Obs and Gynae

Question 1

Uterus descends into vagina?

Answer 1

uterine prolapse

Question 2

Woman with hysterectomy
top of vagina sags down into vaginal canal

Answer 2

Vault prolapse (top of vagina = utero vaginal canal)

Question 3

defect in the anterior vaginal wall allowing bladder to prolapse backwards

Answer 3

cystocele

Question 4

prolapse urethra

Answer 4

uterocele

Question 5

prolapse of bladder and urethra

Answer 5

cystocele

Question 6

defect in posterior vaginal wall allowing rectum to prolapse forwards into vagina

Answer 6

rectocele

Question 7

rectocele leading to constipation?

Answer 7

rectocele can lead to faecal loading in prolapse area (large mass of dry, hard stool that remains stuck in rectum)
= sig constipation, urinating retention (compresses urethra) and palpable lump in vagina (pressing can correct position = bowels open)

Question 8

RF for prolapse

Answer 8

think weak and stretched muscle/ligaments
- multiple vaginal deliveries
- instrumental, prolonged, traumatic delivery
- older, postmenopausal
- obese
- chronic resp disease = coughing
- chronic constipation = straining

Question 9

presentation of pelvic organ prolapse?

Answer 9

feel smth coming down into vag
draggong/heavy feeling
urinary symptoms
bowel symptoms
sexual dysfunction
lump pressing down/pushing back up themselves
worse when straining or bearing down

Question 10

Examination of prolapse

Answer 10

sim’s speculum (u-shaped) to assess anterior and posterior wall
ask to cough
left lateral position
empty bowel/bladder

Question 11

Grades of prolapse?

Answer 11

pelvic organ prolapse quantification system (POP-Q)
0 = normal
1 = lowest part more than 1cm above introitus
2 = lowest part within 1cm of introitus
3 = lowest part more than 1cm below introitus
4 = full descent w/ inversion of vag

Question 12

stress vs urge incontinence

Answer 12

stress = urine leaks when bladder under pressure eg. cough
urge = sudden, intense urge leads to wee