferent

3

Which nerve type fiber carry out pain from the vagina

Visceral afferant (pelvic part)
Somatic sensory (perineum)

4

Which nerve type fiber carry out pain from the perineum

Somatic seconry

5

Which nerve type fiber carry out uterine cramping (menstruation)

Hormonal (sympathetic/parasympathetic)

6

Which nerve type fiber carry out uterince contraction (during labour)

Hormonal (sympathetic/parasympathetic)

7

Which nerve type fiber carry out pelvic floor muscle contractions

somatic motor

8

What is the fundamental question when figuring out the nerve type for each function in the repro accociated area

Is the structure in the pelvis or Perineum

9

What fiber type supply structures in the pelvis

Sympathetic, parasympathetic and visceral afferent

10

What fiber type supply structures in hte perineum

Somatic motor
Somatic sensory

11

Pain from female repro system - the two important spinal cord levels are

T11-L2
S2-S4

12

Visceral afferents can run alongside sympathetic or parasympathetic fibers depending on

If they are from organs touching the peritoneum or not. Peritoneum touching=Sympathetic

13

At what level does sympathetic fibers from pelvic organs enter the spinal cord

T11-L2

14

Pain from the superior aspect of pelvic organs are perceived as

Suprapubic

15

Pain from the inferior aspect of pelvic organs are perceived as

In S2,S3,S4 dermatome

16

Visceral afferent from inferior aspect of pelvic organs run alongside ____ and enters spinal cord at levels ____

Parasympathetic
S2,S3,S4

17

Structures in the perineum send signals through ___ and enter spinal cord at ____

Pudendal nerve
S2,S3 and S4

18

Three regions of pain sensation in the repo system

Intraperitoneal viscera
Subperitoneal viscera
Somatic structures

19

Types of Anaesthesia in labor

Spinal anaesthetic
Epidural anaesthetic
Pudendal nerve block

20

At what level does the spinal cord become cauda equina

L2

21

At what level does the subarachnoid space end

S2

22

Where is Spinal and epidural anesthetic injected

L3-L5 region

23

What is the Spinal anesthetic injected into

Subarachnoid space

24

What is the Epidural anesthetic injected into

Just outside the Dura mater, into the epidural space

25

What does the needle pass through in Epidural Anesthetic

Skin --> Supraspinous ligament --> Interspinous ligament --> Ligamentum flavum --> epidural space

26

All arterioles are supplied by ___ to maintain ____

Sympathetic fibers to maintain sympathetic tone

27

What happens when spinal anesthetics block sympathetic output

Vasodilation (flushed and warm lower limbs, reduced sweating)
Same as hypotension

28

During labor, when is the pudendal nerve blocked

Episotomy incision
Forceps use
Perineal stitching post delivery

29

Pudendal nerve exits pelvis via ____ passes ____ to ____ and re-enters pelvis via ____

Greater Sciatic foramen
Posterior to Sacrospinous ligament
Lesser sciatic foramen

30

What is used as a landmark when administer pudendal nerve block

Ischial spine

31

What are the degrees of perineal tear during birth

1st - around vagina, no muscle
2nd - around vagina, muscle torn
3rd - Perineal skin towards anus w/muscles
4th - Anal sphincter and muscles involved

32

What is done to avoid Perineal tearing during birth

Episiotomy
Posterolateral or medial incision

33

Three P's of Labor that are key factors

Power
Passage
Passenger

34

What two hormones makes the uterus contract

Estrogen and Oxytocin

35

What are the stages of Labor

1st - Latent phase up to 3-4cm dilation
Active stage: 4-10cm
2nd - Delivery of baby
3rd - Expulsion of placenta and membranes

36

How long is Latent phase of the first stage

May be a couple of days

37

What happens during Latent phase of first stage of labor

mild irregular uterine contractions
Cervix shortens and softens

38

What happens during active phase of first stage of labor

Slow decent of presenting part
Contractions progressively become more rhythmic and stronger

39

What is the dilation during active phase of first stage of labor

4cm to full dilation

40

What is considered prolonged second stage of labor

Nulliparous - >3h w/ analgesia >2h w/o analgesia
Multiparous - >2h w/ analgesia >1h w/o analgesia

41

What is second stage of labor

From complete dilatation to delivery of baby

42

What is third stage of labor

From delivery of baby to expulsion of placenta and fetal membranes

43

What is the duration for third stage of labor

Average 10min
3min--1h

44

If third stages of labor exceed 1h, what is done?

Preperation made for removal under GA

45

Why is active management of third stage of labor preffered

Lowers risk of post partum hemorrhage

46

What is active management of third stage of labor

Prophylatic Oxytocin 10units
Ergometrine 1mL
Cord clamp and cut
Controlled cord traction
Bladder emptying
Injection of oxytocin directly into the cord

47

What is Ergometrine

Ergot alkaloid
Use to uterus contractions to treat post partum hemorrhage

48

What are the uterus contractions that are prior to labor

Braxton Hicks contractions

49

When is Braxton Hicks contractions felt

May start at week 6
Normally felt in second and third trimester

50

What is the timing between True Labor Contractions initially

5 minutes apart

51

What is the pattern of True Labor Contractions

Evenly distributed
Time between gets shorter
Intensity increase

52

What hormone causes True Labor Contractions to start

Oxytocin

53

Does True Labor Contractions resolved with change in position

No

54

Where is Uterine muscle of highest density

At the fundus

55

What is cervical tissue made out of

Collagen (mainly type 1-4)
Smooth muscle
Elastin

56

Where is the Uterine Contractions initiated

Tubal ostia
Fallopian tube os

57

When is Uterine contraction maximized

In second stage

58

What is the frequency of contractions in second stage

3-4 every 10minutes

59

What is the duration of uterine contractions in second stage

Initially 10-15 seconds
Max 45seconds

60

What is the best type of pelvis

Gynaecoid Pelvis

61

What type of pelvis is heart shaped? What origin has higher risk of this

Android Pelvis
African-Caribbean women

62

What is oval shaped with large anterio-posterior diameter and comp. smaller transverse diameter called

Anthropoid pelvis

63

Which is the normal fetal position at birth

Longitudinal lie
Cephalic presentation
Ocipito-anterior

64

How is fetal position described with cephalic presentation

(Side) (Bone, occiptal) (Hip bone part)
Right Occipito transverse
Left occipto-anterior
And so on

65

What are the openings of the scull called

Fontanelles

66

What is the suture between the parietal bones and the occipital bones called

Lamboid suture

67

What is the suture called anteriorly to the anterior fontanelle

Metopic suture

68

What is the shape of the anterior fontanelle

Diamond

69

What is the shape of the posterior fontanelle

Triangle

70

How is the decent of the head described

In abdominal fifths

71

What is crowning

Appearance of a large segment of fetal head at the introitus

72

What are abdominal fifths

How far the head has moved down. Fifths are measured above the pubic symphisis
5/5 is not down at all
0/5 is all the way down
2/5 = head is engaged

73

How is fetal station described

in cm in relation to ishial spine
-5 is above
+5 is below

74

What are the 5 parameters to characterize the cervix

Effacement
Dilation
Firmness
Position
Level of presenting part

75

What scoring system is used to evaluate the delivery

Bishops score

76

What are the five elements in the Bishops score

Position
Consistency
Effacement
Dilation
Station in Pelvis

77

What Bishops suggests that labor is unlikely to start w/o induction

5 or less

78

What Bishop score suggests that labor will commence naturally

9 or more

79

What is the highest possible score in the Bishop score

13

80

What are some Analgesic options during labor

Paracetamol/Co-codamol
TENS
Entonox
Diamorphine
Epidural
Remifentanil
Spinal

81

What is considered normal blood loss during labor

500mL or less

82

What is considered significant blood loss during labor

1500 mL or more

83

How is the placenta seperated from the uterus wall

Placenta is inelastic and thus looses traction when the uterus is contracted

84

What are the classic signs to indicate placental seperation

Uterus contracts, hardens and rises
Umbilical cord lengthens permanently
Gush of blood in variable amount

85

What is considered upper length of normal placental expulsion

30 minutes

86

How is hemostasis of utuerus achieved after delivery

Tonic contractions - inhibits blood flow
Thrombosis of torn vessels - pregnancy is a hyper-coaguable state

87

What is Puerperium

Period of repair and recovery

88

How long is Puerperium

6weeks

89

What is Lochia

Vaginal discharge containing blood, mucus and endometrial castings

90

What are the three stages of Lochia

Lochia rubra - Red
Lochia serosa - brownish
Lochia Alba - Yellowish-white

91

What is the size change of the uterus during Puerperium

From about 1kg to 50-100g

92

How long does it take for the fundal height to return to within pelvis

2 weeks

93

What is Colostrum rich in that has a long ter protective effect for the baby

Immunoglobulin

94

What is the hormonal changes of Estrogen, Progesterone and prolactin after labor

Decrease in Estrogen
Decrease in Progesterone
Prolactin is maintained

95

What counts as abnormal labor

Too early, late, painful or long
Fetal distress (hypoxia/sepsis)
Requires intervention - operative delivery

96

Does Epidural anesthesia impair uterine activity

No

97

Is Epidural anesthesia associated with longer stage of labor

Yes, but only stage 2.

98

How is Progress during Labor assessed

Cervical dilation
Descent of presenting part
Signs of obstruction

99

What is suspected delay in Stage 1

Nulliparous -

100

What is bigger at the pelvic inlet, transverse or AP diameter

Transverse

101

What is bigger mid-pelvic cavity, transverse or AP diameter

Equal

102

What is bigger at the pelvic outlet, transverse or AP diameter

AP diameter

103

What is the graph used to assess progress during labor

The Partogram

104

What is assessed on the Partogram

Fetal heart
Amniotic Fluid
Cervical dilation
Descent
Contractions
Obstruction/Moulding
Maternal observation

105

What causes acute fetal distress

Abruption
Vasa Previa
Cord Prolapse
Uterine rupture
Feto-maternal hemorrhage
Uterine hyperstimulation
REgional anesthesia

106

What assessment is used to monitor fetal heart

CTG assessment

107

What is normal fetal baseline heart rate during labor

110-150bpm

108

what is normal Variability in fetal heart rate during labor

5-25pbm

109

What 4 features are assessed on CTG

Baseline fetal heart rate
Baseline variability
Presence or absence of decelerations
Presence of accelerations

110

What are the outcome classificiations of the CTG assessment

Normal
Non-reassuring
Abnormal

111

What is normal decelerations in the CTG assessment

None or early
Before contraction

112

What mnemonic is used for CTG interpretation

DR. C. BRAVADO

113

DR. C. BRAVADO mnemonic. First D

Deterimine

114

DR. C. BRAVADO mnemonic. first R

Risk

115

DR. C. BRAVADO mnemonic. C

Contractions

116

DR. C. BRAVADO mnemonic. B

Baseline

117

DR. C. BRAVADO mnemonic. Second R

Rate
(With the first A)

118

DR. C. BRAVADO mnemonic. First A

RAte
(With the previous R)

119

DR. C. BRAVADO mnemonic. V

Variability

120

DR. C. BRAVADO mnemonic. Second A

Accelerations

121

DR. C. BRAVADO mnemonic. Second D

Decellerations

122

DR. C. BRAVADO mnemonic. O

Overall impression

123

What is Tocolysis

Anti-contraction. Reduce contractions to slow down labor. Type of management for fetal distress

124

Name a Tocolytic drug

Terbutaline

125

What is measured in Fetal Blood sampling

pH

126

What is considered normal, borderline and abnormal fetal blood sampling results

Normal - >7.25
Borderline - 7.20-7.25
Abnormal

127

What is the action when Fetal blood sampling is abnormal

Deliver

128

What is a Ventouse

Vacuum-assisted vaginal delivery or vacuum extraction (VE)

129

Definition of Ante-Partum Hemorrhage (APH)

Bleeding from the genital tract after 24weeks gestation

130

Causes of APH

Placenta previa
Placental abruption
Vasa previa
Uterine rupture
Cervical
Others

131

What is Placenta previa

Abnormally sited placenta, all or part of the placenta implants in the lower uterine segment

132

What types of Placenta previa are there

Type 1 - Lateral
Type 2 - Marginal
Type 3 - Central, minor
Type 4 - Central, major

133

Clinical features of Placenta Previa

Small/large vol. blood loss
Painless. Recurrent bleed
Soft uterus
Malpresentation

134

How is Placenta Previa diagnosed

By ultrasound

135

What should be avoided in suspected Placental Previa

Vaginal examination
P/P has to be excluded prior to Vaginal examination

136

What is Placenta Accreta

When the chorionic villi invade into the myometrium

137

Clinical features for Placental abruption

Small/Large vol. of blood
Painful
Uterine activity
Tense, tender uterus
Difficult to feel fetal parts

138

Is the fetus hard to feel in Placental abrubption

Yes

139

Is the fetus hard to feel in Placenta previa

No

140

What is Vasa Previa

An obstetric complication in which fetal blood vessels cross or run near the internal orifice of the uterus

141

What history is important in Ante-partum hemorrhage

Bleeding - Pain - Contractions - Fetal movements - Post-coital - Smear and Scan history

142

What examinations are important in APH

Volume of blood
Fundal height
Uterine tenderness and activity
Fetal lie and presentation
Auscultation of fetal heart

143

What is the first sign of schock

Increased pulse

144

Rhesus negative means

Maternal RBC does not have D antigen and can therefor develop Anti-D antibodies

145

Up until what gestation should Steroids be administered

Up to 36weeks

146

Why is steroids administered to pre-term babies

Promote fetal lung surfactant production

147

Which steroid is administered to pre-term deliveries

Betamethasone
(preferred over Dexamethasone)

148

How is steroids administered pre-delivery

12mg Betamethasone IM
2 injections 12h apart

149

How is delivery managed if Placenta Previa is found

Cesarean section at 38 weeks
Sooner if significant hemorrhage

150

What is considered minor Post partum hemorrhage

151

What is considered moderate Post Partum Hemorrhage

500-1500mL

152

What is considered Major Post Partum Hemorrhage

>1500 mL

153

What is the etiology of Post Partum Hemorrhage

4T's
Tone -- Trauma -- Tissue -- Thrombin

154

Probably cause - Vaginal bleeding, severe abdominal pain, shoulder tip pain

Ruptured uterus

155

Initial management of PPH

Uterine massage
5 units IV Syntocinon stat
40 units Syntocinon in 500m: Hartmanss - 125ml/h

156

Non-surgical Intervention if persistent PPH

Packs and Balloons
Tissue sealants
Factor V11a
Arterial embolisation

157

Surgical intervention of persistent PPH

Undersuturing
Brace sutures
Artery ligation (Uterine or Internal Illiac)
Hysterectomy

158

What does aCGH stand for (genetic testing)

Array Comparative Genomic Hybridization

159

What does FISH stand for (genetic testing)

Fluorescent In Situ Hybridization

160

What genetic tests are done when the diagnosis is suspected (not looking at one specific spot)

Chromosome analysis OR
Array CGH

161

What genetic tests are done when the diagnosis is known (looking at one specific spot)

FISH
DNA analysis

162

When is Chorionic Villus Biopsy done

at 11.5+ weeks

163

When is Amniocentesis done

at 16+ weeks

164

What is Pre Implantation Genetic Diagnosis (PGD)

Performing a genetic test on an embryo before re-implanting one with the "correct" genotype

165

What is the govering body of genetic testing in the UK

HFEA
Human Fertilization and Embryology Authority

166

What does ICSI stand for (in vitro fertilization

IntraCytoplasmic Sperm Injection

167

Screening questions for mental health issues in antenatal care

During the last month, have you been bothered by feeling down, depressed or hopeless?
During the last month, have you been bothered by having little interest or pleasure in doing things?
Is this something you feel you need or want help with?

168

Why should benzos be avioided in pregnancy

Increased risk of cleft palate/lip. and neonatal withdrawal

169

Side effects of Valproate in pregnancy

Neural Tube Defect risk inc.
Craniofacial defects
IUGR
CVS abnormalities
Reduced IQ, Cleft

170

Side effects of Carbamazepine

Facial dysmorphism, cardiac anomalies.
Vit K deficiency

171

What is important if Bipolar medication is continued

Increased folic adid
5mg/day

172

Recommendations of lithium and pregnancy

Do not offer pre-pregnancy
Decrease lithium over 4 weeks if already on it and pregnant.
Avoid in first trimester
Do not breastfeed while on lithium

173

Are typical antipsychotics safe in pregnancy

Generally yes
Haloperidol and Chlorpromazine appears safe

174

Can anticholinergic drugs be used in pregnancy

No

175

Depression and pregnancy

Stop pharmacological treatment if mild-moderate
Continue if mod-severe, refer to psyc

176

Are Tricyclic antidepressant safe in pregnancy and breastfeeding

Amitryptilline and Nortyptiline safe in preg and ok for breast feeding

177

Are SSRI safe in pregnancy

Yes, use with caution after 20 weeks, increased risk of pulmonary hypertension

178

Which SSRI is better for breastfeeding

Sertraline

179

When is the onset of postnatal depression

2-6 weeks postnatally

180

How long does Postnatal depression last

weeks to months
1/3 lasts a year or more

181

Treatment of Postnatal depression

mild-mod -- self help, counselling
mod-severe -- psychotherapy and antidepressants

182

When is the onset of Baby blues

Day 3-10 postnatally

183

What is Baby Blues

Brief period of emotional instability

184

Treatment of Baby Blues

Support and reassurance
Self limiting

185

When is the presentation of Puerperal psychosis

Within 2 weeks of delivery

186

Signs and symptoms of Puerperal psychosis

Sleep disturbance and confusion
Irrational ideas
Mania, delusions, hallucinations, confusion

187

How common is puerperal psychosis

0.1% women

188

Treatment of Puerperal psychosis

EMERGENCY
Admission
Antidepressant, antipsychotics, mood stabilizers and ECT

189

What happens to BP in early pregnancy

BP falls

190

When does BP start to increase in pregnancy

around 22-24 weeks

191

What is considered hypertension in pregnancy

>140/90 on 2 occasions
Diastolic >110 OR
>30/15 over booking BP

192

What are the three types of hypertension in pregnancy

Pre-existing
Pregnancy induced (PIH)
Pre-eclampsia

193

When does PIH resolve

Within 6/52 of delivery

194

What is pre-eclampsia

Hypertension
Proteinuria
Edema

195

Two stages of pre-eclampsia

Stage 1 - Abnormal placental perfusion
Stage 2 - Maternal syndrome

196

Risk factors of pre-eclampsia

Age (>40=2x risk)
BMI (>30=2x risk)
FH (mother=25% inc risk, sister=40%)
Previous PET (7x)
Parity
Multiple pregnancy

197

When should patient be admitted for pre-eclampsia

BP >170/110 OR BP >140/90 w/ proteinuria
Significant symptoms
Abnormal biochemistry
Significant proteinuria
Need for antihypertensive therapy
Signs of fetal compromise

198

When a patient is admitted for pre-eclampsia, how often should BP be done

Every 4h

199

Treatment of hypertension in pregnancy

Labetolol
Methyldopa
Nifedipine
Hydralazine

200

That type of drug is Labetalol

alpha and Beta antagonist

201

What type of drug is Methyldopa

Centrally acting alpha2 agonist

202

What type of drug is Nifedipine

Ca channel antagonist

203

What type of drug is Hydralazine

Vasodilator

204

Contraindications for Labetalol

Asthma

205

Contraindications for Methyldopa

Depression

206

What is the cure of pre-eclampsia

Delivery

207

What is eclampsia

Tonic-clonic seizure occuring with features of pre-eclampsia

208

How is severe PET/eclampsia treated

Control BP
Stop/prevent seizures
Fluid balance
Delivery

209

What is used for seizure treatment/prophylaxis in eclampsia

First line: Magnesium sulphate IV
If persistent: Consider Diazepam

210

Prevention of pre-eclampsia

Low dose aspirin in high risk women
Commence before 12weeks
75mg Aspiring daily

211

What are the three layers of the pelvic floor

Pelvic diaphragm
Muscles of perineal pouches
Perineal membrane

212

What does the Pelvic diaphragm consist of

Two muscle groups
Levator ani
Coccygeus

213

Three parts of the Levator Ani muscle

Puborectalis
Pubococcygeus
Iliococcygeus

214

What are the pelvic ligaments

Utero-sacral ligament
Transverse cervical ligament
Lateral ligament of bladder
Lateral rectal ligaments

215

What does the Deep Perieneal Pouch contain

Part of the urethra (and vagina), bulbourethral glands in male, neurovascular bundle for penis/clitoris, extensions of the ischioanal fat pads and muscles

216

What muscles lie in the Deep Perineal pouch

Deep transverse perineal muscle
Compressor urethra
External urethral sphincter

217

What are the muscles in the superficial perineal pouch in both males and females

Bulbospongiosus
Ischiocavernosus

218

How many degrees of Uterine prolapse are there

3

219

Describe 1st degree of Uterine prolapse

Cervix descended into upper vagina

220

Describe 2nd degree of Uterine prolapse

Cervix descended to the introitus

221

Describe 3rd degree of uterine prolapse

Cervix is outside the introitus

222

What is it called when the Uterus and Cervix is entirely outside the introitus

Procidentia
or 4th degree uterine prolapse

223

What is a cystocele

Fibrious tissue between vagina and bladder is weak and allows bladder to prolapse into the vagina.
Also called Anterior prolapse

224

What is it called when the urethra prolapse

Urethrocele

225

What is a enterocele

Prolapse of small bowel

226

What is a rectocele

Prolapse of the wall between the rectum and vaina

227

How is cystocele, urethrocele, enterocele and rectocele presented

lump in the vaginal wall

228

How is cystocele, enterocele, urethrocele and rectocele treated

Pessary or Surgery

229

How is prolapse surgically treated

Sacrospinous fixation
Mesh sling through obturator canal

230

What muscle surrounds the bladder

Detrusor muscle

231

What is Micturition

Voiding urine/peeing

232

What is the sympathetic innvervation during Micturition

Inhibits detrusor muscle
Stimulates Internal urethral sphincter
Anti-voiding

233

What is the parasympathetic innervation during Micturition

Stimulates detrusor muscle
Inhibits Internal urethral sphincter
Inhibits somatic innervation
Voiding

234

What is the somatic innervation during micturition

Stimulates External urethral sphincter
Anti-voiding

235

Which nerve is the sympathetic innervation to the bladder

Hypogastric nerve

236

What type of sympathetic receptors on the detrusor muscle

Beta-adrenergic

237

What type of parasympathetic receptors on the detrusor muscle

Cholinergic

238

What type of sympathetic receptor on the internal urethral sphincter

Alpha-adrenergic

239

Where is the predominant location of M1 muscarinic receptors

Brain (cortex,hippocampus)
Salivary glands

240

Where is the predominant location of M2 muscarinic receptors

Heart
Brain
smooth muscle

241

Where is the predominant location of M3 muscarinic receptors

Smooth muscle
Glands
Eye

242

Where is the predominant location of M4 muscarinic receptors

Brain (forebrain, striatum)

243

Where is the predominant location of M5 muscarinic receptors

Brain (substantia nigra
Eye

244

Which muscarinic receptor regulates hearth rate and heart rate variability

M2

245

Which muscarinic receptor regulates saliva secretion

M1

246

Which muscarinic receptor is associated with dopamine functions in the brain

M4 and M5

247

Which muscarinic receptor contracts the iris

M3

248

Two main types of urinary incontinence

Stress urinary incontinence
Overactive bladder

249

What is stress urinary incontinence

Leakage of urine during raised intra-abdominal pressure

250

What is overactive bladder

Leakage associated with urgency, usually with detrusor activity

251

Symptoms of urinary incontincence other than incontinence

Frequency, urgency, nocturia, dysuria.
Hesistance, poor flow, incomplete emptying

252

What type of incontinence is most common in women

Stress urinary incontinence

253

Explain bladder chart

Filled in by patients. Input and output (voiding normally) +if pads get wet or not.

254

When is Urodynamics a good investigation

Differentiate between stress incontinence and ovaractive bladder in patients who is considered for surgery

255

How do you differentiate between stress incontinence and overactive bladder on cystometry

OAB - Detrusor pressure is wavy
Stress- Void after abdomial pressure goes up/without detrusor pressure goes up

256

How does bladder outlet obstruction look on cystometry

High detrusor pressure with low flow rate

257

First line treatment of Stress urinary incontinence

Lifestyle - Loose weight, stop smoking, avoid caffeine, avoid excessive fluid intake
Physiotherapy

258

Drug treatment of Stress Urinary Incontinence

Duloexetine
Combined noradrenaline and serotonin reuptake inhibitor (increase intraurethral closure pressure)

259

Surgical treatment of Stress Urinary Incontinence

Low tension vaginal tape
Intraurethral injection
Artificial sphincters
Colposuspension

260

First line treatment for Overactive bladder

Lifestyle - avoid caffeine
Physio - Bladder training

261

What drugs are used in Overactive bladder

Antimuscarinic (Oxybutynin)
B3 receptor agonists

262

How does Oxybutynin work

Block detrusor muscarinic receptors and decrease the ability of detrusor muscles to contract

263

What are the surgical treatments of Overactive bladder

Botox injections
Sacral nerve modulation
Augmentation cystoplasty
Bladder overdistension

264

What is PTNS in overactive bladder stimulation

Posterior Tibial Nerve Stimulation

265

What prolapse in a Enterocele

Pouch of Douglas containing small bowel

266

Symptoms of Cystourethrocele

Stress urinary incontinence
Urinary retention
Recurrent UTI

267

Symptoms of uterine prolapse

backache
Ulceration if procidentia

268

Symptoms of Rectocele

Constipation
Dyschezia (painful defecation)

269

First line treatment of Uterovaginal prolapse

Avoid heavy lifting, loose weight, stop smoking
Physiotherapy
Vaginal estrogen ONLY IF atrophic vaginitis

270

Who is suitable for Pessaries for pelvic organ prolapse

Women unfit for sugery
Relief symptoms prior to surgery
Pregnant or future pregnancy

271

When is surgical management considered for pelvic organ prolapse

Only when conservative management failed and if it is a major impact on quality of life

272

What is a common surgical procedure for pelvic organ prolapse

Sacrospinous ligament fixation