2230 part 1

Question 1

Pop risk factors x 5

Answer 1

1. Vaginal birth
2. Birth > 4kg
3. 3rd/4rth degree tears
4. Instrument delivery
5. Pushing phase or labour > 1.2 hours

Question 2

SUI treatment x 3?

Answer 2

Supervised PFMT
The knack
Weight loss

Question 3

UUI/OAB treatment x 4?

Answer 3

Bladder retraining
Urge suppression
Supervised PFMT
Weight loss

Question 4

Extended management for bladder SUI, UUI/OAB? for GP

Answer 4

SUI

GP - medication (alpha-adrenergic agonist)

GP - Medication (antimuscurinic or topical eostrogen)

Question 5

Pelvic floor muscle assessment x 3? + 1 extra extended

Answer 5

Superficial palpation of TA
Real time ultrasound
Vaginal examination (assess trauma,

Levator ani avulsion and sensory loss)
Biofeedback (WHP)

Question 6

Explain transabdominal ultrasound and limitations?

Answer 6

Assess voluntary PFM contraction & length of hold
Empty bladder 1 hr prior and drink 500 ml within the hour. Look for bladder case and aim to visualise PFM contraction. Cue to reduce bracing or breath holding or glute/adductor co-contraction.

Limitations: 1. Only assess deep layer
2. Only movement, not strength
3. Requires moderate bladder volume
4. Can’t assess prolapse

Question 7

Bowel dysfunction treatment x 4?

Answer 7

1. E+A: go on first urge, avoid straining, seated < 10 mins, movement for motility
2. hydration and fibre for BSS
3. Positioning: foot elevation, thigh support, relax abs
4. PFM relaxation / diaphragmatic breathing

Question 8

Extended management for WHP with SUI, UUI and bowel symptoms?

Answer 8

SUI: Vaginal pessery
UUI/OAF: TTNS
Bowel: PFMT (down- training /relaxation)

Question 9

PGP risk factors? x 6

Answer 9

1. History of pregnancy
2. Ortho dysfunction
3. BMI
4. Smoking
5. Work dissatisfaction
6. Belief of improvement

Question 10

AN red flags x 2?

Answer 10

Fluid loss or vaginal bleeding
Neurological symptoms

Question 11

PGP differential diagnosis x 3

Answer 11

Piriformis syndrome
Somatic pain lumbar spine
Myalgia

Question 12

P –ERFECT and what to assess for during?

Answer 12

Endurance
Repetitions to fatigue
Fast contractions
Every Contraction Timed
**Assess for bracing, breath holding, pelvic tilt and glute/adductor squeezing

Question 13

AN contra-indications x 2?

Answer 13

Poorly controlled T2 diabetes
Pre-eclampsia

Question 14

ACOG guidelines for exercise

Answer 14

20-30 mins of moderate exercise most days
<60-80% of age predicted max maternal GR
Avoid head (thermoneutral)

Question 15

Birth prep treatment x 4

Answer 15

1. Positions for labour (constant movement) e.g. laying on 3 pillows with knees bent or laying on chair with knees bent
2. Pelvic floor relax / brething techniques
3. Perineal massage post 35 weeks (1-2 times per week)
4. TENS in labour

Question 16

5 types of PGP assessments to conduct? for SIJ and Pubic symphysis?

Answer 16

SIJ:
ASLR (0-5)
Long dorsal ligament palpation (> 5 seconds pain)
Thigh trust (posterior pain +-)

Pubic symphysis:
1. Modified trendelenburg (pain + pelvic drop)
2. Palpation of pubic symphysis (>5 sec pain)

Question 17

how to do ASLR and what to look for?

Answer 17

Pain
0-5 difficulty
Pelvic stability / breath holding or coning
Does compression help?

Question 18

PGP management (general) x 4

Answer 18

Reassurance ++
Support belts
Exercise
Manual therapy

Question 19

Extended management for PGP (GP + WHP)

Answer 19

GP - pain medication
WHP - PFM concerns

Question 20

Incontinence and prolapse management x 3?

Answer 20

1. E + A on risk factors for prolapse such as constipation, modify heavy lifting, weight.
2. PFMT reduces US during and post natal
3. The knack (SUI) pre cue prior to cough

Question 21

Referral (incontinence + prolapse) GP and WHP

Answer 21

WHP/Gyni/GP - ongoing UI symptoms
WHP/GP/Gyni prolapse assessment = VE+Pop-Q

Question 22

Management of pregnancy related PGP x 6

Answer 22

1. Modify SL standing activities
2. Frequent position changes
3. Log roll in bed
4. mermaid into car
5. Pillow between legs
6. SIJ belts
   **Core and pelvic floor exercises
   **Avoid supine 16 weeks