Useful Topics

Mechanisms of urinary continence

Urinary Tract Infection

• >10⁵ colony forming units per ml

• in male >100 CFU/ml may be relevant

• 6% sexually active women get UTIs

Organisms

• 80% are E. coli

• 20% are streptococcus faecalis

• if sympomatic then staphylococcus may be relevant

• Klebsella associated with stone or catheter

Complications of UTI

1. Urinary tract infection  »»»»

2. renal parenchymal infection »»»»

3. cytokine and prostaglandin release »»»»

4. PGE₂ and PGF_2alpha »»»»

5. LABOUR

Developmental abnormalities

Uterus didelphys

• Problems with
  • fertility
    • early pregnancy loss in 20-30th week
  • cervical incompetence
  • malpresentation
  • problems with tampon use
  • urinary tract abnormalities 20-25%
    • pelvic kidney

Semenalysis

Normal values

• 60 million / ml
• 60% motile
• 60% normal forms

Group B Streptococcus

haemolysis

• beta  - complete
• alpha - partial, green residue

Lancefield groups A-G

• Group A
  • "strep throat"
  • beta-haemolytic
• group B
  • found in gut of 1 in 3 pregnant women at some point
  • found in vagina of 1 in 7 women during labour

Neonates

• 50% neonates are colonised
• can cause septicaemia »»» cerebral damage
• 1:3000 die
• increased risk
  • pre-term
  • in MSU

Management

• Labour at <32 weeks
  • penicillin
  • anti-Gram -ve
    • erythromycin
    • gentamycin
• 32 weeks
  • screen for group B

Hyperglycaemia

Drugs in pregnancy

1st trimester is sensitive period for teratogenicity

Perinatally

• opiates - respiratory depression
• oxytocin - hyponatraemia and haemolytic jaundice
• anti-prostaglandins e.g. indomethacin
  • premature closure of ductus arteriosus
• antihypertensives
  • hydralazine seems safe
  • alpha-methyldopa can cause haemolysis and give false +ve Coombs test
  • beta-blockers
  • diazoxide - leads to hyperglycaemia
• anticonvulsants

Pain Relief in Labour

Gastric Reflux

• Mendelson's syndrome - aspiration of acid stomach contents
  • so give ranitidine to reduce acid

Resuscitation of the Newborn

• Airway
• Breathing
• Circulation
• Drugs
  • naloxone, via umbilical vessels
  • calcium gluconate

Premature babies

• difficulty breathing so may need CPAP

If can't breathe

• any depressant drugs present?
• ? diaphragmatic hernia
  • tracheal shift
  • scaphoid abdomen

Examination of the Newborn

• Head
  • circumference
  • sutures and fontanelles
• Ears
• Face
  • ear-eye relationship
  • mongoloid (Down's)
• Tongue
  • size
• Palate
• Heart
  • murmurs
  • machinery murmur due to ductus arteriosus usually closed within 24 hours
• Umbilicus
  • herniation
• Spine
  • meningocoele
  • spina bifida occulta
• Anus
  • esp. if not passed meconium
• Genitalia
  • virilisation (due to excess androgens)
  • testicular feminisation
• Feet
• Eyes
  • cataracts (check red reflex), associated with rubella, trichomonas
• Hips
  • do last as baby often screams

Sexually transmitted infections

mother to baby transmission

• HIV
• chlamydia

Ethics

Sex difficulties

• following pregnancy
  • painful episiotomy
  • vaginal dryness
    • breastfeeding
  • worry over failed contraception
  • male factors after witnessing birth
• menopause
• hysterectomy
• diagnosis cancer
• post-coital bleeding
• radiation therapy