Uterine Prolapse Flashcards
The definition of prolapse is a downward movement of pelvic structures secondary to weak connective tissues. What % of women >50 y/o are expected to have some symptoms of pelvic floor prolapse?
1 - 5%
2 - 15%
3 - 50%
4 - 80%
3 - 50%
The definition of prolapse is a downward movement of pelvic structures secondary to weak connective tissues. What % of women with uterine prolapse will need corrective surgery at some point?
1 - 2%
2 - 5%
3 - 20%
4 - 60%
3 - 20%
What age does uterine prolapse typically peak?
1 - 30
2 - 45
3 - 55
4 - 70
4 - 70
- can occur earlier depending on risk factors
In a prolapse, which organs can be effected?
1 - uterus
2 - bladder
3 - urethra
4 - rectum
5 - vaginal vault
6 - all of the above
6 - all of the above
all protrude out of the vagina
Which of the following is NOT a risk factor for developing uterine prolapse?
1 - Childbearing and vaginal delivery
2 - Age
3 - Obesity
4 - Chronic cough
5 - Abdominal mass (eg fibroids)
6 - Pelvic surgery
7 - Connective tissue disorders
2 - Age
Women with uterine prolapse can present with a variety of symptoms which typically get worse as the day progresses. Which of the following is NOT a common symptom of uterine prolapse?
1 - increased pelvis pressure
2 - urinary incontinence
3 - dysuria
4 - difficulty emptying the bladder or bowel
5 - dyspareunia
6 - general back/pelvic pain
3 - dysuria
- pain/stinging when urinating
- patients can also be asymptomatic
The pelvic floor support structures help hold the rectum and vagina entry in place. Which of the following ligaments holds in place the rectum and vagina posteriorly?
1 - utero sacral ligaments
2 - cardinal ligaments
3 - white line of fascia (arcus tendineus fascia pelvis)
4 - pubo cervical fascia
1 - utero sacral ligaments
- attaches from cervix to sacrum
The pelvic floor support structures help hold the rectum and vagina entry in place. Which of the following ligaments holds in place the rectum and vagina laterally?
1 - utero sacral ligaments
2 - cardinal ligaments
3 - white line of fascia (arcus tendineus fascia pelvis)
4 - pubo cervical fascia
2 - cardinal ligaments
- attaches from cervix to greater sciatic foramen before
The pelvic floor support structures help hold the rectum and vagina entry in place. Which of the following ligaments holds in place the rectum and vagina anteriorally?
1 - utero sacral ligaments
2 - cardinal ligaments
3 - white line of fascia (arcus tendineus fascia pelvis)
4 - pubo cervical fascia
4 - pubo cervical fascia
- attaches from cervix to symphysis
The prolapse can be categorised based on which compartment of the pelvis is affected. What is the name given if the anterior compartment is affected?
1 - rectal prolapse
2 - cystocele prolapse
3 - uterine prolapse
4 - rectocele prolapse
2 - prolapse
- causes bulging at the front of the vagina
- can also be a urethrocele
urethrocele = urethral
cystocele = bladder
The prolapse can be categorised based on which compartment of the pelvis is affected. What is the name given if the posterior compartment is affected?
1 - rectal prolapse
2 - cystocele prolapse
3 - uterine prolapse
4 - rectocele prolapse
4 - rectocele prolapse
- causes bulging at the back of the vagina
- can also be called a enterocele
rectocele = rectal
enterocele = small bowel herniation)
The prolapse can be categorised based on which compartment of the pelvis is affected. What is the name given if the uterus is affected?
1 - rectal prolapse
2 - cystocele prolapse
3 - uterine prolapse
4 - rectocele prolapse
3 - uterine prolapse
In a patient with a suspected prolapse, what should be the 1st line investigation?
1 - urinalysis
2 - PR examination
3 - bimanual pelvic examination
4 - ultrasound
3 - bimanual pelvic examination
- speculum will tell you exactly where the bulge is coming from
- valsalva manoeuvre can be performed to elicit the prolapse by increasing intra abdominal pressure
- can also assess for pelvic masses, tenderness, or cervical motion tenderness.
Are all prolapses the same severity?
- no, different stages
- stage 4 and 5 are the worse
What is a procidentia in terms of a prolapse?
1 - bowel protrudes into bladder
2 - pelvic organs protrude outside the vaginal
3 - uterus folds in on itself
4 - bladder moves into abdominal cavity
2 - pelvic organs protrude outside the vaginal
Typically what is the first line treatment for a patient with a prolapse?
1 - Physiotherapy
2 - Pessary treatment
3 - Surgery
4 - botox injections
1 - Physiotherapy
- ineffective in advanced cases, but useful in less severe cases
How can a pessary help treat a prolapse?
1 - provides structural support
2 - provides electrical current to strength pelvic muscles
3 - contains estrogen which is effective at strengthening the pelvic muscles
4 - all of the above
1 - provides structural support
- positioned behind pubic bone and posterior fornix
- should be no pain or discomfort
If a vaginal pessary is proving helpful for a patient with a prolapse, how often should they be checked and changed?
1 - every week
2 - every month
3 - every 6 months
4 - every year
3 - every 6 months
- can increase discharge and cause ulceration and damage to vaginal wall
Surgery for prolapse is common place. Which of the following is NOT a benefit of surgery for prolapse?
1 - Very effective initially
2 - Mostly conducted vaginally rather than abdominally
3 - Low recurrence rates
4 - Amenable to spinal anaesthesia
3 - Low recurrence rates
- there is a high recurrence rate
Surgery for prolapse is common place. Which of the following is NOT a negative of surgery for prolapse?
1 - High recurrence rate
2 - Complications of surgery in often elderly patients
3 - Straightening of urethra in prolapse correction may lead to de-novo stress incontinence
4 - small intestine perforation
4 - small intestine perforation
