Pelvic relaxation

Question 1

the ureter runs under which ligament?

Answer 1

uterosacral

Question 2

what are the signs and symptoms of pelvic floor prolapse?

Answer 2

• pelvic pressure or pain
• bulging from the vagina
• dyspareunia or difficulties with intercourse
• difficulties voiding or evacuating bowels

Question 3

what are the 3 levels of vaginal support? which is most important?

Answer 3

level 1 - CT support to upper vagina
level 2 - fascial arcus in mid vagina
level 3 - anterior: fusion of anterior vagina and urethra and muscles involved in urethral support, posterior: fusion of posterior vagina and perineal body

level 1 is most important

Question 4

an anterior compartment prolapse is AKA:

Answer 4

• cystocele
• cystourethrocele
• hypermobile urethra

Question 5

a posterior compartment prolapse is AKA:

Answer 5

rectocele

Question 6

an apical vaginal prolapse is AKA:

Answer 6

vaginal vault prolapse

Question 7

what is the dove tail sign? what does is mean?

Answer 7

flattening around anterior surface of anus

indicates perineal injury

Question 8

what is the result of damage to level 1 vaginal support? what is level 1 support?

Answer 8

uterine or vaginal vault prolapse

level 1 support = CT support to upper vagina

Question 9

what causes an apical prolapse?

Answer 9

loss of apical support from the uterosacral ligaments

Question 10

cystocele / rectocele is a result of failure of which level of vaginal support?

Answer 10

level 2

Question 11

fascial arcus in the mid vagina

Answer 11

level 2 of vaginal support

Question 12

loss of fusion of the posterior vagina and perineal body results in:

what level of vaginal support is this?

Answer 12

perineocele

level 3 posterior

Question 13

loss of support in the fusion of anterior vagina and urethra and muscles involved in urethral support results in:

what level of vaginal support is this?

Answer 13

hyeprmobile urethra

level 3 anterior

Question 14

definition: hypermobile urethra

Answer 14

over 30 degrees from horizontal by Q tip test

proximal urethra moves out of abdominal cavity

Question 15

what are the risk factors for fecal incontinence and parturition?

Answer 15

• instrumental delivery
• prolonged 2nd stage labor
• birth weight over 4 kg
• OP position
• episiotomy

Question 16

why do patients with stage III or IV prolapse present without incontinence?

Answer 16

functional obstruction in the outflow tract that can simulate continence

Question 17

what are the two main categories of urinary incontinence?

Answer 17

• hypermobility

- intrinsic sphincter deficiency

Question 18

how does hypermobility cause urine incontinence?

Answer 18

related to movement of bladder neck and urethra triggered by abdominal straining (lifting, jogging)

Question 19

how does intrinsic sphincter deficiency cause urine incontinence?

Answer 19

leakage of urine with minimal exertion related to instrinsic weakening of the bladder outlet closure mechanism

Question 20

which type of incontinence results in continuous leakage of small amounts of urine?

Answer 20

overflow incontinence

Question 21

what are the baden walker classifications of pelvic floor prolapse?

Answer 21

grade 1 - prolapsed tissue descends halfway to the hymen

grade 2 - prolapsed tissue extends to the level of the hymen

grade 3 - prolapsed tissue extends outside the hymen with straining

grade 4 - prolapsed tissue extends outside the hymen without straining

Question 22

grade 1 baden walker classifications of pelvic floor prolapse

Answer 22

prolapsed tissue descends halfway to the hymen

Question 23

grade 2 baden walker classifications of pelvic floor prolapse

Answer 23

prolapsed tissue extends to the level of the hymen

Question 24

grade 3 baden walker classifications of pelvic floor prolapse

Answer 24

prolapsed tissue extends outside the hymen with straining

Question 25

grade 4 baden walker classifications of pelvic floor prolapse

Answer 25

prolapsed tissue extends outside the hymen without straining

Question 26

prolapsed tissue extends to the level of the hymen

Answer 26

grade 2

Question 27

prolapsed tissue extends outside the hymen with straining

Answer 27

grade 3

Question 28

prolapsed tissue descends halfway to the hymen

Answer 28

grade 1

Question 29

prolapsed tissue extends outside the hymen without straining

Answer 29

grade 4