WOMEN'S HEALTH & OBSTETRICS Flashcards
1
Q
STUDY PAGE 3-7
A
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2
Q
This is the interlocking ridges and grooves of the bony joint surfaces of the pelvis
A
Form Closure
3
Q
This Fits of the wedge shaped sacrum between the ilia
A
Form closure
4
Q
PAGE 9
A
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5
Q
Pelvic floor muscles have 3 major fun ctions:
A
-Support of the pelvic organs:
bladder, urethra, prostate (males),
vagina and uterus (females),
anus, and rectum, along with the general
support of the intra-abdominal contents.
-Contribute to continence of urine and feces.
-Contribute to the sexual functions of arousal and orgasm
6
Q
PAGE 11
A
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7
Q
This is a Thin, muscular layer of tissue that forms the inferior border of the
abdomipelvic cavity
A
Pelvic Diaphragm
8
Q
T/F The Pelvic Diaphragm is composed of a thin, cylindricalshaped sling of fascia or muscle
A
F, FUNNEL SHAPED
9
Q
Pelvic diaphragm extends from the ________ to the ______ and from one _____ sidewall to the other
A
Symphysispubis
coccyx
Lateral
10
Q
PAGE 13
A
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11
Q
This is a strong, muscular membrane with triangular ligament
A
Urogenital Diaphragm
12
Q
The urogenital diaphragm occupies the space between _______ and _____
A
Symphysis pubis
Ischial tuberosity
13
Q
T/F The urogenital diaphragm stretches across the triangular posterior portion of the pelvic outlet
A
F, ANTERIOR
14
Q
The urogenital diaphragm is ____and ___to the pelvic diaphragm
A
external and inferior
15
Q
PAGE 15
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16
Q
Pelvic ligaments are not actual ligaments and it is the thickening of the ________fascia
A
Retroperitoneal
17
Q
T/F Pelvic ligaments consist primarily of blood vessels, nerves, and fatty connective tissue
A
T
18
Q
This is the continuations of the transversalis fascia of the abdomen
A
Subserous fascia or endopelvic fascia
19
Q
PAGE 17
A
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20
Q
T/F Broad ligaments are thick, mesenteric-like single reflection of peritoneum
A
F, THIN & DOUBLE
21
Q
Broad ligaments stretches from ________ to the ______
A
lateral pelvic sidewalls
uterus
22
Q
Cardinal/Mackenrodt’s ligaments extend from the lateral aspects of ________ and the ____ to the pelvic wall
A
the upper part of the cervix
vagina
23
Q
Uterosacral ligaments extend from the______ posteriorly to the _____
A
upper portion of the cervix
S3
24
Q
Superficial muscles
A
⚬ External anal sphincter
⚬ Perineal body
⚬ Puboperineal (Transverse perinei) muscles
25
Deep muscles
⚬Ileococcygeus
⚬ Pubococcygeus
⚬ Coccygeus
⚬ Puborectalis
26
PAGE 21-23
MEMORIZE PAGE 22
27
T/F There are two types of anal sphincters: Internal anal/External Anal
T
28
This sphincter is the extension of the circular muscle layer of the rectum
Internal Anal sphincter
29
This sphincter is the extension of the longitudinal muscles of the rectum
External anal sphincter
30
T/F The external anal sphincter is not part of the levator ani muscles
F, technically part
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PAGE 29
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Innervation of the pelvic floor
⚬ Pudendal nerve (S2 -S3)
⚬ Direct branch from S4
￭ Nerve to Levator Ani
33
T/F Pelvic floor dysfunction involves the abnormal activity or function of
the pelvic floor musculature
T
34
One of the largest and unaddressed issues in
women's health care today
Genital prolapse
Urinary/Fecal incontinence
35
T/F If the pelvic floor is contracted, or damaged, the PFM cannot actively
support
F, is relaxed
36
Pelvic floor dysfunctions may lead to the following:
⚬ Urinary incontinence
⚬ Fecal incontinence
⚬ Pelvic organ prolapse
⚬ Sensory and emptying abnormalities of the lower urinary tract
⚬ Defecation dysfunction
⚬ Sexual dysfunction
⚬ Chronic pain syndromes
37
Boat in the Dry Dock Theory
A. Ship
B. Ropes
C. Water
1. ligaments and fascia
2. PFM support
3. Pelvic organs
B
C
A
38
T/F When the PFM relaxes or is damaged, the pelvic organs must be held in
place by the ligaments and fasciae alone
T
39
T/F If the PFM cannot actively support the organs, over time the connective tissue will become contracted and damaged.
F, stretched and damaged
40
PAGE 31
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41
T/F Soda can theory states that the core are abdominal muscles
T
42
Proposed the Soda-Pop Can Model of Postural Support
Mary Massery
43
T/F The glottis is the bottom of the soda can.
F, top
*If you open the top of a soda pop can, it can
easily be deflated and reshaped.
44
The can pressure for the soda can theory is _________
intraabdominal pressure
45
A can that is closed creates pressure within the can, which is crucial not
only to the shape of a soda-pop canbut that imagery also relates to the
function of your core and maintaining good postural control.
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PAGE 33
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47
PREDISPOSING FACTORS CAUSING PELVIC FLOOR DYSFUNCTION
gender,
genetic,
neurological,
anatomical,
collagen,
muscular,
cultural, and
environmental
GGCA
48
INCITING FACTORS CAUSING PELVIC FLOOR DYSFUNCTION
MNC
childbirth,
nerve damage,
muscle damage,
radiation,
tissue disruption,
radical surgery
49
PROMOTING FACTORS CAUSING PELVIC FLOOR DYSFUNCTION
constipation,
occupation,
recreation,
obesity,
surgery,
lung disease,
smoking,
menstrual cycle,
infection,
medicine,
menopause
COR
50
DECOMPENSATING FACTORS CAUSING PELVIC FLOOR DYSFUNCTION
ageing, dementia, disease,
environment, medication
51
T/F The PFM are only responsible for gross motor movements alone
F, but ALSO work in synergy with other trunk muscles
52
Pelvic floor dysfunction may lead to symptoms during movement and
perceived restriction in the ability to stay physically active.
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53
may lead to a change in movement patterns
during physical activities , withdrawal from regular fitness activities,
and troublesome difficulties when being active
Urinary incontinence
54
T/F During pelvic floor dysfunction, the PFM is subject to continuous strain throughout the lifespan
T
55
In particular, the pelvic floor of women is subject to tremendous strain
during _____
Pregnancy and childbirth
56
In addition, hormonal changes may influence the pelvic floor and pelvic
organs, and a decline in muscle strength may occur due to ageing
-
57
The PFM may need regular training to stay healthy throughout life
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58
A thorough examination of the ________________ is important for differential diagnosis
lumbar spine, pelvic girdle, lower limbs, and
PFM
59
PELVIC FLOOR EXAM
⚬ Vaginal & Anal Exam
⚬ Neurologic exam of lower sacral segments
⚬ Assessment of internal structures (gynecologic, urologic,
colorectal)
60
Common patient complaints include
⚬ leaking urine or stool
⚬ problems with having a bowel movement
⚬ pressure or discomfort in the pelvis
⚬ seeing or feeling a bulge protruding out of the vagina or anus
⚬ pain while urinating or during sex
⚬ incontinence
⚬ difficulty emptying the bladder or bowels completely
61
Other assessments of the pelvic floor:
⚬ Vaginal/anal palpation
⚬ Electromyography
⚬ Vaginal squeeze pressure measurement
⚬ Pel vic floor dynamometry
⚬ Ultrasound of the PFM and pelvic organ descent
⚬ MRI of the PFM and Pelvic floor
62
Outcome Measures:
⚬ Pelvic Floor Impact Questionnaire (PFIQ-7)
⚬ Australian Pelvic Floor Questionnaire
⚬ Pelvic Pain Questionnaire
63
PAGE 42
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64
This is the involuntary leakage of urine with 3 main types
Urinary Incontinence
3 main types
￭ Stress Urinary Incontinence
￭ Urge Urinary Incontinence
￭ Mixed Urinary Incontinence
65
Loss of urine with increased intraabdominal pressure such as coughing, laughing, sneezing, or physical exertion
Stress Urinary Incontinence
66
Due to deficiencies in the PFMs, urethra, bladder, and/or sphincter, it
is difficult to maintain urethral closure pressures
STRESS URINARY INCONTINENCE
67
ETIOLOGY OF STRESS URINARY INCONTINENCE
pregnancy,
vaginal delivery,
pelvic surgery,
pelvic organ prolapse, neurologic causes, active lifestyle, obesity, and
aging
68
This is the Involuntary leakage accompanied by or immediately preceded by the
sudden onset of the urge to void that cannot be deffered easily
Urge Urinary Incontinence
69
T/F Urge Urinary Incontinence can be caused by voluntary detrusor contraction that overcomes
the sphincter mechanism
F, Involuntary
70
Urge urinary incontinence Can also be caused by ________ that is due to the loss of the viscoelastic properties of the bladder
poor bladder compliance
71
Urge urinary incontience may neurogenic in nature __________,___,__,__, or idiopathic
SCIs, spinal stenosis,
MS, and stroke
72
Non neurogenic urger of urinary incontinence may be caused by ______
radiation
73
Occurs when the patient experiences both SUI and UUI symptoms
Mixed Urinary Incontinence
74
PAGE 48
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75
PERCENT PREVALENCE OF UI
34%
76
Risk Factors of Pelvic Floor Dysfunction
￭ Race, hormonal status, obesity, history of pregnancy or childbirth, chronic disease, constipation, family history
￭ Risk increase with smoking, increased BMI, and increased parity(SBP)
77
High-level female athletes
￭ SUI prevalence _____
41.5%
78
Characterized by pain, muscular tautbands, and trigger points that cause pain reffera l with pressure
Pelvic Floor Myofascial pain
79
PFMP can also be caused by the ff:
overuse,
dysfunctional postures,
weakness of PFMs
80
PFMP contributes to
dysparenuria,
painful sexual intercourse,
chronic pelvic pain
81
T/F PFMP may be d/t hx of birth trauma/sexual abuse
T
82
EPIDEMIOLOGY
⚬ 22% of women (14-79) with chronic
⚬ 70% of women with pregnancy related pelvic girdle pain
⚬ 52% of women with chronic lumbopelvic pain that began during
pregnancy
⚬ 25% of community dwelling adults
83
Mainstay treatment of Pelvic Floor Myosfascial Pain
Pelvic PT
*NSAIDs, antidepressants, other medications
84
GOALS OF RX for Pelvic Floor Myofascial Pain
￭ Restore muscle imbalances
￭ Improve function
￭ Improve posture
￭ Reduce pain
85
PAGE 53
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86
What are changes of the body during pregnancy
Increase in:
-anterior pelvic tilt
-body mass
-demands for the hip extensors, hip abductors, ankle plantar flexors, and PFMs
-ligamental laxity
-lumbar lordosis
-pelvic tilt
-Lengthening of the abdominal muscles
ABL
87
Pregnancy and Postpartum Pelvic Floor Dysfunction pain may arise from these areas:
-Lumbar spine
-Pelvic girdle
-Hip
-PFM
88
Most common cause of back and pelvic pain in pregnancy
Pelvic Girdle Pain
89
Pelvic Girdle Pain is experience between the _____ and _____
posterior iliac crest
gluteal fold
90
Etiologies of Pelvic Girdle Pain
mechanical, hormonal, inflammatory, collagen abnormalities, and neural
HIM
91
A hormone produced by the corpus luteum that relaxes the uterine musculature, ligaments, and joints to allow pelvic
expansion
Relaxin
92
* Epidemiology
⚬ PGP affects 20% of pregnant women
93
Risk factors for Pregnancy and Postpartum Pelvic Floor Dysfunction
￭ History of low back pain
￭ History of pelvic trauma
￭ Parity
￭ Workload
94
4 subgroups of PGP
⚬ Double-sided SIJ syndrome -6.3%
⚬ Pelvic girdle syndrome -6%
￭ Pain in all 3 pelvic joints
⚬ One-sided SIJ syndrome -5.5%
⚬ Symphisiolysis or pubic symphisis pain 2.3%
95
Treatment for Pregnancy and Postpartum Pelvic Floor Dysfunction
⚬ Individualized PT for realignment and stabilization
⚬ Pelvic floor PT
⚬ Pelvic manipulation and SIJ belts have shown to be beneficial
⚬ Bed rest, ice and acetaminophen
⚬ NSAIDs may be done after the pregnanc
96
Can be a source of CPP and can co-exist with all other pelvic floor
dysfunctions such as PFD and PMPS.
Pelvic Nerve Injuries
97
Nerves affected during pelvic nerve injuries
￭ Iliohypogastric
￭ Ilioinguinal
￭ Genitofemoral
￭ Pudendal
98
￭ May cause urinary incontinence and sexual dysfunction
Pudendal neuropathy
99
Nerves affected in Pfannenstiel or low transverse incision
Iliohypogastric and ilioinguinal
100
may be compressed during gynecologic surgery
Genitofemoral nerve
101
Commonly injured during vaginal delivery and may cause urinary inc & sex dysfunc
Pudendal nerve injury
* May also be injured d/t pelvic trauma, bicycle riding, and anal
intercourse
102
PELVIC NERVE INJURY TREATMENT
⚬ Pelvic PT and medications
⚬ Corticosteriods
⚬ Creams with ketamine or other pain medication
⚬ Radiofrequency ablation
⚬ Pulsed radiofrequency treatment
⚬ Neuromodulation at the sacral plexus or spinal cord
103
⚬ Impairment characterized by the separation of the two rectus
abdominis muscles along the linea alba
Diastesis Recti Abdominis
104
May be seen congenitally,
but most commonly develops during pregnancy and in the early post-pregnancy period
Increased inter rectus distance (IRD)
105
A widening of ____ at the level of the umbilicus is considered a
pathological diastasis of the rectus abdominis muscle
>2.7 cm
106
T/F Diastesis Recti Abdominis Most commonly affects the women at the 2nd trimester
F, 3rd
107
Natural resolution and greatest recovery of DRAM occurs between _____
day and ___ weeks after delivery, after which time recovery plateaus
1
8
108
Incidences of DRAM has been reported ranging from 66% to 100%
during the third trimester of pregnancy, and up to 53% immediately
after delivery
-
109
Diastesis Recti Abdominis may result in
-altered trunk mechanics,
-impaired pelvic stability
- changed posture
-lumbar spine and pelvis more vulnerable to injury
-herniation
110
PAGE 65-66
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111
Treatment for diastesis recti
⚬ Bracing
⚬ Facilitation, concentric activation, and stabilization of the abdominals
⚬ Pelvic floor muscle exercises
⚬ Maintenance of stability and mobility of the trunk
112
Incorporated during exercise which works as a harness, so that there is an adequate intra-abdominal force generated which can
protect the diastasis from worsening
Bracing
113
PAGE 68-69
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114
During pelvic exercises the Correct way of doing a PFM contraction:
Squeeze around pelvic openings and inward/cranial lift
115
⚬ Explain to patients the position of pelvic floor muscles
⚬ Remind patients to continue breathing and not to strain during the
exercise
⚬ Check for contraction of abdominals, hip muscles, and gluteals
⚬ May do in different positions such as supine, sitting, or standing with
standing being the most difficult
-
116
Pelvic exercises May start with ____ seconds, then increase, ___ set of _and increase sets
2-3
1
10
117
Variations of Pelvic exercise
⚬ Kegel’s with heel slides
⚬ Kegel’s with toe taps
118
* Pelvic Exercise for Hypertonic PFMs
-Diaphragmatic breathing
-General relaxation exercises
-Happy Baby pose
119
Hypotonic
Hypertonic
1. difficulty initiating or maintaining urination
2. pelvic pressure or fullness
3. bowelor urinaryleakage
4. difficulty emptying your bladder
5. constipation
6. frequent urge to urinate, even if you just went
7. decreased sensation in the vaginal canal
8. painful vaginal penetration
9. straining during bowel movements
1. HYPER
2. HYPER
3. HYPO
4. HYPER
5. HYPER
6. HYPO
7. HYPO
8 HYPER
9. HYPER
120
Defined as a condition of 3 interrelated components that exist on a
continuum of severity
FEMALE ATHELETIC TRIAD
121
The female atheletic triad consists of:
￭ Energy deficiency
￭ Menstrual dysfunction
￭ Impaired bone health
122
All three components of the triad do not have to be present in an
athlete simultaneously to be affected by the condition or diagnosed
with it
-
123
PAGE 77-78
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124
This is AKA low energy availability which experiments have shown this to be
the starting point of severe health implication
Energy deficiency
125
Four pathways of energy deficiency
-Clinical eating disorders
-Disorder eating (DE) patterns
-unintentional undereating d/t high energy
expenditure sports
-Intentional weight loss
CDII
126
⚬ Eumenorrhea -> amenorrhea
Menstrual Dysfunction
127
￭ When a girl has not started her first period by age 15
Primary amenorrhea
128
￭ When menstrual periods are absent for 3 months or 90 days
Secondary amenorrhea
129
Three different components can lead to HPG suppression:
*hypothalamic-pituitary-gonadal axis
-Disordered eating
-Intense exercise
-psycho. stress
130
PAGE 81
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131
Impaired bone health which is A systemic skeletal disease characterized by low bone density and microarchitectural deterioration of bone tissue with consequent increase in bone fragility
Osteoporosis
132
Formation and absorption rates of bone are affected by:
-Aging
-Calcium intake
-Vitamin D
-Estrogen levels
133
Medical consequences of Female Athlete Triad could reach other systems such as endocrine, gastrointestinal, renal, neuropsychiatric, musculoskeletal, and cardiovascular.
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134
T/F Intermittent amenorrhea or luteal deficiency leaves women infertile
since there is no follicular development, ovulation, or luteal function
F, Persistence
135
T/F Osteoporosis makes bones more fragile and more prone for fracture
T
136
TREATMENT FOR OSTEOPOROSIS
-Prevention is key
-Early recognition = early dx
-early detection and rx = optimizing bonehealth
-Clinical ED warrants a referral to a mental health practitioner and or a
sport dietician
-Regular weightbearing exercises should also be considered both as a
preventive measure or as a management option among all sports
137
First line of treatment is addressing the elements that cause LEA and
the restoring normal energy balance
-
138
PAGE 85 -86
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139
An endocrine disorder characterized by changes in hormone levels
Polycystic ovarian syndrome
140
Polycystic Ovarian Syndrome is associated with increased prevalence ofserious clinical problems such
as:
Anxiety
Cardiovascular risk
Depression
Diabetes
Dyslipidemia
Hypertension
Insulin resistance
Obesity
Reproductive implications
ADH
141
Most common reproductive symptoms of PCOS:
-anovulatory infertility
-high production of male hormones
-irregular menstruation
-pregnancy complications
142
88-89
-
143
High levels of insulin stimulate ovaries to increase ________ secretion
and have inhibitory effects on the hepatic production of _______
androgenic
sex hormone binding globulin (SHBG)
144
T/F Insulinresistance affects ovulation and decrease the risk of infertility
F, increase
145
Lifestyle modification such as diet and physical activity can reduce
insulin resistance, improve metabolism, and improve reproductive
function.
-
146
PAGE 91
147
TREATMENT FOR PCOS
-Exercise
-Weight reduction =improve glucose tolerance
148
Women with PCOS may also present with the following:
* Lowback/Sacral Pain
* Lowerquadrantabdominal pain
149
Beaware that glucose intolerance and insulin resistance may affect the
patient’s abilitytoparticipateinactivities
-
150
Medication that induce insomnia, vomiting, blurry vision, and frequent urination
Clomephene citrate
151
Commonly referred to as menstrual cramps
Primary dysmenorrhea
152
T/F Primary dysmnorrhea is defined as the pain occurring in the lower abdomen before or during the menstrual cycle, in the absence of any other pelvic pathology (e.g.,
endometriosis)
T; Prevalence rate of 20 to 90%
153
Systematic symptoms of primary dysmenorrhea may include:
Diarrhea
Fatigue
Fever
Headache or light-headedness
Nausea
Vomiting
154
Dysmenorrhea Thought to be caused by increased levels of _______ and
_________
prostaglandins
vasopressin
155
Treatment for dysmenorrhea
NSAIDS
Modalities (Heat therapy and TENS)
*Several studies have reported beneficial effects of exercise,
including stretching, aerobic exercise (e.g., jogging), yoga
and kegel exercises, to treat primary dysmenorrhea
156
⚬ Gender-affirming surgery for transgender women
VAGINOPLASTY
157
⚬ Gender affirming surgery for transgender men
PHALLOPLASTY
158
Both surgeries require reconstruction of the genitals and require
dissection through the superficial and deep pelvic floor musculature
-
159
T/F Surgical disruption can cause problems with the urethral sphincter and
may affect bowel and continence as well
T;*SUI from vaginoplasty has been reported as 16-33%
160
* Pelvic floor PT has been shown to help with pelvic pain and pain-related
sexual dysfunctions and can help treat urinary incontinence
* PTs can also evaluate and educate patients preoperatively for better
functional outcomes
-
161
PTs may assist with _____ as some are trained to use dilators
neovaginal dilation
162
T/F The higher prevalence of pelvic floor dysfunction (postoperatively) may be
attributed to tucking, avoidance of public restrooms, hormone
replacement surgery, and sexual assault
F; PREOPERATIVELY
163
EVALUATIONSINCLUDE
⚬ Postural assessment (looking at your posture);
⚬ Muscle testing;
⚬ Internal muscle and fascial palpation of the pelvic floor
muscles (seeing if the muscles inside your pelvic floor move
correctly);
⚬ EMG testing
⚬ Checking for scar and soft tissue restrictions, gait, and
movement patternS
164
* Goals for PT Treatment
⚬ Having fewer bathroom accidents (incontinence);
⚬ Having less pain when urinatin g or go to the bathroom
⚬ Having less pain while sitting, walking, standing, and during
sex
