Gynaecology
Abnormal Uterine bleeding
Acute
-
-
Chronic
-
-
Bleeding
Causes of
.
abnormal
AUB
PALM
:
:
iatrogenic
cause
polyp
A- Adenomyosis
L
Leiomyoma
p
regularity
,
Uterine
/
General
-
of
Aetiology
-
Blood
Malignancy
Men
Causes
dyscrasia
-
-
-
-
-
-
Ovulatory dysfunction
Hyperplasia
I
-
in
are
6 months
of
absence
excluded )
.
.
clinically
any
This term
.
attention
detectable
been
has
organic
replaced
by
systemic
,
AUB
or
completely
now
.
Endometrial
-
Iatrogenic
-
N
Not
-
classified
:
Contraceptives
-
pelvic adhesions
-
Uterine fibroids
Endometrial
-
Hormonal
NCD
.
IDUB
Ovulatory
-
Post tubal sterilisation
-
progesterone only pills
Hyperplasia
.
irregular
ripening
irregular shedding
Italian 's disease)
Anorulatory-metropalhiahaemorrhagi.ca/ Schroeder's
disease
Adenomyosis
-
-
-
.
Coagulopathy
o
DID
-
occurs
( pregnancy and fibroids
pelvic causes
Coagulopatny
thyroid dysfunction
Genital TB
-
orrhagea
&
bleeding that
immediate
to require
For past
timing
C-
E
-
-
or
quantity
AGO Classification
-
M
sufficient
of
Abnormal
Classification
COEIN
-
volume
in
Bleeding
Uterine
Dysfunctional
:
heavy menstrual bleeding
Episode of
Feminizing
tumor of ovary
Endometriosis
Pelvic congestion
Investigations
-
-
-
-
CBC
-
Bleeding
time
&
-
Thyroid function tests
-
pelvis
Diagnostic Hysteroscopy
USG
-
-
Endometrial
tissue
sampling
Diagnostic laparoscopy
sono Ipingography
pelvic angiography if
>
may show
other
by D4C
detect cause
Arteriovenous fistula
investigations fail
vaniosity
&
to
.
.MX
menorrhagia
v
v
Older women
Young patient
I
v
Rule out
u
v
Conception
and
contraception
desired
desired
cancer
uterine
pathology
v
✓
Normal Uterus
v
.
Combined 0C
Etnamsylate (NSAID)
v
'
-
cantifibn.no/ytic)
-
u
Medroxy progesterone Acetate
Norethisterone 5mg
Mirena
10mg aid
-
×
ydays
-
-
Releases LNG
Effective
as
•
pills contraindicated over 40 years
progesterone and others
months
v
No
response
v
Hysterectomy
fails
with
removal of ovaries
v
6- A
therapy
-0C
-
v
v
Medical
Rough day
GnRH analogues 13-4
continue R, for
minimally
-
month or
-
required
follow
-
invasive
surgeries
D4C
Endometrial
ablation
QR)
up
pathology present
pills
Progesterone
Transexamic acid
Uterine
.
Hysterectomy
of
ovaries
with conservation
( 750 years)
Appropriate
surgery
Dysmenorrhea
-
It
defined
is
as
menstruation
a
painful
enough
to
incapacitate
day
day aunties
to
.
Secondary (congestive)
Primary (spasmodic)
.
.
.
pelvic pathology
any
confined
mostly
adolescent
to
presence of
-
In
-
Etiology
in
occurs
2) DID
3) Ovarian cysts & tumors
a) Cervical stenosis
5) fibroids
myometn.at hyperactivity
Uterine
6)
,
Junctional
zone
132)
&
hyperplasia
hyperactivity
H Overactivity
of
sympathetic
nerves
8) Intrauterine adhesions
9) Transverse vaginal septum
Hyperion; city of circular fibres
,
of
isthumus
.
3) RPG Fa
ovulatory cycles
in
Psychosomatic
Ischemia
>
factors anxiety
,
myometrium
of
C1F :
11
low pain threshold
,
Adenomyosis
7) Polyps
,
Dys peristalsis
4)
Endometriosis
11
.
theories :
1)
Pain starts
C1F :
menses
,
5)
Syncope
6)
Clinical
in
hrs
.
Investigations
USG
:
.
reveal any abnormalities
-
Rule out
Given for
Mefehamic acid
-
-
-
Na broken
pelvic pathologies
.
:
days
950
.
-500mg
25mg
cycles
lid
tid
275mg lid
Hyaline compounds
Drotaverine
Glycerol trinitrate transdermal patches
0C
pills
.
progesterone releasing
-
For 3-6
Antispasmodics
-
.
1-3
:
Indomethacin
-
Trans
a) surgery
-
-
to
underlying
US9
investigations
.
:
NSAIDs
-
:
Routine
:
medical
related
CTIMRI
,
does not
cutaneous
-
IUD
Electrical
Relieve paint
contraceptive benefits
nerve
stimulation
Rarely required
Laparoscopic Uterine Nerve ablation
( LUNA)
Laparoscopic pre sacral heurectomyll.HN )
relieves
with start
in nature
dull
Hysteroscopy
-
"
is
severe cases
exam
Investigations
periods and
.
may radiate to back & medial aspect of thigh
may be alw nausea vomiting cold sweats
4
days prior to
3) Other symptoms
1) Pain begins few hours or just before
a) Pain lasts for few hours to 24
3) Spasmodic lower abdominal pain ;
4)
its
of bleeding
2) Pain
.
pathology
pelvic
.
ovulation cycles & is usually cured
pregnancy and vaginal delivery
pain always
after
-
of
absence
In
MX
:
treatment
of
underlying
cause
.
pathology present
PCOS
-
Definition :
Heterogeneous
resulting
.
Incidence
4- 12%
:
in
characterised
syndrome
complex
menstrual
irregularity
of women
,
reproductive age
in
infertility
by
chronic
and
anovulation
and hirsutism
Hyperandrogen Ism
Diagnostic Criteria
1) Oligo
C1F :
!
-
Anovulation
or
Biochemical
:
or
clinical
12 follicles
At least
US9 :
On
size
I -9mm
,
-
present within
t
or
both ovaries
Investigations
1) Serum
4
women
young
.
Hirsutism
Acne
nigricans
male pattern alopecia
Acanthus's
-
Induction agents :
Ovulation
:
Hormone values
in
710Mt
ovarian volume
.
seen
Infertility
-
OR
Generally
obesity
Oligomenorrhoea I Amenorrhoea
-
b)
resistance ,
central
-
-
a) Hyper androgen ism
insulin
alw
.
.
.
frequently
;
.
DU0M iphone citrate
( Doctor anovulatory infertility)
50mg 1 day for 5 days ( Day 2-6 or 5-9 of cycle)
:
E2
4 LH
-
success rate for ovulation -801
.
4 Testosterone & And rostenedione
SHBG ( sex Hormone binding globulin)
H a- hydroxy progesterone 7300 nglml
4 Prolactin
+
2) Letrozole
2.5mg 1 day
X 5
20mg
days
on
day 3
-
A
2)
USG
ovaries
( Necklace
-
-
1 day
X 5
days
Insulin
fasting
-
,
4) Anastrozole
,
size 2 -9mm
and volume of
4
echo gene city
4
in
endometrial thickness
3) Thyroid function tests
( Reserved
placed peripherally
pattern)
of pearls
in
4) Laparoscopy
5) Gonadotropin s
volume 710mm's
follicles
12 or more
-
20 -40mg
:
Enlarged
-
serum
3) Tamoxifen
-
unopposed estrogen stimulation
women
Injection hCG
side Effects :
.
FSH
5,000-10,000
IU Im
Multiple pregnancies
a) Ovarian Hyper stimulation syndrome 10USD
3) A risk of epithelial ovarian cancer
D
SX for Ovulation Induction
BIL enlarged ovaries
-
HMG & Recombinant
stroma
due to
obese
in
-
:
for therapeutic purpose)
-
-
Only
No
in
cases of
risk of
OHSS
Laparoscopic
:
failure with
Or
drilling
medical therapy
ovarian
multiple pregnancy
.
RI
-
-
.
counselling of patient about disease
Lifestyle modification Balance diet
Regular exercise
.
:
-
Insulin sensitizes :
-
-
stop smoking alcohol
,
specific 14
D
-
a) Myoinositol
:
Irregular periods I amenorrhoea
:
:
-
-
and
RI is
4 upto
once a
day
1000mg twice
a
day
0C
suppress
:
0C pills 1
-
Newer insulin sensitize
Cyclical progesterone
pills
Anti androgens
Ovulation
:
Antiandrogen s
induction
Assisted reproductive
4) Hyper insulin emia
Best
Can be
500mg
-0C
-
3) Infertility
start at
.
2) Hirsutism
-
-
Weight loss
.
.
1) Metformin
technology ( ART)
Insulin sensitizes
:
1) spironolactone 25 -100mg
a) Flutamide
3) Fina sterile
a) Cyproterone
pills
as
acne
and
it
regularises cycles
Hirsutism
.
acetate
twice
a
day
Prolapse
Support
Uterus :
of
(
tier
Upper
① Endo pelvic fascia
② Round ligaments
-
-
Remnants of gubernaallum
function to maintain anteverted position
Double layer of
Acts
-
peritoneum attaching
Endo pelvic fascia
.
of Uterus
Broad & Round
ligaments
are
-
④
considered False support
Genital Prolapse : Downward displacement
.
Aetiology
:
.
)
② Birth injuries
-
-
-
-
nerve
Operative
delivery
injury
-
-
:
-
Raised intra abdominal
C1F
symphysis
to
anterior cervix
1 Cardinal Imackerodt 's ligament
cervix to lateral pelvic walls
from
utero sacral
ligaments
normal anatomical position
its
upper 213
:
lower yg
:
Upper 43
.
:
213
Lower
Ie
stourethrocde
}
.
stage
.
stage
.
Stage
Enterocele
Recto
descent
of cervix
0
Quantitative)
No prolapse
:
Ii All
I
points
stage III
into vagina
upto introits
Hymen
within 1cm of
-1 and +
Hymen
1)
lowest point 71cm below hymen
but not complete prolapse
:
complete prolapse
stage II :
.
above
71cm
point
lowest
:
I btw
.
descent of cervix
:
( Pelvic organ prolapse
urethra
:
POPQ staging
.
Cystocele
:
to poster lateral cervix
From periosteum of 523,4 vertebrae
:
-
pudenda 1
Chronic
pubic
from
c) Uterine descent
perineal tear
Others
.
-
Large baby
-
-
labor
forming
perineal body
③ Urogenital diaphragm
at places
B) posterior vaginal wall
multiparty
-
-
-
:
Prolonged
-
③
-
Menopause
-
is condensed
A) Anterior vaginal wall
weakness of supports
Congenital
-
organ from
Classification
.
Atonicity
①
of
② Perineal muscles
ligaments :
Transverse cervical
-
.
① Levator ani muscle
d) Pubocervical ligament
to side
-
.
form
to
for uterus
mesentery
as
Inferior Tier
① Dericervical ring
② Endo pelvic fascia
③ Broad ligaments
-
)
middle Tier strongest support
descent of cervix outside introits
or
vault aversion
Providential Entire uterus outside introits
.
pressure
bronchitis
Mx :
:
.NU/liparous: Abdominal sling Sx
:
.
pregnancy
.
post Natal
Ring pessary upto
:
16 weeks
1) Vaginal symptoms
-
Sensation of bulge
-
-
-
Pressure
or
profusion
2) Urinary symptoms
:
frequency
4
,
surgery
.
Young
.
woman
urgency
-
:
straining during defecation
-
4) Dyspareunia
-
Indications :
Procedure
with 2nd I 3rd
1) Anterior
:
Colporrhaphy
degree
uterine
-
tip
of
ligament
amputated
in
cervix covered
front of cervix
by vaginal flap
6) using stormdorff sutures
7) Cold operineorrhaphy is done
complications : ①
Haemorrhage
② Cervical incompetence
③ Cervical stenosis
④ Cervical
dystonia
prolapse
⑤ Infertility
⑥ Premature rupture
-
:
posterior
Colporrhaphy
Manchester operation
sling surgeries
or
:
:
static
,
,
isthmus
,
Closed loop anterior sling
,
Tape anchored to anti abdominal wall 4 ant
.
aspect of
isthumus
②
of membranes
:
② Purandara 's CerviCOPEXU : Dynamic
Khanna 's
-
.
uterine
prolapse
Closed loop posterior sling
Tape anchored to sacral promontory 4 posterior aspect
of
3) Amputation of cervix
5) Posterior
:
① Shirodkar's sling
done
Macken rodt 's
vaginal wall prolapse Ant.CO/porrhaphy
sling surgeries :
prolapse
2) Cervix dilated
4) Dlication of
.
vaginal surgery (Fertility sparing )
family complete
vaginal Hysterectomy with Ant ¢ posterior
colporrhaphy ( pelvic floor repair)
operation :
young patients
Conservative
Women 740 years
.
Manchester ( Fothergill )
Ant
Floor exercises
required
Posterior vaginal wall
-
-
symptoms
( in Redocele )
:
if
( 140 years)
incomplete emptying
-
.
& Heaviness
Excessive whitish discharge (due to venous congestion )
Blood stained discharge due to deulbitous ulcer independent part
3) Bowel
Ring pessary ¢ pelvic
'
sling
Tape anchored
:
static open neutral
,
to
A9S
④ Virkud 's composite sling :
,
sting
& anterior aspect of islhumus
static
+
dynamic open
,
,
Anterior + posterior sling
.
Male infertility
'
failure
to conceive
primary :
.
previous
:
Aetiology
.
1) Genetic
pregnancy
,
but failure
sex
.
to
subsequently
conceive
[
-
Irrespective
:
.
Abnormal y chromosome
-
regular unprotected
of
year
one
conceived
Never
Secondary
.
after
Kline fetter 's
,
Investigations :
1)
syndrome
previous pregnancy ]
of
of outcome
Routine
Blood sugar
:
CBC
2)
Diordels
-
spermatogenesis
of
Hormonal
,
Testicular
:
a)
Varicocele
-
-
absence
trauma
,
masturbation &
:
ideal time
-
4) Disorders
:
-
Kartagener syndrome limmotile
-
Sperm
5) sexual dysfunction
:
-
6)
7)
Zonapelkida
binding
USG
for potency of
-
drugs smoking
,
,
D)
chromosome
and genetic
analysis
:
Correct
For
-
,
weight
Impotence
Psychosexual help
-
loss
sildehafil 50.100mg
11 hr before
sexual activity )
-
thyroid
disorders
Retrograde ejaculation
.
-
.
.
phenyl ephrine
( improve tone of
Hypogonadotrophk
Hypogonadism
sphincter)
Inj HM9
Dulsatile GnRH
.
-
Treat infections
-
to
Advice
-
-
-
-
-
Surgeries
.
Astaxanthin
Hypogonadism
(testicular failure)
-
IUI
IUI
-
-
coenzyme Q
multivitamins
-
Transurethral
led E)
resection of
For obstruction of
ejaculatory
duds
-
improves
levocarnitine
Reproductive technology
:
IUI
,
IVFIICSI
Semen Exam
Not mat
v
✓
.
IUI
3- E
cycles
v
( with ovarian stimulation
with
Abnormal
omiphene citrate)
Failed
IUI
v
✓
IVF
ICSI
t
v
v
If Count
more
investigations
than
10 motile
sperms
correction of
It count
05×106
motile
sperms
v
fails
I
IVI
-
donor
Adoption
abnormality
vaslepididymis
semen
Donor
Adoption
:
Vasovdsotomylvasoepididymostomy
-
-
IVFIICSI
-
For vaniocele
-
zinc
Assisted
Clomiphene citrate
Hypergonadotropin ic
,
Antioxidants
-
.
stop smoking alcohol
Medical Mx
'
:
Inj HCGSOOOIU
-
-
-
.
alcohol
Control sugar
-
vas
a) Sperm function
-
Exercise
-
Testosterone , prolactin
LH ,
scrotal USG
8) Vasogram
Improve general health
-
,
premature
Lifestyle modification
-
FSH
:
biopsy
6) Trans rectal
Chronic illness
-
of abstinence
Fructose content in seminal fluid
5) Testicular
4 Fusion defect
Psychological
.MX
.
4)
7)
8) Substance abuse
days
cilia)
acrosome defect
Impotence
-
3- 5
frequency
low coital
-
After
electro ejaculation
oocyte fusion defect
-
-
,
inflammatory blockage
,
3) Hormonal evaluation
Ivesiculah fluid
of sperm
( silicone polyurethane )
vibratory stimulation 4
Penile
Radiate
sterile container
collection in
Collection condom
,
congenital
Semen analysis
sample
-
Cryptochordism
orchitislmumps.TN
Drugs ( cimelidine spironolactone ) 4
-
:
Urine routine
,
Absent germ cells
-
-
3) Duct disorders
Hypothyroidism Hyperproladinemia
,
Kallman n syndrome
-
-
TSH
Hypothalamic pituitary
:
.
aleality
Aetiology
-
Female infertility
:
② Tubal
① Ovarian
peritoneal
Anovulation
it
Diminished
iil
③
4
tuba , obstruction due to
ovarian
'
Reservation mature
ovarian Failure
i )pID
iiilufealpha Defect
irllutenisedunruptored
this
NTUbd
V
follicle
on
) Adhesions
⑤ vaginal
Stenosis
iilprolapse
ilvaginal Atresia
iiilscantdmuw.li) Transverse
a) Polyps
( Asherman
Endometriosis
"
ikervicdl
1) fibroids
3) Sisnechiae
ii )tB
④ Cervical
Uterine
syndrome) ivkerviatis
a) uterine Hypoplasia
g)septalelpsicornuale
uterus
*
body temp
Tests for Tubal
-
potency
:
-
( forth)
-
Sr
g)
-
,
uterine
recent ovulation
3)
FSH
serum
smoking
Infections
Douglas
on
TVs are
.
serum
Measure
on
SIS
ASH
on
'
I
cycle days
day
.
+
ovaries not
well
on
days 5-9
10
I
Back to normal
Elevated
.
:
100mg Clomiphenecitratelday
2) Administer
4) Hyskrosalpingo
Contrast nography 5) Hysleroscopy
SRLH
Cigarette
of
Clomiphene citrate Challenge Test
4) laparoscopy
viiltransvaginal USG
( for follicular study )
t
Normal function
functioning
5) Laparoscopy
6) Falloscoby
Direct method
*
of
4 Free fluid in touch
sonographycsis)
progesterone
Addison 's disease
-
-
Features
2) HS4
3)
Hypothyroidism)
thyroiditis
-
Hyproladinemia
1) Measure
saline infusion
-
srestradiol
-
E-
Galadosemia
chemo tradition
cervical mucus
iffndometrial biopsy
estimation
II. Ovarian failure
anomalies
iiilcervi.ca/mucusstudy2IHysIerosalpingograph YLHSGI
ivlvaginal cytology
vilhlormone
-
Detects fibroid ,
polyps
.
-
PCOS
-
DUSG
1) Rubin 's test
1) Menstrual History
ii ) Basal
Hypothalamic pituitary failure
I.
* collapsed follicle
Diagnosing Ovulation
Indirect methods
-
I
Ovarian failure causes
vaginal septum
↳ Anti sperm
antibody in
Investigations
-
Anovuldtion
-
Laparoscopy
g) salpingoscobll
Test for Ovarian Reserve
-
FSH
1) Day 's Basal
2)
Basal Estradiol
[760 pglml
phase
>
in
early follicular
Reproductive aging
&
Hastened
cykdev)
3) Anti.mu/lerianHormone
4)
Inhibits Bt with
tin number
of
oocytes
5) Clomiphene
citrate
Challenge
6)
Test
USG
-
Antral Follicle count
Rt
•
:
therapeutic
DAnovulalion.fuboblastysx.tt
Adhesiolysis
Ovulation Induction
Hysleroscopy
agents
:
-
Clomiphen @ Citrate
150.250mg Iday )
-
-
-
-
Fimbrioplasty
quality improvement
by oestrogen
HMG.MG
-
acetyl eystein
d) Diminished
-
-
-
reserve
iii. steroids
Case
DHEA 25mg tid
IVF
2) Control
of sugar in
DM
3) Correction
of
thyroid disorders
Reversal of
tubal ligation
'
stop smoking alcohol
improves sperm
corneal connotation
penetration
:
weight loss
-
,
ii)N
Tubotubal anastomosis
Iv
-
1) Lifestyle modification
Salpingostomy
,
-
:
-
letrozole Ancestral
-
General measures
itcervicalmucus
4
of endometriosis
in
of anti sperm
antibodies
4) stress relief
5) Appropriate
therapy
of infections if present
R
,
NF with donor
oocyte
'
Unexplained infertility
-
super ovulation
✓
-1
Intrauterine insemination
Fails
In vitro fertilisation
'
In case of
Normal ovaries & Absent Uterus
Indications
for
therapeutic Hysleroscopy
1) polyps G fibroids ( Hysleroscopicpolypectomylmyomectomy)
a) Intrauterine adhesions
3) Lateral wall metroplasty for
4) Septum resections
:
surrogacy
:
1-
shaped uterus
Endometriosis
Definition
'
It
:
is
other
defined
functional
presence of normal
endometrial cavity
than
as
endometrial
mucosa
(glands & stromal
-
is
Extremely
rare
-
Genetic
-
a
hormone
proliferative
menarche
before
susceptibility
theories
-
sites :
.
Endometriosis
in
seen
Isi
dependent disease of childbearing period
and disappears after
cases
.
menopause
1)
.
Pelvic
.
4) Ovarian
5) Chocolate cyst of ovary
6) Appendix pelvic lymph nodes
scar endometriosis
1) Metastatic Lungs
:
Sampson 's theory of Retrograde menstruation ( most accepted )
a) Coelomic metaplasia Ivan off & Meyer
3) Haematogenous spread
a) Lymphatic spread that ban 's theory)
5) Direct implantation
,
-
,
:
.
Investigations
1) Laparoscopy
-
:
Infertility
-
Dyschezia
-
Pain
-
on
Cyclical
-
.
findings
Mx
( pain
on
micturition
Haematite 'd
mostly
edometriosis
in
seen
iii) Matchstick
of pouch of douglas
lif
frequency
involved )
Bladder
burnt
spots
in Blueberry lesion
v
) Red 1 Purple raspberry lesion
vi) sub ovarian adhesions
vii) sub peritoneal defects ( Allen Master syndrome)
defecation )
& Teed
cysts
iit powder bum spots
21
USG trans vaginal )
3)
CT
4)
CA 125
IMRI
-
Nonspecific marker
:
symptomatic
Asymptomatic
medical : symptomatic relief from pain dysmenorrhoed
,
-
Observe 6-8 months
t size
of
lesions
for
infertility
it
pills
0C
ii )
1) Minimal Invasive
2 tabs X 6-9 months
Medroxy progesterone
-
acetate
( 10 mgtid )
110 mg Hay )X
Dihydrog estrone
-
Destruction
-
progesterone
oral
surgery
.
1) Pseudo pregnancy regimen
V
Investigate
of endometriosis & staging
:
it chocolate
bdominal pain and back Dain
4-Jeep dyspareunia
site
choice
ablation of removal
menorrhagia & premenstrual spotting
Pelvic pain
=
Investigation of
biopsy
surgically treat endometriosis by
Dysmenorrhoea
-
:
Take
Asymptomatic
-
:
Detects
C1F :
-
Endometriosis
2) Pouch of Douglas
3) Utero sacral ligament
.
1)
.
locations
in
.
Aetiology :
.
implanted
abnormally
Xo g months
Excision
-
-
f- a month
Iii Im
progesterone
medroxy progesterone 150mg
in Levonorgestrel releasing IUD
d) Pseudo menopause regimen
Danazol 400mg in 4 divided
-
doses X 6- a months
( Rarely used )
-
-
-
Gastrinone
25mg
g) medical castration
-
-
:
twice
a
week × 6- a months
GnRH analogue CMK )
leuprolid@3.ls mg
Im
Nata reline
intra nasal
200mg
monthly
daily
X 6 month
X 6
months
a) Dienogest oral semisynthetic active steroidal progesterone
:
1 Laser
ablation
pain relief
LUNA
a) Laparotomy
:
-
by cautery
cyst
presacralneurectomy.fr
-
at 3 months interval
-
laparoscopy
Adhesions is
-
)
of
:
Hysterectomy
Excision
with bk
salpinooophoredomy
of scar endometriosis
Fibroid
v
✓
cervical
Uterine
t
1
Iv
v
-
u
Interstitial
subgenus
sub mucous
-
Intramural
)
( most
sessile
-
-
common
-
Anterior
posterior
Central
lateral
pedunullated
-
Effects
'
.
Incidence
20%
:
Etiology
C1F :
-
Estrogen dependant tumor
Multiparty
-
(
Infertility
-
fibroid
are
-
-
-
infertile 4
causes
Infertile women
prone
-
Obesity
-
Deletions of chromosome
-
7
-
-
*
'
smoking
protective
is
Investigations
Blood group
.
USGCIOC)
-
Doppler USG
-
.
Blood sugar
Hyperechoic
Determine
:
→
ECG
,
,
,
chest
hypo echoic
Calcification
,
x
ray etc
.
preterm labor
IUGR
.
.
prolonged Iobstructed labor
-
APHEIPPH
Infertility
Lump
in
pressure
abdomen
symptoms
On examination
cervix
,
urinary
or
firm to hard enlarged uterus
with
moves
dysuria
-
movement of
mass
retention
42-14 wks
felt
or more )
per abdomen
.
.
mass
Anechoict Necrosis
vanity
fibroid
differentiate
Saline infusion
adenomyosis
from
.
( Blood
flow surrounds fibroid
,
but
diffuses
through adenomyosis)
.
nography
MR1 1CT
.
.
,
,
-
'
-
concentric solid
-
-
'
malpresentations
:
CBC
,
.
Dysmenorrhoea
-
to develop fibroids )
Asymptomatic
menorrhagia
metorrhagia
:
pregnancy
Abortions
-
.
on
Hyskroscopy
-
Diagnostic
as
well
therapeutic
as
.
laparoscopy
RI
Fibroid
✓
v
symptomatic
Asymptomatic
v
w
Surgery
Regular supervision
↳ months interval )
-
-
-
•
✓
Size
stationary
t
follow
-
-
surgery
sizes Rwks
Pedunullatd
causing hydrometer
Symptoms
t
young
Myomectomy
① vaginal
:
Removal
Uterine
Family complete
Hysterectomy
tnyomedomy
of
fibroid
leaving
uterus
behind
u
r
u
.
③ Laparoscopic
② Hysleroscopic
+
+
sub mucous
fibroids
artery embolisation
appear
surgery
up
v
Old
size tses
-
For
v
✓
fubmucous fibroids not
-
removable easily by vaginal
Implications
Route
:
① Cervical trauma
④ Uterine adhesions
② thermal injury
③ Bleeding
⑤ Infection
⑥ Failure
For
a) Peduncle lated fibroid
b) sub serous (
not 710cm
,
not
74in number)
preoperative
therapeutic
Pelvic pain
Acute pelvic pain
Causes :
Obstetric
-
Abortions
-
,
septic abortion
degeneration
Red
-
of
fibroid
Twisted ovarian cyst
Acute
-
-
Molar pregnancy
-
-
Urinary retention
Appendicitis
Abdominal TB
-
DID
-
Endometriosis
-
syndrome
Ovarian Hyperstimulation
Ovarian
Acute cystitis
-
mittelschmerz
-
-
Hydraamnios
others :
Dysmenorrhoea
-
Ectopic pregnancy
-
-
Gynaecological
UT1
-
tumors
Abrupt'o placenta @
-
Chronic pelvic pain
Investigations :
Aetiology
US4
Doppler USG
-
-
1)
Gynaecological
causes
:
mostly Organic
Ovaries
i
-
-
-
)
Iii Tubal
-
-
Adhesions
Residual Ovarian
syndrome
-
-
parameter 'tis
in Uterine
MRI
Hysterosoopy
Diagnostic laparoscopy
-
fibroids
pyelography
Intravenous
-
Adhesions
of joints
CECT
-
Tumors
colonoscopy
Radiography
-
Chronic P1D
-
urine tests
-
Endometriosis
pelvic congestion
For
Conscious
-
Pain mapping
-
Laparoscopy
interaction
Adenomyosis
various
fixed retro rated uterus
pyometra
4 Pelvic TB
a) Functional
-
-
and adhesions
.
-
medical
-
causes :
① NSAIDs
② progesterone therapy
:
Congestive dysmenorrhoea
③
mittelschmerz
SSRI
Cpps
pelvic
varicose veins
-
-
Adjuvant therapy
fluoxetine
gynaecological
causes !
-
-
-
-
-
-
-
-
-
Intestinal TB
surgeries
Diverticulitis
Irritable
bowel
①
Ca
on
touching
organs
song Hay
① Acupuncture
:
Endometriosis
in
1 day
wave
diathermy
presacral
Rectum
( LUNA)
utero sacral Nerve ablation
Laparoscopic
>
②
Drugs & doses
:
syndrome
Intestinal obstruction ( chronic)
patient
with
10 -60mg
sertraline
② Short
g) Non
t
Mx
-
-
under LA
side effects : prolapse
,
Bladder dysfunction
Neuredomy
ureteric colic
Nerve
Joint
entrapment
-
static
magnetic therapy
stimulation
pains
-
has
been
for
a week
helpful
in
or
Transcutaneous
some
cases
nerve
.
for varicosity of pelvic veins : Embolisation
Sderotnerapy 151 ethanol amine
.
mdleate)
Cervical cancer
symptoms
Risk factors :
Young
①
at 1st intercourse
age
② Multiple
sex
③ cigarette
smoking
416
years)
partners
vaginal discomfort
malodorous vaginal discharge
-
④ Race
-
⑨ High
parity
⑥
HPV
infection
⑦
HN
pelvic pain
-
Dysuria
-
frequency
:
Cachexia
Anaemia
-
-
,
urgency
rectum invaded)
involved
pelvic wall
-
⑨ Low socioeconomic status
A
.
constipation ( if
-
⑧ Immunosuppression
vaginal bleeding
Abnormal
-
leg
edema
,
pain
,
Hydronephrosis
Investigations
'
-
.MX
Pre clinical
Pap
-
stage
( Exfoliate cytology)
smear
① stage IA1
HPV DNA test
-
-
:
:
testing
Colposcopy
and
DNA
Diagnostic
cone
Biopsy
-
young patient therapeutic cauterisation
old patient
simple Extra facial Hysterectomy
:
② Stage IA2 IB
,
Clinical stage
-
Punch
-
Late ca
&
Biopsy
③ Stage IB
-
R,
Meigs Obayashi Hysterectomy)
operable
by Radiotherapy ( External
beam RT
to pelvis
&
Brachytherapy )
-
ray to rule out pulmonary mats
Abdominal 91mm to rule out liver mets
Chest
-
-
x
Radionuclide
-
Addition of
Cisplatin 40mg weekly improves
:
.
IA
Can be
-
radio sensitivity
.
Depth of
¥§gi;
II
to
or
IA
.
-
-
-
:
are
all Radio sensitive
:
Invasion
,
depth
Max
of invasion ( 5mm
⑥ Poorly differentiated tumor
13mm
Invasion
3- 5
mm
in depth
Neo adjuvant
Greatest dimension
.
.
beyond uterus
to
,
not extend
but does
to
lower
43 of
vagina
upper
213
vagina without
parametric
involvement
.
size gem
size 7,4cm
Involvement
of
Involves
lower
Extension
to
:
IIB
:
parametric m but
113 of
pelvic
not
upto pelvic wall
.
vagina
but
not
pelvic wall
wall
or
Hydronephrosis IN on functioning kidney ( not
IIc
-
:
Involvement
III ;
Pelvic
of
LN
Para aortic
pelvic
metastasis
or
only
LN metastasis
IB
:
:
spread to adjacent pelvic organs
spread to distant organs
.
any other known
due to
14 paraorlic lymph nodes
II
IIA
chemotherapy :
① paclitaxel 90mg -11ns Ifosfamide 1000mg -1
Masha 400mg
weekly for 3 cycles
II
II A
post op RT:
reseated margin
③ Evidence of lymph oracular invasion
74cm
limited
IA2
.
② Positive
pelvic wall
:
:
:
invades
IA1
IB
I
invasion 75mm
Size
Carcinoma
:
:
sgifgelffnfcm.in
IB1
-
① Positive LN for metastasis
IA2
:
I
:
IA1
IB
stage
indication of
strictly confined to cervix
diagnosed only microscopically
carcinoma
I
89
scanning
FIGO staging 12018)
-
Hysterectomy
USG
-
.
I : Not
cytoscopy ¢ proctoscopy
-
-
-
Colposcopy
-
Wertheim 's
cervix
Hysteroscopy
-
-
on
RFT 4 left
-
.
ulcer
or
CBC
-
:
(aka
:
growth
from
IA
,
.
cause )
② cisplatin 50mg
weekly
Endometrial Cancer
Risk Factors : Estrogen dependent
Postmenopausal Bleed DIDS
cancer
-
( Anovulationt Hyperestrogen Ism)
① PCOS
cell tumor of ovary ( estrogen
menarche and late menopause
② Granulosa
③ Early
④ Age ,
Uterus :
C1F
secreting)
I
so years
⑤ Multiparty
-
⑥ Tamoxifen therapy
⑦ Unopposed estrogen therapy in HRT
⑧ Atypical endometrial Hyperplasia
⑨ Lynch a syndrome
-
Atrophic endometrium
-
postmenopausal bleeding
senile endometntis
HRT
-
perimenopausalpolymenorrhag.io
Offensive watery discharge
Endometrial Hyperplasia
Endometrial cancer
-
-
Simpson 's pain
Endometrial polyp
-
Uterine sarcoma
-
fibroids
-
.
.
Cervix
Cancer
-
Investigations :
.
Cerviatis
-
① Fractional
⑦ Pre op evaluation
curettage
② DEI C
-
③ Endometrial
biopsy
-
④ Hysterosoopy
⑤ Transvagindl Ultrasound
thickened Endometrium
Hyperechoic endometrium with
CBC
,
FBS
chest
-
x
,
-
.
RFT LFT
,
rsedrasalan.ly
on
Vagina
ray
-
EC9
-
.
irregular
polyps
.
-
-
Erosion
-
Ovary
Atrophy
Cancer
-
Tumors Cancer
,
outline
.
Doppler
Fallopian
rare)
tube ca( very
⑥ CTIMRI ( if needed)
My :
.
Staging
-
:
Total Abdominal Hysterectomy with BIL
salpingo-oopherectomy
.tn
Tumor confined to uterus
→
:
+
IA
-
IB
-
No
:
142 myometn.at invasion
or
vaginal cuff radiation
Radiotherapy
the myometn.at invasion
:
-
9%3%8%1
:
External beam radiation
modified Radical
Hysterectomy
tBKsalpingo-oopheredomyt.tt
Cervical stromal invasion but not beyond uterus
IN dissection
RTC 4500-500044)
External
>
:
.
I
TIA
-
IIB
-
-
.
Beam
-1
:
Invades
:
Vaginal lparametn.at
aerosol or adnexa
invasion
IIC
>
IICI
>
IC2
:
:
pelvic LN involved
Para aortic LN involved
I
-
-
s
IIA
:
IB :
Invasion of bladder 1 bowel
Distant
De bulking
surgery
followed by
Radiotherapy
( External Beam)
mucosa
metastasis
.
Chemotherapy
Advanced
and Hormonal therapy
recurrent cases
or
Chemotherapy Agents
-
-
-
-
-
Cisplatin
Carbo plain
Cyclophosphamide
paclitaxel
Adriamycin
is
used
in
.
Hormonal
-
-
-
therapy
progestins
GnRH analogues
Aromatase inhibitors