Welcome to week 4 Obstetrics and Gynecology

1. Welcome to week 4Obstetrics and Gynecology

2. Error review from urology week 3

3. What is Obstetrics and Gynecology? • Obstetrics: care of women during pregnancy, childbirth, and after • Obstetrician: specialist in the management of pregnancy and childbirth • Gynecology: specialty in diseases of the female reproductive system • Gynecologist: specializes in the health of the female reproductive system • OB/GYN: both GYN health and reproductive issues

4. Anatomy of the Female Reproductive System • External genital organs • Clitoris: Small mass of erectile tissue anterior to opening of the urethra • Bartholin glands: Lubricant for vaginal opening • Skene glands: Located at lower end of urethra • Labia: Sets of skin folds that cover genital organs • Labia majora • Labia minora • Mons pubis: Rounded mound of fatty tissue that covers public symphysis (pelvic bone)

5. Normal anatomy

6. Internal Genital Organs • Ovaries • Produces female egg cell (ovum) • Follicles: contain immature ovum (oocyte) • Ovulation: follicles discharge one ovum from the ovary • Fallopian tubes • Infundibulum: wide, flared end • Fimbriae: finger-like extensions

7. Uterus (womb) • Fundus • Body • Cervix: Neck of the uterus • Three Layers: • Endometrium: inner lining • Myometrium: middle layer • Perimetrium: outer layer

8. Vagina (birth canal): Connects the uterus to the outside of the body • Mammary Glands • Colostrum: produced during pregnancy • Milk: after pregnancy, induced by prolactin

9. Menstrual cycle: Makes eggs available for possible pregnancy • Hormones stimulate growth of follicles • FSH and LH: from the pituitary gland • Estrogen and progesterone: from the ovaries • Follicles release ovum • Ovum travels through fallopian tube • No pregnancy: menstruation occurs

10. Menopause: Time preceding and following last menstrual flow • Premenopause: Transition to menopause • Postmenopause: End of menopause • Menarche: Age of first menstruation

11. Abnormal bleeding • Menometrorrhagia: bleeding both during menses and at irregular intervals • Dysmenorrhea: difficult or painful menstruation • Amenorrhea: absence of bleeding

12. Fundamentals of Human Reproduction • Fertilization: sperm and egg merge • Fraternal twins: two eggs simultaneously fertilized • Identical twins: one egg which divides into two halves • Embryo: time of implantation until 8th week gestation

13. Ectopic pregnancy: fertilized egg implants itself outside the uterus (e.g., the fallopian tube) • Fetus: 8 weeks until time of delivery • Receives nutrients from placenta • Umbilical cord connects baby to the placenta.

14. Documenting Obstetrical History • Gravida: total number of pregnancies • Para: number of viable births, multiples counting as one • Abortus: number of pregnancy losses • GPA system: uses letters G, P, and A

15. TPAL system T = Number of term infants P = Number of premature infants A = Number of abortions L = Number of living children

16. Other terms to describe obstetric history: • Nulligravida (no pregnancies) • Primigravida (one pregnancy) • Secundigravida (two pregnancies) • Nullipara (no deliveries of viable offspring)

17. Fertility Issues • Infertility: The inability of a couple to become pregnant, regardless of the cause • In vitro fertilization (IVP): A method of helping a couple to achieve pregnancy by artificial means in which eggs from a woman are combined with sperm in a laboratory dish, where fertilization takes place • First “test tube baby” was born in Great Britain in 1978

18. Labor and Delivery • Labor: The term given to the efforts of giving birth to a child • Pre-delivery procedures: • Assess amniotic fluid for rupture of membranes (ROM) or premature rupture of membranes (PROM), or preterm premature rupture of membranes (PPROM, pronounced “P-prom”) • Assess effacement and dilation • Effacement: thinning of the cervix (“ripening”) • Dilation: opening of the cervix during labor, measured in centimeters (cm)

19. Labor and delivery

20. Labor and Delivery (Continued) • Station: Refers to the position of the baby’s presenting part (face/chin, foot, etc.) in relation to the mother’s ischial spine located at the lower end of the spine. Measured in numbers from -4 (just entering pelvis) to +4 (ready to be born) • Fetal well-being: Refers to whether baby is receiving enough blood and oxygen from placenta during birth process • Fetal heart tones measure increases (accelerations) or decreases (decelerations) in heart rate • Tocodynamometer measures uterine contractions along with intrauterine pressure catheter (IUPC) alongside baby • Fetal scalp electrode (FSE) monitor’s baby’s heartbeat

21. Augmentation: Methods to hasten labor and delivery • Oxytocin: hormone that causes uterine contractions • Pitocin = synthetic form oxytocin • Other drugs: prostaglandin (Cervidil) and misoprostol (Cytotec) • Terbutaline: slows rate of contractions and delays labor

22. Normal spontaneous vaginal delivery (NSVD) • Forceps-assisted delivery • Vacuum-assisted delivery • Cesarean section (C-section) delivery • When abnormal conditions complicate labor and vaginal delivery • Dystocia: difficult labor • Apgar score: evaluates infant at 1 and 5 minutes after birth

23. Common Gynecologic Diseases and Treatments • Human Papilloma Virus (HPV) • Associated with cervical cancer • Transmitted through sexual intercourse • Treatment: removing warts and monitoring for cancer cells • Drugs: TCA and imiquimod (Aldara) and podofilox (Condylox) applied to genital warts

24. Pelvic Inflammatory Disease (PID) • Inflammation of the uterus (endometritis), fallopian tubes (salpingitis), or ovaries (oophoritis) • Bacteria invade internal structures, causing inflammation and tissue damage • Treatment: Antibiotics to prevent damage to reproductive organs, such as Levaquin, Flagyl, and Rocephin

25. Cervical dysplasia • Development of abnormal (precancerous) cells in the lining of the cervix • Strongly associated with HPV infection • Squamous intraepithelial lesion (SIL): abnormal cells • Low-grade SIL (LGSIL): early changes in the cells • High-grade SIL (HGSIL): a large number of precancerous cells

26. Cervical intraepithelial neoplasia (CIN) • CIN levels categorize abnormal changes in cervical tissue • Example: CIN-1, CIN-2, or CIN-3

27. Endometriosis • Endometrial tissue grows elsewhere in abdominal cavity • Adhesions: bands of scar-like tissue in the tubes and ovaries • Treatment: no cure but focused on relieving symptoms • Pain medications: ibuprofen (Advil, Motrin), naproxen (Aleve) • Hormone suppression

28. Surgery: • Laparoscopy: diagnosis and treatment • Laparotomy: larger incision in the abdomen • Hysterectomy: surgical removal of uterus and sometimes cervix

29. Uterine Fibroids (myomas, leiomyomas) • Noncancerous growths in the wall of the uterus • Medications: NSAIDs with progestin to treat pain • GnRH agonists to shrink fibroids • Surgery: • Myomectomy: laparoscopically removal of fibroids • Myolysis: electric current to destroy fibroid

30. Cryomyolysis: Freeze and destroy tissues • Endometrial ablation: Surgically removes the lining of the uterus • Uterine artery embolization: Small particles injected to cut off blood supply to fibroid • Focused ultrasound surgery (FUS): High-frequency sound waves

31. Gynecologic Cancers • Ovarian Cancer (ovarian carcinoma) • Epithelial carcinomas: Surface of the ovaries • Germ cell tumors: Cells that produce eggs in the ovaries • Stromal cell tumors: Connective tissue of the ovaries

32. Uterine Cancer • Endometrial cancer: Affects endometrium • Uterine sarcoma: Affects myometrium • Papillary serous carcinoma • Clear cell carcinoma

33. Cervical Cancer • Develops in the lining of the cervix • Cause: unknown, but HPV is strongly associated • Treatment: • Early cervical cancerous tissue removed or destroyed • Loop electrosurgical excision procedure (LEEP)

34. Breast Cancer • Carcinoma in situ: confined to the place where it began • Ductal carcinoma in situ (DCIS): confined to ducts only • Lobular carcinoma in situ (LCIS): confined to lobules only • Invasive (infiltrating) ductal carcinoma (IDC): starts in ducts, spreads • Invasive (infiltrating) lobular carcinoma (ILC): starts in lobules, spreads

35. Treatment: Goal is to remove as much of cancerous tissue as possible • Lumpectomy: removes only breast tumor and some tissue • Simple mastectomy: removes one or both breasts but leaves muscle and skin • Modified radical mastectomy: removes entire breast as well as surrounding tissues and structures

36. Diagnostic Studies and Procedures • Laboratory Studies • Human Chorionic Gonadotropin Test: detects hCG in blood or urine • Pap Smear • Wet Mount: evaluates the cause of vaginal irritation and discharge • STD Cultures

37. Obstetric Studies • Fertility Studies • Hysterosalpingogram (HSG): x-ray study of the uterus and fallopian tubes • Hysteroscopy: visual examination of the uterus and fallopian tubes • Sonohysterogram (SHG): similar to HSG but uses ultrasound • Amniocentesis – Evaluation of amniotic fluid for problems in the fetus such as genetic defects, infections, or fetal lining immaturity

38. Gynecologic Studies • Laparoscopy: Visualization of the uterus, fallopian tubes, and ovaries with use of laparoscope • Colposcopy: Evaluation of abnormal areas in the vagina and cervix with use of colposcope • Acetowhite lesions = Abnormal cervical changes • Biopsies can be taken for examination • Endocervical curettage (ECC): removal of tissue in the cervix using a curet • Cone biopsy: More extensive cervical biopsy where cone-shaped piece of cervix is removed and examined for abnormalities

39. Mammography: An x-ray picture of the breasts used to detect tumors and cysts and to help differentiate between benign and malignant tumors • BI-RADS system – Developed by the American College of Radiology to report mammogram results using a common language with a single-digit score (0-5) and final assessment indicating specific course of action

40. Questions and answers------