Document info

Result type: Gynecology Outpatient Provider Note

Result date: Aug 23, 2022, 03:53 p.m.
Result status: modified
Performed by: Alex Francoeur
Verified by: Alex Francoeur
Modified by: Cecilia Wieslander

FPMRS NEW H&P

EKATERINA
Patient: DOB: Dec 17, 1973
BELACH

Subjective Language Used and Translator

HPI: 48 year old G8P3053 here for evaluation of pelvic organ prolapse Preferred Language: English
and thickened endometrial lining
Problem List/Past Medical History
Ongoing
Patient reports a bulge since 2019 that has been getting worse. She states
No qualifying data
that it hangs out and is hard to walk and distressing when she is in public
Historical
places. It is severely affecting her quality of life. Very minor urinary
Pregnant
symptoms except that she has to push her prolapse back up in order to
Pregnant
void. She otherwise reports normal periods every month.
Pregnant
UROGYN ROS: Medications
Pelvic pressure/bulge: big buldge, like the size of her fist Inpatient / In-Clinic
Digital decompression to void/BM: reports having to push it up to pee No active inpatient medications
Feeling of incomplete bladder emptying: no, feels she empties completely Home
Urine stream (strong/normal/weak): normal No active home medications
SUI frequency: sometimes
UUI frequency: no Allergies
Pad use (#, type): no No Known Allergies
Urinary urgency: some
Urinary frequency: no
Voids per day: A few times a day
Voids per night: Yes 1-2 times
Nocturnal enuresis: no
# UTI past year: no
Dysuria: no
Hematuria: no
Pyelo: no
Renal calc: no
Constipation (# BM per day/wk/hard stool/straining): no
Anal incontinence (flatus/liquid/stool): no
Dyspareunia (external/deep/n/a): yes, bladder pain with intercourse

GYN History:
LMP: 7/22/22
Menarche: 13
Periods: yes monthly, 5 days of bleeding, normal 2 days heavy
Last Pap: 2018
H/o abnl Pap: no
H/o STI: no
No sexually active right now but married with husband

Ob hx:
G8P3053
- Heaviest baby 11 pound, daughter, others 9 and 10 pounds
NSVD x3
3 miscarriage
2 abortions

PMH: Gallstones, HTN

PSH: Breast cyst surgery, tummy tuck, breast lift
Fam Hx: paternal grandmother breast cancer
Meds: none
All: NKDA
Soc: not working, no t/e/d
BMI: 28
PCP: NERFed in ED

Review of Systems
Review of systems documented as above

Objective
Vitals & Measurements
T: 35.9 °C (Oral) HR: 83(Peripheral) RR: 18 BP: 117/72 WT: 76.100 kg
WT: 76.1 kg
Physical Exam
GEN: NAD
Abd: Soft, nontender, nondistended.
Ext: no LE edema or calf tenderness
PELVIC:
Complete procidentia noted, cervix with irritation and inflammatory changes
noted. No pelvic floor tenderness noted but severe pelvic floor weakness
laxity noted

POP Q
Aa +4
Ap +3
C +5
GH 6
PH 4
D -3
Ba +4
Bp 0
TVL 8

Chaperoned by Dr. Wieslander and Angie

Pain Present: No (08/23/22 15:34:00)

Diagnostic Results
FINDINGS:
The uterine myometrium is mildly heterogeneous. The endometrial
thickness is provided below. There is also suggestion of
polypoid focal thickening of the endometrium measuring up to
approximately 2 to 3 cm.

The right ovary is sonographically normal in appearance.Right

ovarian vascular flow is noted.

The left ovary is sonographically normal in appearance. Left

ovarian vascular flow is noted.

There is no adnexal mass.

There is no free fluid.

MEASUREMENTS:
Uterine size: 10.9 x 6.9 x 6.5 cm
Endometrial thickness: 17 mm
Right ovarian size: 8 cc
Left ovarian size: 3 cc

IMPRESSION:
*Heterogeneous uterine myometrium, nonspecific. Query
adenomyosis.
*Questionable polypoid thickening in the endometrium measuring
up to approximately 2 to 3 cm. Query an underlying endometrial
polyp versus atypical endometrial thickening. Recommend
short-term interval follow-up to ensure resolution versus direct
visualization.
*Please read the full report for additional details and other
findings.

Assessment/Plan
# Procidentia
- Noted to have complete procidentia on exam
- Emphasized benign nature although can very much affect quality of life
- Discussed surgical and non surgical options
- Patient is very much interested in surgery
- Given complete procidentia, discussed trial of pessary while preparing for
surgery, patient amenable
- Fitted with #5 RWS, did very well able to insert and take out on own
- Likely could do well with #6 RWS but none in stock. Could consider at next
visit
- Very happy with pessary
- No indication for premarin given pre menopausal
- Brief discussion of surgery sacrocolpopexy vs TVH USLS, would strongly
consider sacrocolpopexy given severe prolapse and age

# Thickened endometrium
- EMB appointment scheduled

# Well woman
- Pap collected
- ED NERF pending

RTC 19G for simple cystometrics, PVR, and pessary check 19G for preop,
19B for EMB

Future Appointments
OVM OBGYN
 Appt. Date: 09/12/2022 9:40 AM
Scheduled Provider: OVM GYN Procedure 19B
14445 Olive View Drive Sylmar, CA, 91342
Phone: (747) 210-3137 Fax: --

OVM OBGYN
Appt. Date: 09/16/2022 8:40 AM
Scheduled Provider: OVM GYN Urodynamics 19G
14445 Olive View Drive Sylmar, CA, 91342
Phone: (747) 210-3137 Fax: --

OVM OBGYN
Appt. Date: 11/02/2022 1:40 PM
Scheduled Provider: OVM GYN Urogyn 19G
14445 Olive View Drive Sylmar, CA, 91342
Phone: (747) 210-3137 Fax: --

Required Assessments
Alex Francoeur R4
DWA Wieslander

Addendum by Wieslander, Cecilia Karin on August 24, 2022 07:31:22 PDT

Pt seen, examined, counseled and pessary placed with Dr Francoeur. I agree with her assessment and plan.

Addendum by Wieslander, Cecilia Karin on November 01, 2022 12:19:58 PDT

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