Week 5 - H - Physiotherapy and public health in Obstetrics and Gynaecology

Question 1

Pelvic floor dyfunction * Urinary symptoms * Pelvic organ prolapse * Vulvodynia * Faecal symptoms * Defaecatory dysfunction What are the three layers that make up the pelvic floor? WHat is vulvodynia?

Answer 1

Pelvic floor * Pelvic diaphragm - Levator ani and cocygeus muscle * The deep perineal pouch - superficial perineal pouch is superficial to the perineal membrane * Perineal membrane Vuvodynia Persistent, unexplained pain to the vulva (the skin surrounding the entrance to the vagina)

Question 2

What are the levator ani muscles?

Answer 2

Levator ani - * Puborectalis, * Pubococcygeus, * Ischiococcygeus The coccygeus is the other muscle that makes up the pelvic diaphragm - deepest layer of the pelvic floor

Question 3

What is the classification/scoring system used to measure the texture of a bowel movement? WHat does it range from?

Answer 3

This is the Bristol Stool chart Ranging from 1 - separate hard lumps to 7 - entirely liquid faeces

Question 4

Urinary incontinence has significant negative effects on quality of life and detrimental effect on wider aspects of health (depression, falls etc) SIGN 79 What aspects of the patients life can urinary incontinence affect?

Answer 4

Psychologically - can cause embarrassment Socially - patient may be scared to socialise due to fear of incontinence Sexually - women may avoid sex due to fear of leakage Domestically - pads are expensive to buy Occupationally - women may have fear of incontinence at work Physically - fear of exercise due to leakage

Question 5

What is the lifetstyle advice for those with incontinence?

Answer 5

Healthy BMI Avoid smoking Reduce caffeine intake - mild diuretic and stimulates detrusor activity Avoid constipation Avoid heavy lifting

Question 6

What exercises are useful to carry out in SUI and MUI?

Answer 6

Carry out pelvic floor exercises 3 times daily for 3 months As well as bladder retraining drills for 6 weeks to try and help the time between voiding Pelvic floor muscle exercises (PFME) have not been shown to be very effected in treating just urge urinary incontinence

Question 7

Evidence suggests positive effects of strengthening PF in pregnancy Women encouraged to do PFM exs throughout pregnancy and after giving birth Which classification of perineal tears extend into the anal sphincters?

Answer 7

3rd and 4th degree perineal tears extend into the anal sphincters

Question 8

In NHS tayside, which women who have had a pregnancy are offered one to one contact where pelvic floor muscle exercise technique is discussed? ie which type of delivery and which type of perineal tear

Answer 8

Women who had forceps delivery or women who had a 3rd or fourth degree perineal tear

Question 9

What is the difference between primary, secondary and tertiary care?

Answer 9

Primary care - usually first point of contact for people in need of healthcare - GPs and Dentists Secondary care - usually hospital and community services Tertiary care - this is usually highly specialised care which is referred by primary or secondary in a facility that has personnel and facilities for advanced medical investigation and treatment, such as a tertiary referral hospital.

Question 10

What is the difference between primary, secondary and tertiary prevention?

Answer 10

Primary prevention - this is stopping a disease before it starts Secondary prevention - early detection of the disease to reduce its severeity and reduce recurrence Tertiary prevention - this is treatment of the disease to prevent is complications

Question 11

Public Health issues in obstetrics and gynaecology Good targets for prevention * Reducing teenage pregnancy * Breastfeeding * Obesity * (Breast cancer) * (Cervical cancer) Which drug given to prevent the rates of pregnancy loss and miscarriage was found to cause clear cell adenocarcinoma of the cervix?

Answer 11

This was found to be diethylstilbesterol (DES) - 15-20 year olds whose mothers took the drug in utero were being found to have clear cell adenocarcinoma of the cervix

Question 12

What are the ways to prevent teenage pregnancy?

Answer 12

Contraception and education mainly

Question 13

What are WHOs recommendations for breast feeding? Ie how long for exclusive feeding? How long to continue feeding after other foods are introduced? How often to feed?

Answer 13

Exclusively breastfeed for the first months of life Introduce other foods to complement breastfeeding and continue with breastfeeding until 2 years or more Feed within an hour of birth and on demand when the baby requires feeding

Question 14

What cancers obesity effect most?

Answer 14

Increases the risk of endometrial then oesophageal cancers the most

Question 15

WHat are the guidlines for IVF treatment?

Answer 15

BMI must be between 18.5 and 430 for the female partner Both partners must not drin alcojhol Both partners must be methdone free for at least one year Partners should be below 43 years of age and have tried regular unprotected sex for at least 2 years without success or had 12 cycles of artificial insemination

Question 16

Most couples (about 84 out of every 100) will get pregnant within a year if they have regular sex and don’t use contraception. However, women become less fertile as they get older. One study found that among couples having regular unprotected sex: * aged 19-26 – 92% will conceive after one year and 98% after two years * aged 35-39 – 82% will conceive after one year and 90% after two years What is artifical insemination?

Answer 16

The amount of couples who get pregnancy after two years almost encompasses all the couples which is why IVF is reserved for those who have tried for 2 years without success Artifical insemination - intrauterine insemination is when the sperm is injected directly into the womb -