Women's Health Flashcards
1
Q
What is pelvic organ prolapse?
A
A slipping forward of the pelvic organs
2
Q
How do you separate pelvic vs abdominal organs?
A
- line drawn at pelvic ring
- above = abdo
- below = pelvic
- in a sagittal view -line drawn from pubic symphysis to sarcum
3
Q
Explain the movement of the pelvic organs in prolapse using the marble analogy
A
- the pelvic floor runs from the pubis symphysis to the coccyx
- if pelvic floor is strong and tight - the organs are supported
- if the pelvic floor starts to get stretched out - then the marbles (aka the organs) will start to move towards the centre of the pelvic floor as they descend - this is why you see the particular vectors of movement in POP
4
Q
How common is POP??
A
- most common in Australia!
- 75% of women develop SOME degree of POP during their lifetime
- 1 in 3 will have prolapse to the level of the vaginal wall
- 1 in 5 will have surgery for it at some point in their lives
- 20% of waitlists for gynae surgery is for prolapse
- 67% recurrence rate if there pelvic floor mm avulsion
5
Q
Who is at risk for POP?
A
- Women with respiratory conditions/chronic constipation
- Women who heavy lift
- Women who are high level athletes (esp high impact sports)
6
Q
What are the 3 major types of trauma women can sustain to the pelvic floor DURING BIRTH
A
- avulsion to levator ani
- perineal tears
- pudendal nerve neuropraxia
> affected with traction
7
Q
What are the 2 main supports for the pelvic organs
A
Muscle Fascia (endopelvic fascia)
8
Q
What are the 3 subcomponents to the endopelvic fascia?
A
- Rectovaginal (in front of rectum and behind post vaginal wall)
- Pubocervical (like a piece of cardboard betwee front vaginal wall and
- Uterosacral - attaches from post uterus to sacrum)
9
Q
Use the boat in a dock analogy to explain the role of ligaments and mm’s in pelvic floor stability
A
- boat is moored in a dock and tethered via ropes (ligaments) and buoyed up by water (mm’s); if the water levels were to drop completely then all the strain is on the ropes (ligaments) - therefore more strain/creep and more likely to have prolapse
10
Q
How can you prevent exercise induced pelvic floor disorders?
A
- pelvicfloorfirst.org - to increase awareness around PFD and exercise; to reduce the # of people getting PFD d/t bad exercise prescription
- educate the community
- educate people on diff between high impact vs low impact on pelvic floor
- educate on need to strengthen PF first before other muscles
- educate on how to perform exercises safely
- educate on how to distinguish between high risk vs low risk for PF
- educate professionals on prescirbing safe ex’s
11
Q
Describe pubic symphysis rupture
A
- seen in pregnany women (usually there’s a 4-9mm widening of PS) but >1cm can mean RUPTURE!
- rupture d/t:
> uneven foot support
> rapid descent of fetal head - immediate pain; excruciating; unable to WB
12
Q
What is the mx for PS rupture?
A
- immob for 48 hrs with legs together
- STRICT BED REST! with IDC
- ice every 4hrs
- US every 2x/day
- after 48 hrs:
> mob walking frame -> crutches
> belt around PS
> educate to use ab bracing before movement
13
Q
Describe coccyx #
A
- from fetal head
- higher chance if birthing position doesn’t allow free movement of coccyx
- might hear audible crack
- pain/trouble sitting
- worse with trying to activate PF mm’s
14
Q
Descirbe the mx of coccyx fracture
A
- can’t immob - 6-12 mons recovery
- use wedge shaped coccyx cushion to facilitate ant pelvic tilt
- crawl into bed don’t sit on the side of the bed and roll over
15
Q
Describe dequervains
A
- so called ‘baby wrist’
- d/t impaired gliding of abd poll longus + ext poll brevis
- worse with radial deviation
- +ve Finklesteins
