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Gynecology and Obstetrics. What are the organs of the female reproductive system? What do they look like - size and shape How are they connected?. Anatomy and physiology. Birger Bre um, MD, OB/GYN. 14/10-2010. Gynecology and Obstetrics. Anatomy and physiology.

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Gynecology and obstetrics

Gynecology and Obstetrics

What are the organs of the female reproductive system?

What do they look like - size and shape

How are they connected?

Anatomy and physiology

Birger Breum, MD, OB/GYN. 14/10-2010


Gynecology and obstetrics1

Gynecology and Obstetrics

Anatomy and physiology

Birger Breum, MD, OB/GYN. 14/10-2010


Gynecology and obstetrics2

Gynecology and Obstetrics

Anatomy and physiology

Birger Breum, MD, OB/GYN. 14/10-2010


Gynecology and obstetrics3

Gynecology and Obstetrics

What is the purpose of the uterus?

What is the purpose of the ovaries?

How does the egg (secondary oocyte) get to the uterus?

Where does the egg meet the sperm cells?

What happens after fertilisation?

Anatomy and physiology

Birger Breum, MD, OB/GYN. 14/10-2010


Gynecology and obstetrics4

Gynecology and Obstetrics

Anatomy and physiology

Birger Breum, MD, OB/GYN. 14/10-2010


Gynecology and obstetrics5

Gynecology and Obstetrics

Birger Breum, MD, OB/GYN. 14/10-2010


Gynecology and obstetrics6

Gynecology and Obstetrics

Guess (hopefully qualified) what we see in this video.

Female Sterilization

What other forms of birth control do you know?

Male condom, female condom, diaphragm, 

spermacides (gel, foam...). birth controll pill, nuvaring,

IUD, injectable contraception (solid og fluid)......

Birth Control

Birger Breum, MD, OB/GYN. 14/10-2010


Gynecology and obstetrics7

Gynecology and Obstetrics

Pathology - what can go wrong?

Cancer

Infection

Cysts

Torsion

Fibroma

Polyps.....

Pregnancy related

Bleeding

Pain

Nausia

Abortion (&missed abortion)

Ectopic pregnancy

Birger Breum, MD, OB/GYN. 14/10-2010


Gynecology and obstetrics8

Gynecology and Obstetrics

22 year old female, goes to the ER due to abdominal pain.

What do we want to know?

Description of pain. Where in the cycle? Is she pregnant? Is she (or has she been) sexually active?Temperature? Urinetest for (HCG, Leukocytes, Nitrate)

A clinical case

Birger Breum, MD, OB/GYN. 14/10-2010


Gynecology and obstetrics9

Gynecology and Obstetrics

22 year old female, goes to the ER due to abdominal pain.

Case 1

Pain started suddenly, 20 hours ago, varies, pain gets worse when moving around, started diffusely, now worst in lower right abdominal quadrant. Period 2 weeks ago. She has not been sexually active for the last three months.

Temperature 38,4 C. Urinetest: HCG negative, 2+ Leukocytes, Nitrate negative)

Appendicitis, Cystitis or PID?

A clinical case

Birger Breum, MD, OB/GYN. 14/10-2010


Gynecology and obstetrics10

Gynecology and Obstetrics

22 year old female, goes to the ER due to abdominal pain.

Case 2

Pain started slowly, a few days ago, varies, pain gets worse when moving around, low in the middle og the abdomen. Period 2 weeks ago. She has not been sexually active for the last three months.

Temperature 38,4 C. Urinetest: HCG negative, 2+ Leukocytes, Nitrate positive)

Cystitis!

A clinical case

Birger Breum, MD, OB/GYN. 14/10-2010


Gynecology and obstetrics11

Gynecology and Obstetrics

22 year old female, goes to the ER due to abdominal pain.

Case 3

Pain started suddenly, 20 hours ago, varies, pain gets worse when moving around, started diffusely, now worst in lower right abdominal quadrant. Trying to get pregnant, but started to bleed around 3 weeks late (usually has irregular menstruation), the bleeding was yesturday. 

Temperature 37,4 C. Urinetest: Leukocytes negative, Nitrate negative) Should we take HCG?

A clinical case

Birger Breum, MD, OB/GYN. 14/10-2010


Gynecology and obstetrics12

Gynecology and Obstetrics

22 year old female, goes to the ER due to abdominal pain.

Case 3

Pain started suddenly, 20 hours ago, varies, pain gets worse when moving around, started diffusely, now worst in lower right abdominal quadrant. Trying to get pregnant, but started to bleed around 3 weeks late (usually has irregular menstruation), the bleeding was yesturday. 

Temperature 37,4 C. Urinetest: HCG positive, Leukocytes negative, Nitrate negative)

A clinical case

Birger Breum, MD, OB/GYN. 14/10-2010


Gynecology and obstetrics13

Gynecology and Obstetrics

22 year old female, goes to the ER due to abdominal pain.

Case 3

Pain started suddenly, 20 hours ago, varies, pain gets worse when moving around, started diffusely, now worst in lower right abdominal quadrant. Trying to get pregnant, but started to bleed around 3 weeks late (usually has irregular menstruation), this was yesturday. 

Temperature 37,4 C. Urinetest: HCG positive, Leukocytes negative, Nitrate negative)

Abortion? Extra uterine pregnancy? VIDEO 3

A clinical case

Birger Breum, MD, OB/GYN. 14/10-2010


Gynecology and obstetrics14

Gynecology and Obstetrics

22 year old female, goes to the ER due to abdominal pain.

Case 4

Pain started suddenly, 20 hours ago, varies, pain gets worse when moving, started diffusely, now worst in lower right abdominal quadrant. Trying to get pregnant, but started to bleed around 3 weeks late (usually has irregular menstruation), this was yesturday. 

Temperature 37,4 C. Urinetest: HCG positive, Leukocytes negative, Nitrate negative)

But ultrasound yesturday: Normal pregnancy!

A clinical case

Birger Breum, MD, OB/GYN. 14/10-2010


Gynecology and obstetrics15

Gynecology and Obstetrics

  • Symptyms of spontanious abortion are: Bleeding and pain, but one or both might not be present (asymptomatic)

  • Symptyms of extrauterine pregnancy are: Bleeding and pain, but one or both might not be present (asymptomatic)

  • Around 20% of normal pregnanciesbleed one or more times.

  • Around 20% of normal pregnancieshave pain or more times. 

  • SOLUTION:

  • Ultrasound and S-HCG

Early pregnancy diagnostics problems

Birger Breum, MD, OB/GYN. 14/10-2010


Gynecology and obstetrics16

Gynecology and Obstetrics

Birger Breum, MD, OB/GYN. 14/10-2010


Gynecology and obstetrics17

Gynecology and Obstetrics

  • Nausia

  • Hypertension, before or because of pregnancy

  • Preeklampsia (hypertension, protein in urine...)

  • Diabetes, before or because of pregnancy

  • Obesity

  • Astma

  • Infections do usually not harm foetus. Exceptions (rubella, toxoplasmosis, Group B streptococs....)

  • Bleeding

  • Intra uterine growth retartion

  • Abortion/foetal death

  • Medicine-changes needed.(Myxoedema, depression)

Some later pregnancy conditions/problems

Birger Breum, MD, OB/GYN. 14/10-2010


Gynecology and obstetrics18

Gynecology and Obstetrics

Children that are born between the 36th and 39th week (38 and 41 weeks after the Last Menstrual Period) are considered as being normal term deliveries.

Statistically, only 2/3 of all children are born within the 3 weeks around the calculated date of birth and around 80 % within a month around the predicted date of birth.

Normal delivery

Birger Breum, MD, OB/GYN. 14/10-2010


Gynecology and obstetrics19

Gynecology and Obstetrics

  • Delivery proceeds in three periods:

    • Dilatation period

    • Expulsion or press period (subdivided into 4 phases)

    • After-birth period

Normal delivery

Birger Breum, MD, OB/GYN. 14/10-2010


Gynecology and obstetrics20

Gynecology and Obstetrics

During delivery the infantile head has to conform to the various pelvic sections. 

In the expulsion period the first 3 phases describe the development of the head while phase 4 that of the shoulders, whereby the head rotates 90° back again.

Normal delivery

Birger Breum, MD, OB/GYN. 14/10-2010


Gynecology and obstetrics21

Gynecology and Obstetrics

Normal delivery

Birger Breum, MD, OB/GYN. 14/10-2010


Gynecology and obstetrics22

Gynecology and Obstetrics

Press Period Problems (Expulsion problems)?

Consider the 3 Ps

Power (or Push or Pattern of contractions)

Pelvis (not large enough?)

Passenger (Babysize, baby orientation)

Usually a comPnation (combination) of the three

Normal delivery

Birger Breum, MD, OB/GYN. 14/10-2010


Gynecology and obstetrics23

Gynecology and Obstetrics

Helping the baby along:

Enforsing contractions:  oxytocin-drip

Direction and force: vacuum extraction/Forceps

Manual manipulation

Alternative route.

Operation: C-section

Pathological delivery

Birger Breum, MD, OB/GYN. 14/10-2010


Gynecology and obstetrics24

Gynecology and Obstetrics

Post partum bleeding

Fysiological (normal bleeding) 300-500 ml

Pathological >500 ml

Imediate action (operating theater) >1000 ml

Pathological delivery

Birger Breum, MD, OB/GYN. 14/10-2010


Gynecology and obstetrics25

Bleeding >500 ml is patological.

Consider:

Tonus: Atonia

Tissue: in uterus (placenta/clots)

Traume: Tears

Thrombin: Koagulation - maybe secondary to bleeding

Bleeding > 1000 ml: Intrauterine palpation, tears in collum, vagina and perineum – Operating theater

Match-test, Hgb, plateles, factor 2-5-7, APTT - perhaps. DIC-screening

Gynecology and Obstetrics

Pathological delivery

Birger Breum, MD, OB/GYN. 14/10-2010


Gynecology and obstetrics26

Treatment

Call help: obstetrician, midwife in charge, healtcareworker

Empty bladder

Uterus massage and compression.

Observations (Respiration, BP, pulse, i.v. fluids, estimated bloodloss, diuresis and medicin).

Trendelenburgs

IV acces 2 large - Bloodmatch

NaCl 2 liter, Plasma expanders 500 - 1000 ml. Oxygen 

Medicin

Intrauterine palpation.

Gynecology and Obstetrics

Pathological delivery

Birger Breum, MD, OB/GYN. 14/10-2010


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