- there is a fascia enclose the vagaina attached to leavator ani and pelvic

- level 1 cardinal and urerosacral ligament connect to sactum and pelvic bone
- Prolabse can be ass w ulcers or bleeding
risk more at 3 pregnency
age make fascoa weaker
obesity > inc intra abd pressure

urinary sym stress incontintence, recurrent UTI *pulging of vagaina > not epty
comletley), over active bladder sym frecuency & urgency
prolapse sym > protrusion of mass, heavyness, doesnt cause back pain,
bowel sym > cosntipation, difficulty defecation, fecal incontinece

assesing by lycotomy position ask to coughno

0 no prolabse , 1 prolabse hialf way of vagaina , 3 hymenal orficie , 3 outsite
vagaine, 4 complete prolase (prostentia)

ergency to treat > complete prolabse, and incontinces and retension >
hydronephrosis > renal failure
picture uterina orolapse stage 4
next vault no uterus, there is ulcers
cystocele (anterior wall problabse)
rectocele digitating is useful

asymptomatic no need for treatment

symptomatic ask or expectation of patient (because it is a quality of life most
likely)
estrogen enhance collagen synthesis but it is not for tratment

1, 3, 5 dontat, 6 pens haha important

space occupying interfere with intercourse
ring no problem with intercourse

heavy vaginal discharge is so common

sacrohystropexy abdomenal > for complete prolapse
sacro spnos fixation from vagaina > for complete prolapse
sacrohystropexy > there is uters
sacropclopopexy > theie is no uterus
dyspprenoua espcially in sacrospinous

urinary incontinence

pontine > impulses to spinal reflex in sacrum > prevent micuration >
parasympathetic
storaging and empting not required the blue schedual slide and the one before it
MI is strees UI
SUI can present with over active bladder
utherral hypermoblity due to fascia of vagaina and ligament are laxtive

RF anything causes fascial weakness

vulvovaginal atropy
Q-tip not done anymore <30 degree normal

To confirm do cytometery > fill bladder wih fluid (intervisceal pressure +

abdmoinal pressure)
Tejsion free vaginal (gold stander for stress incontinece) not sure
over active bladder OAB
2.5 liter is advices not
aboid caffine, etc diet
bladder training advice if she goes each 30 min next week 45 min till 3h
anticholenric to relax the muscle

antepartum hemorrhage
- <24 wk
- Causes mischarhage, ectopic, molar
- during delvery intrapartum
postpartum, prepartum

>24 : fetus, placenta, uterus, umblica lcourse

MC cause abruptio placenta then placenta preis, arranged
decdua has multiple layers > mitubich layer is important
\abrupto placenta > painful bleeding
vagainal bleeding revealed
polhydromenus because of pressure defferance
- 80 vaginal 80 %, 20% concealed
Toxolytic don't give because the contraction is physiological proccess
less than 2cm low lying placenta
Importan 4-6% have some ...