Applied Anatomy

Question 1

What is an episiotomy?

Answer 1

Surgically planned incision on perineum & posterior vaginal wall during second stage of labour

Question 2

When is an episiotomy required?

Answer 2

• Normally used to prevent further tearing or prevent tearing occuring at all
• Sometimes need to expedite the birth if the women is getting exhausted
• Creates space for shoulder dystocia
• May be required for normal birth /forceps delivery
• May have a spontaneous tear

Question 3

What are the degrees of episiotomy?

Answer 3

1. Vaginal mucosa
2. Towards perineal muscles
3. External anal sphincter
4. Internal anal sphincter

Question 4

Definition of ceasarian section? Risks?

Answer 4

Defined as delivery of the fetus through incision in the abdominal wall & uterine wall

• Bladder injury 1 in 1000
• Uteritic injury 1 in 10000

Question 5

What is a hysterectomy? Reasons for procedure?

Answer 5

Surgical removal of the uterus

• Fibroids, post partum haemorrhage, malignancy

Question 6

What is the course of the ureter?

Answer 6

• Crosses over bifurcation of the common iliac vessels
• Runs retroperitoneally on the lateral pelvic wall
• At the level of the ischial spine, turns forward and medially
• Crossed by the uterine artery
• Passes about 2 cm lateral to the cervix and in front of the lateral border of the vagina.
• Enters the back of the bladder

Question 7

Which ureter/kidney is more effected by dilatation in pregnancy?

Answer 7

Right

Question 8

What are fibroids?

Answer 8

The commonest benign tumour arising from the myometrium, mainly affecting smooth muscle

Question 9

SSx with fibroids?

Answer 9

Often assymptomatic but may present with dysmenorrhoea, menorrhagia, pressure symptoms and pain

Question 10

Management of fibroids?

Answer 10

• Symptom relief
• Hormonal vs intervention
  
  • Myomectomy (surgical removal of fibroids)
  • Hysterectomy
  • Uterine artery embolization
  • GnRH analogues

Question 11

What is endometriosis?

Answer 11

Chronic inflammatory condition defined by endometrial stroma and glands found outside the uterine cavity.

Most common sites are pelvic peritoneum and ovaries.

Question 12

What are the symptoms in endometriosis [and reasons for the symptoms]?

Answer 12

• Endometriotic tissues detach and bleed: resulting in internal bleeding

Symptoms

• Presence of risk factors
• Dysmenorrhoea
• Chronic pelvic pain
• Dyspareunia (painful sex)
• Sub-fertility

Question 13

Management of endometriosis?

Answer 13

Fertility not desired: pain without endometrioma or suspected severe disease.

1. Oral contraceptive pill, adjunct NSAID

Fertility not desired: pain with endometrioma or suspected severe disease

1. Surgery adjunct, post surgery hormonal therapy

Immediate fertility desired

1. Controlled ovarian hyperstimulation
2. IVF

Question 14

What is a radical hysterectomy?

Answer 14

A radical hysterectomy is the removal of the womb, cervix, tissue around the cervix (parametrium) and upper part of the vagina. The pelvic lymph nodes are usually removed as part of this operation.