Pelvic Organ Prolapse Flashcards
(30 cards)
What are the three main muscles composing the levator ani?
Puborectalis, Pubococcygeus, and Iliococcygeus.
What structures provide Level 1 (Apical) pelvic support according to Delancey?
Uterosacral ligaments and Cardinal (transverse) ligaments, supporting the uterus and upper vagina.
What can defects in Level 1 pelvic support cause?
Uterine prolapse or Vaginal vault prolapse.
What structures provide Level 2 (Mid-vaginal) pelvic support?
Pubocervical fascia (anteriorly) and Rectovaginal fascia (posteriorly), attaching the vagina laterally.
What can defects in Level 2 pelvic support cause?
Anterior vaginal wall prolapse (Cystocele) or Posterior vaginal wall prolapse (Rectocele).
What structure is key to Level 3 (Distal) pelvic support?
The Perineal body, along with fusion of the distal vagina to surrounding structures.
Name three major categories of causes (aetiology) for Pelvic Organ Prolapse.
- Age & Menopause (estrogen decline), 2. Obstetric factors (childbirth trauma), 3. Increased intra-abdominal pressure (coughing, straining, obesity).
Give two examples of obstetric risk factors for POP.
Repeated childbirth, Forceps delivery, Prolonged labor, Macrosomia (BW > 4kg), Perineal trauma. (Any two)
Give two examples of factors causing increased intra-abdominal pressure leading to POP.
Chronic cough (smoking, COPD), Chronic constipation/straining, Heavy lifting, Obesity. (Any two)
What is the basic pathophysiology of POP?
Failure of the interaction between the levator ani muscles and the supporting ligaments/fascia.
What is a Cystocele?
Prolapse of the upper anterior vaginal wall, involving the bladder.
What is a Rectocele?
Prolapse of the lower two-thirds of the posterior vaginal wall, involving the rectum.
What is an Enterocele?
Prolapse of the upper posterior vaginal wall, involving the small bowel.
What is Uterine Prolapse?
Descent of the uterus down the vaginal canal.
What is Vault Prolapse?
Descent of the vaginal apex (top of the vagina) after a hysterectomy.
Name two direct symptoms of POP.
Sensation of vaginal bulge, Visible protrusion, Dragging sensation. (Any two)
Name one urinary symptom associated with POP.
Hesitancy, Poor stream, Retention, Urgency, Stress/urge incontinence, Need for digitation to void. (Any one)
Name one bowel symptom associated with POP.
Incomplete evacuation, Incontinence, Need for digitation to defecate. (Any one)
What is the standard quantitative system for staging POP?
Pelvic Organ Prolapse Quantification (POPQ) System (1996).
Describe Stage 2 POP according to the POPQ system.
The most proximal portion of the prolapse is between 1 cm above and 1 cm below the level of the hymen.
Describe Stage 4 POP according to the POPQ system.
Complete eversion of the vagina, or protrusion to within 2 cm of the total vaginal length.
What is Procidentia?
A severe form of uterine prolapse where the entire uterus is outside the introitus (equivalent to Stage 4 POP involving the uterus).
Name two potential complications of POP.
Recurrent UTIs, Decubitus ulcers (on cervix/vagina), Bleeding/discharge from ulcers. (Any two)
What are the two main conservative management options for POP?
- Pelvic Floor Muscle Training (PFMT), 2. Vaginal Pessaries.
