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GENERAL EXAMINATION
General condition:  Height and build are to be noted. noted.  Weight:  Pallor and icterus  Breasts  Thyroid Gland:  Lymphadenopathy:  Dependent edema  Examination of the cardiovascular and respiratory systems

Abdominal Examination
Inspection: The abdomen is inspected to note any  distension of abdomenabdomen scars of previous surgery  eversion of the umbilicus  cutaneous nodulesnodules Cullen¶s sign

 A suprapubic lump could be due to  a) Pregnancy  b) A full bladder  c) Uterine neoplasms:  d) Ovarian neoplasms:  e) Tubo-ovarian mass (TO mass) Tubo f) Haematometra and haematocolpos: . but the lower border cannot be reached.Abdominal Examination Palpation:  In a pelvic mass upper and lateral margins can be felt.

 Dullness in the flanks which shifts indicates the presence of free fluid in the peritoneal cavity or ascites .Abdominal Examination Percussion:  Large ovarian cysts are dull to percussion  The flanks are resonant.

Abdominal Examination Auscultation:  Bowel sounds-absence indicates peritonitis soundsor paralytic ileus. exaggerated indicates bowel obstruction  Souffle over a tumour indicates its vascularity. . Uterine soufflé is heard in pregnancy and large fibroids.

Pelvic examination  

Includes examination of the external genitalia, bimanual and rectal examination. The prerequisites are a good light, a chaperone, gloves, and lubricant jelly.

Examination of the external genitalia:
The vulva is inspected for  Distribution of public hair  Any redness or swelling in the labia majora  Any prolapse or genital descent

Speculum examination:
For visual inspection of the cervix and vagina. Two types of specula are available. 


The Cuscoe¶s self retaining speculum The Sims vaginal speculum

The examining fingers now lift up the uterus which is bought within the reach of the abdominal hand for assessing its position. size.Bimanual examination:   The labia-minora are separated with the thumb and labiaindex fingers of the left hand. mobility. shape. Two fingers (index and middle fingers) of the right hand are introduced (after lubrication) throught the vaginal introitus. or tenderness . The cervix is then moved from side to side to see if it causes pain (cervical excitation) eg. The direction of cervix and its consistency are noted. Ectopic pregnancy and acute PID.

Rectal examination   Virgins for bimanual assessment of pelvic structures Carcinoma cervix to determine the extent of parametrial involvement .

 edema.Evaluation of a gynaecological patient HISTORY  General condition  Height and weight  Pallor  icterus.  lymphadenopathy .

Evaluation of a gynaecological patient EXAMINATION  Examination Breasts  Thyromegaly  Abdominal examination  Per-speculum examination Per Bimanual examination  Rectal examination .

INVESTIGATIONS IN A GYNAE PATIENT GENERAL ± Full blood count Urinalysis Blood sugar Blood urea and serum creatinine Liver function tests Chest X-ray XECG Blood group and RH type HBsAG and HIV (in selected cases) .

INVESTIGATIONS IN A GYNAE PATIENT SPECIFIC ±  Pap smear  Colposcopy  X-ray admomen and pelvis  Ultrasonography  HSGCT scan  MRI .

GYNECOLOGICAL PROCEDURES .

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cervical smear. smear. Pap test. smear test) is a screening test) test used in gynecology to detect premalignant and malignant (cancerous) processes in the endocervical canal). .Pap smear The Papanicolaou test (also called Pap smear. smear. or test.

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Pap smear Indications  screening starts about the age of 20 or 25  continues until about the age of 50 or 60  Women should wait a few years after they first have intercourse before they start screening.  Pap smear screening is still recommended for those who have been vaccinated against HPV .

spatula.Pap smear Procedure  The health care worker begins by inserting a speculum into the woman's vagina.  The health care provider then collects a sample of cells from the outer opening or os of the cervix by scraping it with an Aylesbury spatula. . the cervix. which spreads the vagina open and allows access to cervix.

Pap smear The cells are placed on a glass slide and taken to the laboratory to be checked for abnormalities. The sample is stained using the Papanicolaou technique.   . in which tinctorial dyes and acids are selectively retained by cells. technique.

with appropriate follow-up. can reduce followcervical cancer incidence by up to 80%. deaths caused by carcinoma of the cervix have been reduced by up to 99% 99%  A regular program of pap smear screening. 80% .Pap smear Effectiveness  Since the introduction of the Pap test.

000 people tested.Pap smear  A medical practitioner performing 200 tests each year would prevent a death once in 38 years. .If only 10.000. then it would save the life of 1 person for every approximately 15.000 are actually tested each year.

Colposcopy .

vulva.Colposcopy  Colposcopy is a medical diagnostic procedure to examine an illuminated. magnified view of the cervix and the tissues of the vagina and vulva. .

smears.Colposcopy Indications  To further investigate a cytological abnormality on their pap smears.  immunosuppression such as HIV infection. Other indications for a woman to have a colposcopy include: include:  assessment of diethylstilbestrol (DES) exposure in utero. or an organ transplant patient  an abnormal appearance of the cervix as noted by a primary care provider  as a part of a sexual assault forensic examination done by a Sexual Assault Nurse Examiner .

Areas of the cervix which turn white after the application of acetic acid or have an abnormal vascular pattern are often considered for biopsy. position. an iodine solution may be applied to the cervix to help highlight areas of abnormality.  Three percent acetic acid is applied to the cervix using cotton swabs. .Colposcopy Procedure  Colposcopy is performed with the woman lying on lithotomy position.  If no lesions are visible. biopsy.

the colposcopist determines the areas with the highest degree of visible abnormality and may obtain biopsies from these areas using a long biopsy instrument. .Colposcopy  After a complete examination.

infection at the biopsy site or endometrium. but may include bleeding. and failure to identify the lesion.Colposcopy Complications  Significant complications from a colposcopy are not common. Some patients experience a degree of discomfort during the curettage. . and many experience discomfort during the biopsy.

 A smoking cessation program should be part of the treatment plan for women who smoke. Smoking predisposes women to developing cervical abnormalities.Colposcopy Follow up  Adequate follow-up is critical to the success of followthis procedure. .

Cervical Biopsy .

Cervical Biopsy  A cervical biopsy is a procedure performed to remove tissue from the cervix to test for abnormal or precancerous conditions. or cervical cancer. .

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 Punch biopsy  Cone biopsy or conization  Endocervical curettage (ECC) .Types of cervical biopsies: There are several types of cervical biopsies.

a surgical procedure to remove a small piece of tissue from the cervix.Types of cervical biopsies  Punch biopsy . . One or more punch biopsies may be performed on different areas of the cervix.

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Types of cervical biopsies  Cone biopsy or conization .a surgical procedure that uses a laser or scalpel to remove a large cone-shaped piece of tissue from the conecervix .

Cone biopsy .

a surgical procedure in which a narrow instrument called a curette is used to scrape the lining of the endocervical canal. an area that cannot be seen from the outside of the cervix .Types of cervical biopsies  Endocervical curettage (ECC) .

Endocervical curettage .

 A positive test for human papillomavirus (HPV). colposcopy- .Cervical Biopsy Reasons for the procedure  A cervical biopsy may be performed when cervical abnormalities are found.  A cervical biopsy is often performed as part of a colposcopy procedure. a sexually transmitted infection. also called a colposcopy-guided cervical biopsy.

Reasons for the procedure     A cervical biopsy may be performed to detect cancer of the cervix or precancerous lesions of the cervix. . Polyps (benign growths) on the cervix Genital warts Diethylstilbestrol (DES) exposure in women whose mothers took DES during pregnancy.

Cervical Biopsy Risks of the procedure    Infection Bleeding In addition. . cone biopsies may increase the risk for infertility and miscarriage.

. vaginal creams or medications. douche. no prior preparation.  sign a consent form.Cervical Biopsy Before the procedure  physician will explain the procedure.  should not use tampons. or have sexual relations for 24 hours before the procedure. such as fasting or sedation.  Generally. is required for a simple cervical biopsy.

shape.  lie on an examination table. as for a pelvic examination. and other characteristics of the abnormalities.Cervical Biopsy During the procedure  empty your bladder prior to the procedure. .  physician will insert a speculum into vagina to spread the walls of the vagina apart to expose the cervix. location.  The type of biopsy performed will be determined by the size.

The Tissue will be sent to a lab for examination . Electrocauterization or sutures may be used in some cases. Bleeding from the biopsy site may be treated with a pastepaste-like topical medication. The amount and location of tissue removed depends on the type of biopsy.During the procedure     The physician may numb the area using a small needle to inject medication.

 Instruct not to douche.  Pain reliever for cramping as recommended by physician. or have intercourse for one week after a biopsy procedure. rest for a few minutes.  Wear a sanitary pad for bleeding.Cervical Biopsy After the procedure  After a simple biopsy. use tampons. .

Dilation and Curettage (D and C) .

.Dilation and Curettage (D and C)  A dilation and curettage procedure. also called a D&C. is a surgical procedure in which the cervix is dilated so that the cervical canal and uterine lining (endometrium) can be scraped with a curette to remove abnormal tissues in the uterus.

.Dilation and Curettage (D and C)  A suction D&C uses suction to remove uterine contents. This is sometimes called a dilation and evacuation (D&E).

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 A D&C may be used following a miscarriage to remove the fetus and other tissues if they have not all been naturally passed. or as part of infertility investigation.  to detect cancer.Dilation and Curettage (D and C) Reasons for the procedure  A D&C may be used as a diagnostic or therapeutic procedure for abnormal bleeding.  A D&C may be used to remove adhered placental fragments so that the endometrium can heal properly. .

Dilation and Curettage (D and C) Risks of the procedure  Heavy bleeding  Infection  Perforation of the uterine wall or bowel  Adhesions (scar tissue) may develop inside the uterus .

Dilation and Curettage (D and C) Before the procedure  explain the procedure.  sign a consent form .

as for a pelvic examination.  An intravenous (IV) line may be started.  Your cervix may be cleansed with an antiseptic solution.  physician will insert a speculum into your vagina to spread the walls of the vagina apart to expose the cervix.  Position on an operating or examination table.Dilation and Curettage (D and C) During the procedure  Empty bladder. .  A urinary catheter may be inserted.

A tenaculum. . A uterine sound. The cervix will be dilated by inserting a series of thin rods. the physician may numb the area using a small needle to inject medication.Dilation and Curettage (D and C)     For local anesthesia. may be inserted through the cervical opening to determine the length of the uterus. may be used to hold the cervix steady for the procedure. This process will gradually enlarge the opening of the cervix so that the curette can be inserted.

Dilation and Curettage (D and C)   The curette will be inserted through the cervical opening into the uterus and the sharp spoon-shaped edges will be passed across the spoonlining of the uterus to scrape away the tissues. Any tissues collected with the procedure will be sent to the lab for examination. suction may be used to remove tissues. . In some cases.

or have intercourse for two to three days after a D&C. you may rest for about two hours before going home.  Instruct not to douche.Dilation and Curettage (D and C) After the procedure  After a D&C using local anesthesia. use tampons.  Wear a sanitary pad for bleeding. .

including no strenuous activity or heavy lifting.Dilation and Curettage (D and C)    Restrict on activity. Pain reliever for cramping or soreness as recommended by physician . Resume your normal diet unless your physician advises you differently.

Endometrial Ablation .

.Endometrial Ablation  Endometrial ablation is a procedure to permanently remove a thin tissue layer of the lining of the uterus to stop or reduce excessive or abnormal bleeding in women for whom childbearing is complete.

Endometrial Ablation There are several techniques used to perform endometrial ablation including the following:  Electrical or electrocautery  Hydrothermal  Balloon therapy  Radiofrequency ablation  Cryoablation (freezing) (freezing)  Microwave ablation - .

electric current travels through a wire loop or rollerball that is applied to the endometrial lining to cauterize the tissue .Electrical or electrocautery  .

heated fluid is pumped into the uterus and destroys the endometrial lining with high temperature . Hydrothermal .

 Hydrothermal heated fluid is pumped into the uterus and destroys the endometrial lining with high temperature .

.a triangular mesh electrode is expanded to fill the uterine cavity. The electrode delivers electrical current and destroys the endometrial lining.Radiofrequency ablation  .

Cryoablation (freezing)  probe uses extremely low temperatures to freeze and destroy the endometrial tissues -A .

.A microwave .Microwave ablation  energy is delivered through a slender probe that has been inserted into the uterus and destroys the endometrial lining.

which is then heated to the point that the endometrial tissues are eroded away -A .Balloon therapy  balloon at the end of a catheter is inserted into the uterus and filled with fluid.

Endometrial Ablation Balloon therapy .

 .Endometrial Ablation Reasons for the procedure Menorrhagia  Abnormal uterine bleeding.

Endometrial Ablation Risks of the procedure  Bleeding  Infection  Perforation of the uterine wall or bowel  Overloading of fluid into the bloodstream .

Endometrial Ablation
Before the procedure 


explain the procedure. sign a consent form .

Endometrial Ablation
During the procedure  An intravenous (IV) line may be started.  position on an operating or examination table, as for a pelvic examination.  A urinary catheter may be inserted.  physician will insert a speculum into vagina to expose the cervix.  cervix may be cleansed with an antiseptic solution.  a tenaculum, may be used to hold the cervix tenaculum, steady for the procedure. procedure.

Endometrial Ablation
The cervix will be dilated by dilators  The hysteroscope or resectoscope will be inserted through the cervical opening into the uterus.  A liquid solution or carbon dioxide gas may be used to fill the uterus for better viewing. 

Endometrial Ablation The ablation instrument will be inserted through the hollow opening of the hysteroscope.  After the procedure has been completed.  . any fluid will be pumped out from uterus and the instruments will be removed. hysteroscope.  the endometrial tissues are destroyed.

including strenuous activity.  Wear a sanitary pad for bleeding.  Instruct not to douche.  restrictions on activity. pulse. activity or heavy lifting.  pain reliever for cramping or soreness as recommended by physician.  Resume normal diet.Endometrial Ablation After the procedure  Once blood pressure. . or have intercourse for two to three days after an endometrial ablation. and breathing are stable will be discharged. use tampons.

Laparoscopy .

Laparoscopy Laparoscopy is a procedure used to examine the organs of the abdominal cavity. a thin flexible tube containing a video camera.  Laparoscopy utilizes a laparoscope.  The laparoscope is placed through a small incision in the abdomen and produces images that can be seen on a computer screen.  .

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Laparoscopy    The advantage of laparoscopy is that it allows a direct view of the abdominal organs and structures without the need for major surgery. . Laparoscopy may also be used to perform biopsies or surgical procedures such as an appendectomy or cholecystectomy (removal of gallbladder).

and fibroids. ovarian cysts.Laparoscopy Reasons for the Procedure  Gynecologic laparoscopy may be used to assess pelvic pain and problems. and to evaluate the fallopian tubes in women experiencing infertility. infertility. . tube. Other uses include treating endometriosis and removing an ectopic pregnancy in the fallopian tube.

.Laparoscopy Risks of the Procedure   bleeding from the site of insertion misplacement of the gas used to help visualize the organs.

generally after midnight.  A sedative prior to the procedure.  The area of the abdomen where the incision is to be made may be shaved.Laparoscopy Before the Procedure  explain the procedure  sign a consent form  eight hours fasting before the procedure.  A cleansing enema may be given a few hours before the procedure. .

 You will be positioned on your back on the operating table.Laparoscopy During the Procedure  A laparoscopy is generally performed under general anesthesia. anesthesia. .  An indwelling catheter may be inserted into the bladder to reduce the risk of bladder perforation.  .  An intravenous (IV) line will be inserted.

breathing. or belly button. and blood oxygen level during the surgery.Laparoscopy     The anesthesiologist will continuously monitor your heart rate. a local anesthetic may be injected into the incision site to numb the area. blood pressure. If general anesthesia is not used. A small incision will be made in the abdomen just below the navel. . The skin over the surgical site will be cleansed with an antiseptic solution.

. Carbon dioxide gas will be introduced into the abdomen to inflate the abdominal cavity so that organs and other structures can be easily visualized.Laparoscopy    Additional incisions may be made so that other surgical instruments can be used during the procedure. The laparoscope will be inserted and the examination will be performed.

the laparoscope will be removed. tape. or surgical staples. The incision(s) will be closed with stitches.Laparoscopy    Once the examination and any additional procedures have been completed. A sterile bandage/dressing or adhesive strips will be applied .

physician.  A pain reliever for soreness as recommended by physician. .  Pt may experience shoulder pain from the carbon dioxide gas that remains in abdomen.Laparoscopy After the Procedure  It is important to keep the surgical incisions clean and dry.

 Diet may gradually be advanced to more solid foods as tolerated.Laparoscopy Avoid drinking carbonated beverages for one to two days after the procedure.  .  Limit physical activity for several days after the procedure.

Loop Electrosurgical Excision Procedure (LEEP) .

tract.Loop Electrosurgical Excision Procedure (LEEP)  Loop electrosurgical excision procedure (LEEP) uses a wire loop heated by electric current to remove cells and tissue as part of the diagnosis and treatment for abnormal or cancerous conditions in a woman¶s lower genital tract. .

LEEP can also remove abnormal cells to allow healthy tissue to grow. . This tissue will be sent to the lab for examination. an electric current passes through the fine wire loop to cut away a thin layer of abnormal tissue.LEEP  With LEEP.

.LEEP Reasons for the procedure  LEEP is also performed to detect cancer of the cervix or vagina.  Polyps (benign growths)  Genital warts  Diethylstilbestrol (DES) exposure in women whose mothers took DES during pregnancy.

LEEP Risks of the procedure  Infection  Bleeding  Changes or scarring in the cervix from removal of tissue  Difficulty getting pregnant  Potential for preterm birth or having a low birth weight baby .

LEEP Before the procedure  explain the procedure  sign a consent form. is required. .  physician may recommend that you take a pain reliever 30 minutes before the procedure. such as fasting or sedation. no prior preparation.  Generally.  LEEP is usually performed when you are not having your menstrual period.

 lie on an examination table.  physician will insert a speculum to expose the cervix.LEEP During the procedure  empty your bladder prior to the procedure. as for a pelvic examination. .

This helps make the abnormal tissues turn white and become more visible. A tenaculum. called the Schiller test. An iodine solution is sometimes used to coat the cervix. . steady for the procedure. The physician will numb the area using a small needle to inject medication. also called acetic acid solution.LEEP    cervix may be cleansed and soaked with a vinegar solution. may be used to hold the cervix tenaculum.

The electrical current will act as a cautery to seal the blood vessels. so usually there is very little bleeding. The tissue will be sent to a lab for further examination .LEEP     The LEEP wire will be inserted through the speculum and passed through the abnormal tissues. It is very important to lie still during the procedure.

including strenuous activity or heavy lifting. or have intercourse for four weeks after LEEP.  Pain reliever for cramping or soreness as directed by physician. use tampons. rest for a few minutes after the procedure before going home.  Wear a sanitary pad for bleeding.LEEP After the procedure  After LEEP.  Instruct not to douche. .  Restrictions on activity.

Pelvic Ultrasound .

cervix. . and ovaries. fallopian tubes.Pelvic Ultrasound   A pelvic ultrasound is a noninvasive procedure used to assess organs and structures within the female pelvis. vagina. A pelvic ultrasound allows quick visualization of the female pelvic organs and structures including the uterus.

Pelvic Ultrasound  Doppler ultrasound may also show blood flow in certain pelvic organs. .

The transducer picks up the reflected waves.Pelvic Ultrasound   Ultrasound uses a transducer that sends out ultrasonic sound waves at a frequency too high to be heard. which are then converted into an electronic picture of the organs. The sound waves bounce off the organs like an echo and return to the transducer. .

Sound travels the fastest through bone tissue. and moves most slowly through air.Pelvic Ultrasound    Different types of body tissues affect the speed at which sound waves travel. is translated by the transducer as different types of tissue. as well as how much of the sound wave returns. The speed at which the sound waves are returned to the transducer. .

Pelvic Ultrasound  A clear conducting gel is placed between the transducer and the skin to allow for smooth movement of the transducer over the skin and to eliminate air between the skin and the transducer for the best sound conduction. .

Absence or faintness of these sounds may indicate an obstruction of blood flow. . The Doppler probe within the transducer evaluates the velocity and direction of blood flow in the vessel by making the sound waves audible.Pelvic Ultrasound    An ultrasound transducer capable of assessing blood flow contains a Doppler probe.

Pelvic Ultrasound  transabdominal (through the abdomen) a transducer is placed on the abdomen using the conductive gel .

a long.Pelvic Ultrasound  transvaginal . thin transducer is covered with the conducting gel and a plastic/latex sheath and is inserted into the vagina .

. Only one method may be used.Pelvic Ultrasound  The type of ultrasound procedure performed depends on the reason for the ultrasound. or both methods may be needed to provide the information needed for diagnosis or treatment.

Pelvic Ultrasound  Pelvic ultrasound can provide much information about the size. and structure of pelvic masses. but cannot provide a definite diagnosis of cancer or specific disease. location. .

 fibroid tumors masses. and other types of tumors within the pelvis  presence and position of an intrauterine contraceptive device (IUD)  pelvic inflammatory disease .A pelvic ultrasound may be used to diagnose and assist in the treatment of the following conditions:  abnormalities in the anatomic structure of the uterus. cysts.

A pelvic ultrasound may be used to diagnose and assist in the treatment of the following conditions:       postmenopausal bleeding monitoring of ovarian follicle size for infertility evaluation aspiration of follicle fluid and eggs from ovaries for in vitro fertilization ectopic pregnancy monitoring fetal development during pregnancy assessing certain fetal conditions .

Pelvic Ultrasound Risks of the Procedure  There is no radiation used and generally no discomfort from the application of the ultrasound transducer to the skin during a transabdominal ultrasound. .  You may experience slight discomfort with the insertion of the transvaginal transducer into the vagina.

 For a transvaginal ultrasound. unless the ultrasound is part of another procedure that requires anesthesia.Pelvic Ultrasound Before the Procedure  explain the procedure  Generally. you should empty your bladder right before the procedure.  For a transabdominal ultrasound. . Do not empty your bladder until the procedure is over. no fasting or sedation is required for a pelvic ultrasound. you will be asked to drink several glasses of water.

 The transducer will be pressed against the skin and moved around over the area being studied. .Pelvic Ultrasound For a transabdominal ultrasound:  lie on your back on an examination table.  A gel-like substance will be applied to gelabdomen.

. Images will be recorded on various media for the healthcare record.Pelvic Ultrasound  Images of structures will be displayed on the computer screen.

.Pelvic Ultrasound For a transvaginal ultrasound:  lie on an examination table.  Images of organs and structures will be displayed on the computer screen. with your feet and legs supported as for a pelvic examination. thin transvaginal transducer will be covered with a plastic or latex sheath and lubricated.  The transducer will be gently turned and angled to bring the areas for study into focus. The tip of the transducer will be inserted into vagina.  A long.

 You may resume your normal diet and activity unless your physician advises you differently. .Pelvic Ultrasound After the Procedure  There is no special type of care required after a pelvic ultrasound.

Uterine Artery Embolization .

. The procedure may also be referred to as uterine fibroid embolization (UFE).Uterine Artery Embolization  Uterine artery embolization (UAE) is a procedure that offers an alternative to traditional surgical removal of uterine fibroids.

Uterine Artery Embolization    Uterine artery embolization shrinks fibroids by blocking off their blood supply. The blood supply is blocked by injecting very small particles into the arteries that supply the fibroids. Once the blood supply is gone. . the fibroids shrink and symptoms usually decrease or disappear.

Uterine Artery Embolization  The most commonly used particle agent is polyvinyl alcohol (PVA). a substance that has safely been used in medical procedures for many years. .

Uterine Artery Embolization  Uterine artery embolization is a minimallyminimallyinvasive (without a large abdominal incision) technique which involves identifying which arteries supply blood to the fibroids and then blocking off those arteries. .

Uterine Artery Embolization  Uterine artery embolization is performed by an interventional radiologist. . a physician specializing in the field of radiology that treats a wide range of internal body conditions without making a surgical incision.

Uterine Artery Embolization Reasons for the procedure  The primary reasons for performing a uterine artery embolization include:  Fibroid tumors  Excessive uterine bleeding .

Uterine Artery Embolization
Risks of the procedure  Hemorrhage (abnormal bleeding)  Injury to the uterus  Infection  Hematoma  Blood clots  Infertility  Amenorrhea (loss of menstrual periods)

Uterine Artery Embolization
Some women experience postembolization syndrome. Symptoms include,  Pelvic pain and cramping  Nausea and vomiting  Low-grade fever Low Fatigue and discomfort  Symptoms last approximately 2 to 7 days.

Uterine Artery Embolization
During the procedure  An intravenous (IV) line will be inserted.  give an antibiotic prior to the procedure.  position on the procedure table lying flat on back.  A catheter (thin, narrow tube) will be inserted into bladder to drain urine.  The groin area will be cleansed with an antiseptic solution.

Uterine Artery Embolization    A sheath will be inserted into groin area to be used as a guide for inserting the catheter to the area to be embolized . . Contrast dye will be injected into the catheter. Using x-ray guidance. Allowing the physician to better visualize the arteries under examination. the physician will xvisualize the vessels which supply blood to each fibroid.

. or gelatin sponge.Uterine Artery Embolization    After the artery is visualized. Additional x-ray images will be taken to verify xblockage of the arteries. Very small particles will be injected into the vessels which provide the blood supply to the fibroids. Trisacryl gelatin. a tiny catheter will be inserted into the femoral artery. The particles may be made of polyvinyl alcohol (PVA).

 Instructed to lie flat for four to six hours.  Encourage to get out of bed within a few hours and perform coughing and deep breathing exercises . .Uterine Artery Embolization After the procedure  Continuous pressure will be applied to the catheter insertion site.  Monitor amounts of vaginal drainage.  Administer pain medication as needed.

 include fiber and plenty of liquids in diet.  Walking and limited movement are generally encouraged. immediately. engage in sexual intercourse. tampons.  Take a pain reliever for soreness.Uterine Artery Embolization At home:  Keep the groin incision clean and dry.  Should not use a douche. . but strenuous activity should be avoided.

Hysterectomy .

Hysterectomy  Hysterectomy is the surgical removal of the uterus. as well as other organs. . may be removed at the same time. Different portions of the uterus.

Hysterectomy Reasons for having a hysterectomy:  fibroid tumors  endometriosis  endometrial hyperplasia  cancer  blockage of the bladder or intestines .

Types of hysterectomy  Total hysterectomy Hysterectomy with bilateral oophorectomy Radical hysterectomy Supracervical hysterectomy (partial or subtotal hysterectomy)    .

including the fundus (the part of the uterus above the openings of the fallopian tubes) and the cervix. This is the most common type of hysterectomy.Total hysterectomy  Includes the removal of the entire uterus. . but not the ovaries.

Hysterectomy with bilateral oophorectomy  Includes the removal of one or both ovaries. along with the uterus. . and sometimes the fallopian tubes.

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most of the tissue that surrounds the cervix in the pelvic cavity. the top portion of the vagina. and may include the removal of the pelvic lymph nodes.Radical hysterectomy  Includes the removal of the uterus. . This is done in some cases of cancer. cervix.

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.Supracervical hysterectomy (partial or subtotal hysterectomy)  Removal of the body of the uterus while leaving the cervix intact.

The procedures for performing hysterectomy?  Abdominal hysterectomy Vaginal hysterectomy LaparoscopeLaparoscope-assisted vaginal hysterectomy (LAVH)   .

along the top of the pubic hairline.Abdominal hysterectomy   The uterus is removed through the abdomen via a surgical incision about six to eight inches long. . or horizontally. The main surgical incision can be made either vertically. from the navel down to the pubic bone.

Abdominal hysterectomy .

Vaginal hysterectomy  The uterus is removed through the vaginal opening. . No external incision is made. or when vaginal repairs are necessary for related conditions. This procedure is most often used in cases of uterine prolapse. which means there is no visible scarring.

Vaginal hysterectomy .

.Laparoscope-assisted vaginal Laparoscopehysterectomy(LAVH)   Vaginal hysterectomy is performed with the aid of a laparoscope. Thin tubes are inserted through tiny incisions in the abdomen near the navel. having a hysterectomy means that menstruation will no longer occur. For women who have not yet reached menopause. flexible tube containing a video camera. nor will pregnancy be possible. The uterus is then removed in sections through the laparoscope tube or through the vagina. a thin.

Laparoscope-assisted vaginal Laparoscopehysterectomy(LAVH) .

When this surgery is done through small incisions using a thin.Robotic Hysterectomy (Robot(Robot-Assisted Laparoscopic Hysterectomy)  Hysterectomy is the surgical removal of a woman's uterus. it is called a laparoscopic hysterectomy. . lighted scope with a camera on the end (a laparoscope).

The surgeon controls the movements of the computer from a computer station in the operating room.Robotic Hysterectomy   Robotic-assisted laparoscopic hysterectomy Roboticuses a computer to control the surgical instruments during the surgery. . The surgeon is able to control the robot's movements steadily and precisely.

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.Robotic Hysterectomy Some reasons why robotic-assisted laparoscopic robotichysterectomy may be recommended:  smaller incisions than in an open type of hysterectomy.  recovery at home may be easier.  risk for complications like bleeding or infection may be reduced.  less pain and a shorter hospital stay after surgery.

Robotic Hysterectomy Risks of the procedure  Reaction to the anesthesia  Infection  Bleeding  Damage to other organs inside the abdomen  Moving clots. .

Robotic Hysterectomy An additional risk of robotic surgery:  Robotic-assisted laparoscopic surgery may Robotictake longer than other types of surgery. which means that you are under anesthesia longer. .

.  Three or four small incisions will be made near belly button.  The laparoscope is inserted into abdomen.Robotic Hysterectomy During the procedure  This surgery is usually done under general anesthesia  Give antibiotics before surgery.  Gas pumped into belly to distend it and give surgeon a better view and more room to work. Other surgical instruments will be inserted through the other incisions. and catheterize bladder to drain urine.

Surgeon will move to the control area to remotely control the surgery.Robotic Hysterectomy    Surgeon will attach the laparoscope and the instruments to the robotic arms of the computer. Uterus will be cut into small pieces that can be removed through the small incisions. .

The tubes and ovaries attached to the uterus may also be removed. . the incisions will probably be closed with one or two stitches and covered with small dressings. the whole uterus may be removed or just the part above the cervix.Robotic Hysterectomy    During laparoscopic vaginal hysterectomy your uterus may be taken out through vagina. After surgery is completed. Depending on the reasons for hysterectomy.

Analgesics are provided  bladder catheter will be removed in one or two days.Robotic Hysterectomy After the procedure  Pain after this procedure is expected.  Encourage to get up and walk as soon as possible.  bleeding from vagina requires the use of sanitary pads. .

 Incision areas should be kept dry for a few days.  Keep walking and gradually resume normal activities in a few days.  Avoid heavy lifting for a few weeks. .Robotic Hysterectomy During recovery at home:  Gradually continue your normal diet.

Hysterosalpingography .

tubes. It entails the injection of a radio-opaque radiomaterial into the cervical canal and usually fluoroscopy with image intensification. .Hysterosalpingography   Hysterosalpingography (HSG) is a radiologic HSG) procedure to investigate the shape of the uterine cavity and the shape and patency of the fallopian tubes.

Hysterosalpingography  A normal result shows the filling of the uterine cavity and the bilateral filling of the fallopian tube with the injection material. . To demonstrate tubal rupture spillage of the material into the peritoneal cavity needs to be observed.

. cervix. rays.Hysterosalpingography Procedure  The procedure involves ionizating x-rays.  The test is usually done with radiographic contrast medium (dye) injected into the uterine cavity through the vagina and cervix.

cavity. . It can be determined whether the fallopian tubes are open or blocked and whether the blockage is located at the junction of the tube and the uterus (proximal) or whether it is at the end of the fallopian tube (distal).Hysterosalpingography   If the fallopian tubes are open the contrast medium will fill the tubes and spill out into the abdominal cavity.

Hysterosalpingography .

and 46% and 95%. The sensitivity was estimated to be 38% in women without risk factors for any tubal pathology. respectively. . respectively. for any bilateral tubal pathology. compared with 61% in women with risk factors.Hysterosalpingography Efficacy  A review estimated the sensitivity and specificity of hysterosalpingography in detecting any fallopian tube pathology to be 53% and 87%.

Hysterosalpingography  For bilateral tubal pathology. these sensitivites were estimated to be 13% without risk factors. versus 47% with risk factors. . For bilateral tubal pathology.93 per year. the sensitivity decreased with age with a factor estimated to be of 0.

allergic reactions to the materials infection. oilused. intravasation of the material. embolisation. . embolisation. if oilbased material is used. and.Hysterosalpingography Complications  Complications of the procedure include infection.

Hysterosalpingography  Air can also be accidentally instilled in to the uterine cavity by the operator. . thus limiting the exam due to iatrogenically induced filling defects.

Magnetic resonance imaging (MRI) .

. MRI makes use of the property of nuclear magnetic resonance (NMR) to image nuclei of atoms inside the body. medical imaging technique used in radiology to visualize detailed internal structures.Magnetic resonance imaging (MRI)  Magnetic resonance imaging (MRI). is a MRI).

CT. Unlike arthrograms. CT. vessels. MRI uses no ionizing radiation and is generally a very safe procedure. also be directly injected into a joint in the case of arthrograms. Contrast agents may inflammation.Magnetic resonance imaging (MRI)  Contrast agents may be injected intravenously to enhance the appearance of blood vessels. MRI images of joints. tumors or inflammation. .

Magnetic resonance imaging (MRI) Pregnancy  No effects of MRI on the fetus have been demonstrated. and it is recommended that their use be avoided.  The use of contrast agents. . gadolinium compounds are known to cross the placenta and enter the fetal bloodstream.

MRI is rapidly growing in importance as a way of diagnosing and monitoring congenital defects of the fetus because it can provide more diagnostic information than ultrasound and it lacks the ionizing radiation of CT.Magnetic resonance imaging (MRI)  Despite these concerns. .

other fetal interventions. surgery. for procedures to safely deliver and treat babies whose defects would otherwise be fatal. in-utero preindiagnosis and evaluation of fetal tumors. . facilitating open fetal surgery. teratomas. and planning interventions.Magnetic resonance imaging (MRI)  MRI without contrast agents is the imaging mode of choice for pre-surgical. primarily teratomas.

Breast MRI .

Breast MRI  One alternative to mammography. MRI or contrast enhanced magnetic resonance imaging (MRI). . has shown substantial progress in the detection of breast cancer. Breast mammography.

Breast MRI
Operation  In this method, the breast is scanned in an MRI device before and after the intravascular injection of a contrast agent (Gadolinium DTPA).

Breast MRI  

The pre-contrast images are "subtracted" from prethe post-contrast images, and any areas that posthave increased blood flow are seen as bright spots on a dark background. Since breast cancers generally have an increased blood supply, the contrast agent causes these lesions to "light up" on the images.

Breast MRI

Breast MRI Comparison to other technologies  The available literature suggests that the sensitivity of contrast-enhanced breast MRI in contrastdetection of cancer is considerably higher than that of either radiographic mammography or ultrasound and is generally reported to be in excess of 95%. .

Breast MRI  The reports of 4. however the call-back rates were low at 10% calland the risk of having a benign biopsy was reported at 5%. .271 breast MRIs from eight large scale clinical trials were reviewed recently by CD Lehman. a significant improvement over mammography.Overall the sensitivity ranged from 71% to 100% in these reports.

Breast MRI Indication  Screening of high-risk patients high evaluation of breast implants in cases of suspected implant rupture  pre-treatment evaluation of patients with prenewly diagnosed breast cancer to assess the extent of the disease .

Breast MRI Vendors  Several medical instrument vendors have entered this arena with breast MRI solutions. . One company. is the only manufacturer to make a breast-dedicated unit breastand as the exclusive patent holder of certain solutions to fat signal suppression that appear to be more or less essential. Aurora Systems.

. General Electric and Philips Medical. Siemens.Breast MRI  Siemens. offer breast MRI products or add-ons. and several addthirdthird-party companies offer aftermarket products to enable breast MRI on conventional MRI instruments. main manufacturers of MRI instruments.

Breast MRI .

Information additional to that obtained by ultrasonic diagnosis was obtained by MRI in 16 of the 25 cases of foetal malformation and in 5 of the 11 cases with other obstetric problems. Foetal curarization was not necessary in most of the cases.RELATED STUDIES   MRI in obstetrics: a supplementary method for ultrasonography. A good MRI technique. The use of magnetic resonance imaging (MRI) as a complementary diagnostic method was evaluated in a group of 36 complicated pregnancies during the last trimester. . can give useful diagnostic information to an obstetrician. for selected obstetric problems and when used in combination with detailed antepartal ultrasonic examinations.