Applied anatomy

Question 1

Definition of an episiotomy

Answer 1

• Planned surgical incision on the perineum and posterior vaginal wall during second stage of labour
• Maybe indicated for normal birth/ forceps assisted
• Most commonly medio-lateral position

Question 2

Definition of a Caesarean section

Answer 2

• Delivery of the foetus through incision in the abdominal wall uterine wall
• Risk of bladder and uterine injury

Question 3

Presentation of post C-section infection

Answer 3

• Fever
• Wound sensitivity, redness and swelling at site
• Lower abdominal pain

Question 4

Risk factors for developing C-section wound infection

Answer 4

• Obesity
• Diabetes/ immunosuppressive disorder
• Chorioamnitis (infection of the amniotic fluid and foetal membrane)
• Long-term steroid use
• Poor prenatal care
• Previous caesarean deliveries
• Lack of prophylactic antimicrobial care
• Long labour/ surgery
• Excessive blood loss in labour, delivery or surgery
• Use of nylon/ staple sutures

Question 5

Gynaecological relevance of the ureters

Answer 5

• Upper half in abdomen, lower half in pelvis
• Enters pelvis over bifurcation fo common iliac vessels
• Runs retro-peritoneally on lateral pelvic wall
• Crossed by uterine artery
• Enter posterior of bladder

Question 6

Symptoms associated post-hysterectomy

Answer 6

• Lower urinary tract symptoms
• Painful bladder syndrome
• Urinary frequency and urgery
• Overactive bladder

Question 7

Types of hysterectomy

Answer 7

• Total hysterectomy → removal of whole uterus and cervix
• Radial hysterectomy → removal of whole uterus, tissue on sides of uterus, cervix, top part of vagina and pelvic lymph nodes, generally only done for malignancy

Question 8

Renal tract and obstetric complications

Answer 8

• Increased size of kidneys during pregnancy
• Urinary tract dilatation → physiological hydronephrosis (more pronounced on right)
• Pelvic kidney → obstruction of labour

Question 9

Differentials of right iliac fossa pain/ tenderness/ guarding

Answer 9

• Renal calculi
• Ovarian cyst accident
• Constipation
• Ruptured ectopic pregnancy

Question 10

Fibroids (leiomyomata)

Answer 10

• Commonest benign tumour of myometrium
• Mainly smooth muscle
• Mostly asymptomatic → dysmenorrhea, menorrhagia, pressure symptoms, pelvic pain
• Management → symptomatic relief, hormonal treatment, surgery (myomectomy, hysterectomy, uterine artery. embolisation, GnRH analogues)

Question 11

Definition of endometriosis

Answer 11

• Presence of endometrial-like tissue outside of uterine cavity
• Tissue detaches and bleeds → internal bleeding, tissue shedding, inflammation, pain and formation of scar tissue
• Can embed in lung, brain, muscle and eyes (rarely)

Question 12

Presentation of endometriosis

Answer 12

• Dysmenorrhea
• Dysparaeunia
• Dysuria
• Adnexal masses/ tenderness
• Nodules/ tenderness in posterior vaginal fornix/ uterosacral ligaments
• Fixed retroverted uterus
• Rectovaginal nodules