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Reproductive > Pelvic organ prolapse > Flashcards

Pelvic organ prolapse Flashcards

1
Q

What is a female POP?

A

Descent of pelvic organs towards or through the vagina

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2
Q

Who is more at risk of POP?

A

Parous women

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3
Q

What are the 3 layers of the pelvic floor?

A

Endo-pelvic fascia
Pelvic diaphragm
Urogenital diaphragm

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4
Q

What is the endo-pelvic fascia?

A

Network of fibre-muscular connective-type tissue that has ‘hammock-like’ configuration and surrounds various visceral structures

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5
Q

What is the pelvic diaphragm?

A

Layer of striated muscles with its facial coverings (Levator ani & coccygeus)

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6
Q

What makes up the endo-pelvic fascia?

A

Uterosacral ligaments
Pubocervical fascia
Rectovaginal fascia

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7
Q

What makes up the pelvic diaphragm?

A

Levator ani

Coccygeus

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8
Q

What is the urogenital diaphragm?

A

Superficial and deep transverse perineal muscles with their fascial coverings

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9
Q

Where does the uterosacral-cardinal complex tend to break?

A

Medially (around the cervix)

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10
Q

What does the uterosacral-cardinal complex attach to medially?

A

Uterus, cervix, lateral vaginal fornices & pubocervical & rectovaginal fascia

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11
Q

What does the uterosacral-cardinal complex attach to laterally?

A

Sacrum a& fascia overlying piriformis

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12
Q

How is the uterosacral-cardinal complex palpated?

A

Down traction on acerbic and, if intact, allows limited side-side movement of the cervix

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13
Q

What does the pubocervical fascia do?

A

Provides the main support of anterior vaginal wall

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14
Q

Where does the pubocervical fascia tend to break?

A

At lateral attachments of immediately in front of cervix

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15
Q

Where does the pubocervical fascia attach centrally?

A

Merge with base of cardinal ligaments & cervix

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16
Q

Where does the pubocervical fascia attach laterally?

A

Arcus tendinous fascia pelvis

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17
Q

Where does the pubocervical fascia attach distally?

A

Urogenital diaphragm

18
Q

What type of tissue is the rectovaginal fascia tissue?

A

Fibro-musculo-elastic tissue

19
Q

Where does the rectovaginal fascia attach centrally?

A

Merge with base of cardinal/uterosacral ligaments & peritoneum

20
Q

Where does the rectovaginal fascia attach laterally?

A

Fuses with fascia over levator ani

21
Q

Where does the rectovaginal fascia attach distally?

A

Firmly to perineal body

22
Q

Where does the rectovaginal fascia tend to break?

A

Centrally - if upper defect e.g. enterocele

23
Q

What are the 3 levels of endopelvic support?

A

Level I: utero-sacral ligaments and cardinal ligaments
Level II: para-vagina to Marcus tendineus fascia: pubocervical/rectovaginal fascia
Level III: urogenital diaphragm and perineal body

24
Q

What are the main risk factors of POP?

A

Pregnancy and vaginal birth: forceps delivery, large baby, prolonged second stage
Advancing age
Obesity
Previous pelvic surgery (continence procedures)
Hormonal factors
Quality of connective tissue
Constipation
Occupation with heavy lifting
Exercise: weight lifting, high-impact aerobics, long-distance running

25
Q

What is a urethrocele?

A

Prolapse of the lower anterior vaginal wall involving the urethra only

26
Q

What is a cystocele?

A

Prolapse of the upper anterior vaginal wall involving the bladder

27
Q

What is a uterovaginal prolapse?

A

Prolapse of uterus, cervix and upper vagina

28
Q

What is an enterocele?

A

Prolapse of the upper posterior wall of the vagina usually containing loops of the small bowel

29
Q

What is a rectocele?

A

Prolapse of the lower posterior wall of the vagina involving the rectum bulging forwards into the vagina

30
Q

What is an apical prolapse the same as?

A

Enterocele

31
Q

What are typical vaginal symptoms in women with POP?

A 
Sensation of bulge/ protrusion
Seeing or feeling bulge/protrusion
Pressure
Heaviness
Difficulty inserting tampons
32
Q

What are typical urinary symptoms in women with POP?

A 
UI
Frequency/urgency
Weak or prolonged urinary stream
Hesitancy
Feeling of incomplete emptying
Manual reduction of prolapse to start or complete voiding
33
Q

What are typical bowel symptoms in women with POP?

A

Incontinence of flatus, or liquid/solid stool
Feeling of incomplete emptying/straining
Urgency
Digital evacuation to complete defecation
Splinting/pushing on around vagina/perineum to start/complete defecation

34
Q

What is the assessment for POP?

A

Examination - exclude pelvic mass
Record position of exam
QoL effect
Objective assessments

35
Q

What are the objective assessments used in POP?

A

Bade-Walking-Halfawy Grading

POPQ score

36
Q

What is the gold standard objective assessment used in POP?

A

POPQ score

37
Q

What is the POPQ score?

A

Stage 0-VI

Measures 9 points in vagina

38
Q

What investigations can be done in POP?

A

USS/MRI
Urodynamics
IVU or renal USS

39
Q

What are preventions to avoid POP?

A

Avoid constipation
Effective management chronic chest pathology (COPD/asthma)
Smaller family - less parity!
Antenatal pelvic floor training

40
Q

What are the treatment options for POP?

A

Physio: PFMT
Pessaries
Surgery

41
Q

How does PFMT help POP?

A

Increase pelvic floor strength/bulk = relieve tension of ligaments

42
Q

How does prolapse occur?

A

Progressive weakness of the pelvic floor muscles followed by breakdown in fascial support

Reproductive (20 decks)

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