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(C) - Reproduction > 4 - Pelvic Floor > Flashcards

4 - Pelvic Floor Flashcards

1
Q

What are the ligaments supporting the uterus?

A
  • Pubocervical
  • Transverse/Cardinal (inferior broad ligament)
  • Uterosacral

Arise from the sides of the cervix and lateral fornix of vagina

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2
Q

What is the clinical importance of the cardinal ligaments?

A

Commonly removed in a hysterectomy as a reservoir for cancerous cells sometimes

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3
Q

Label the following superficial structures of the female pelvic floor.

A
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4
Q

Label the deep muscles of the female pelvic floor

A
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5
Q

What are the functions of the pelvic floor?

A
  • Support the pelvic organs like vagina, uterus, ovaries, bladder, rectum
  • Maintain intra-abdominal pressure during sneezing and laughing
  • Facilitate childbirth
  • Continence
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6
Q

What are the 3 levels of support that the pelvic floor provides?

A

1. Suspension: by cardinal and uterosacral ligaments. round ligament holds in anteversion

2. Attachment: attachment to other pelvic organs e.g vagina to endopelvic fascia, levator ani and perineal body

3. Fusion: fusion of tissues, e.g urogenital diaphragm and perineal body

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7
Q

What is the lower half of the vagina supported by?

A

Anterior: urethra

Laterally: levator ani

Posterior: perineal body

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8
Q

How does the urethra maintain continence?

A

Lies anteriorly and above the fascia so in increased intra-abdominal pressure it gets compressed against the fascia closing it

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9
Q

What ar the main components of the pelvic floor?

A
  • Urogenital diaphragm/Perineal membrane
  • Perineal body
  • Perineal muscles
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10
Q

What are the deep muscles of the pelvic floor?

A

- Coccygeus

- Levator ani: pubococcygeus, puborectalis, iliococcygeus

Midpoint is the perineal body. Fibres insert on lower part of coccyx and anococcygeal raphe

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11
Q

What are the superficial muscles of the pelvic floor?

A
  • Transverse hold vagina laterally
  • Bulbospongiosus can be torn by stretching
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12
Q

What might you do if a mother is having an issue with delivery as the baby is too large? What are the risks and benefits of this procedure?

A

- Medio-lateral episiotomy

  • May cause issues with infection, haemorraghe, external anal sphincter and dyspareunia
  • Done to avoid damage to perineal body as this is central to support
  • Also done to prevent perineal damage like 2nd/3rd degree tears
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13
Q

What is the perineal body and the urogenital diaphragm?

A

- Perineal body: Central point between vagina and rectum. Site of attachment for pelvic floor muscles and structure

- Urogenital Diaphragm: Sheet of dense fibrous tissue across anterior half of pelvic floor, attached to vagina, urethra and perinally body. Support

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14
Q

What is the blood supply and innervation to the pelvic floor?

A

Blood: external and internal pudendal arteries

Lymphatics: inguinal

Nerve: pudendal nerves S2,S3,S4, so damage to this nerve issue with pelvic floor support

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15
Q

Label this diagram of the pelvic floor

A
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16
Q

What are some conditions caused by pelvic floor dysfunction?

A
  • Pelvic organ prolapse
  • Urinary incontinence
  • Posterior compartment pelvic floor dysfunction
17
Q

How can we classify pelvic organ prolapses?

A
  • Loss of support for the uterus, bladder, colon or rectum so there is a prolapse into the vagina
  • Some can be symptomatic, e.g dragging, pain on sex, constipation and some asymptomatic
18
Q

What are some causes and risk factors of pelvic organ prolapse?

A
  • Age
  • Parity (how many kids)
  • Vaginal delivery
  • Obesity
  • Chronic raised intra-abdominal presire
  • Postmenopausal oestrogen deficiency
  • CT and Neurological disorders, e.g DMD, Marfan’s
19
Q

How would you assess a present pelvic organ prolapse?

A

- History: patient may find a lump down below or something coming down

- Symptoms like constipation or dragging

- Examine and use the POP-Q system

20
Q

How would you manage a pelvic organ prolapse?

A

Need to consider severity, how much QoL lost, fitness for surgery, plans for children, nature of work, sexual activity

- Non surgical: Use of pessaries

- Surgical: hysterectomy, mesh in a vault prolapse (risk of reoccurence)

21
Q

How do you prevent an obstetric anal sphincter injury?

A
  • High morbidity rate if 3rd/4th degree tears
  • Episiotomy
  • Encourgae mother not to push when head is crowning
22
Q

What is stress incontinence, what are the risk factors and how is it managed?

A
  • Dysfunction of pelvic floor so when raised intra-abdominal pressure there is inadequate support to urethral sphincter so leakage of urine
  • Same risk factors as POP, oestrogen deficiency and age especially
  • 1st line is pelvic floor exercises. Can also surgically create slings to support urethral sphincter
23
Q

What are some vulval problems that the pelvic floor can cause?

A

- Vestibulodynia: painful vulva due to tension in the levator ani muscles

- Vaginismus: pain on vaginal penetration due to involuntary muscle spasm

24
Q

What is the definition and different types of female genital mutilation?

A

Procedures involving parital or total removal of the external female genitalia or other injury to female genital organs.

25
Q

What are the complications with FGM?

A
26
Q

What should you do if you discover someone is a victim of FGM?

A
  • Illegal for UK nationals to do this here or abroad
  • Also illegal to close back after episiotomy even if lady requests it
  • Needs to be reported to police and put as safeguarding if female is under 18
27
Q

What is posterior compartment pelvic floor dysfunction?

A
  • Range of conditions affecting posterior pelvic floor, e.g constipation and incomplete evacuation, anal incontinence
  • In women usually due to OASIS
28
Q

What is the point of insertion of the levator ani muscles?

A

Perineal body

29
Q

According to the WHO classification, which part of the female external genitalia is predominantly affected in type 3 FGM?

A

Labia majora

30
Q

How does the perineal body function to maintain pelvic organ support

A

Acts as point of attachment for perineal muscles

31
Q

What are some risk factors for pelvic organ prolapse?

A
  • Menopause
  • Heavy lifting
  • CT disorder
  • Vaginal delivery: stretch of ligaments, damage to muscle, stretching of pudendal nerve
32
Q
A
33
Q

Distinguish between spermatogenesis and spermiogenesis. Where does each occur?

A
34
Q

Give 2 risk factors for developing CIN.

A
35
Q

What is the lymphatic drainage of the cervix?

A
36
Q

When do syncytiotrophoblasts start to produce hCG in significant levels?

A

2 weeks after conception

37
Q

Why may the mother develop anaemia during the second trimester of pregnancy

A

Increase in plasma volume greater than increase in red cell mass. Dilutional anaemia

(C) - Reproduction (21 decks)

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