Athira symposium gynaecology final year mbbs

822 views
547 views

Published on

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
822
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
16
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Athira symposium gynaecology final year mbbs

  1. 1. INVESTIGATIONS
  2. 2. Infertility one year or longer Initial evaluation , history ,physical examination Irregular Unilatera or Structural Abnormal Normalmenses,no bilateral endometria semen evaluationovulation tube block abnormality analysis Uterine MaleAnovulation Tubal factor Unexplained factor factor Counselling and psychosocial support Multiple factors – investigate and manage
  3. 3. HISTORY• Age• Duration of marriage• Menstrual history• Past obstetric history – PROM , puerperal sepsis• Previous use of contraceptives and its type• Medical History - tuberculosis , pelvic infection , STD ,diabetes , thyroid dysfunction .• Surgical history
  4. 4. CLINICAL EXAMINATION• Height and weight• Blood pressure• Features of hirsuitism• Galactorrhoea• Palpation of thyroid• Breast and lymph nodes• Abdominal examination
  5. 5. GYNAECOLOGICAL EXAMINATION• Examination of perineum• Speculum examination
  6. 6. INVESTIGATIONS FOR CERVICAL FACTORS• POST COITAL TEST / SIMS TEST / HUHNERS TEST• MILLER - KURZROK TEST• SEMEN CERVICAL MUCUS CONTACT TEST
  7. 7. POST COITAL TEST Done on day 12 or 13 of menstrual cycle. Report to clinic within 8 hours of intercourseEndocervical mucus is collected and placed on a slideNumber and motility of sperms seen under microscope
  8. 8. MILLER KURZROK TESTCervical mucus of the wife at the time of ovulation is placed on slide Semen of the husband is placed alongside Penetration of the sperms is studied under microscope
  9. 9. MILLER KURZROK TEST
  10. 10. SEMEN CERVICAL MUCUS CONTACT TEST• A test for anti sperm antibodies .• The sperm and mucus are mixed and sperms viewed under microscope for characteristic shaky movement.
  11. 11. Wife’s mucus+ donor Abnormal Abnormal NormalsemenHusband’s semen+ Abnormal Normal Abnormaldonor mucusInference Problem in Wife’s Immunologic both mucus problem in abnormal male
  12. 12. INVESTIGATIONS TODETECT TUBAL PATENCY• HYSTEROSALPINGOGRAPHY• LAPROSCOPIC CHROMOTUBATION• SONOSALPINGOGRAPHY• HYSTEROSCOPY AND FALLOSCOPY• AMPULLARY AND FIMBRIAL SALPINGOSCOPY
  13. 13. HYSTEROSALPINGOGRAPHY• To visualize uterine cavity and fallopian tubes• Done on day 10 of menstrual cycle PROCEDURE Atropine is Clean the lower genital tract given 30 min before Radiopaque dye injected procedure through cannula Radiographic pictures taken
  14. 14. LAPAROSCOPIC CHROMOTUBATION• To visualize pelvis , fallopian tubes and ovaries and to verify HSG findings.• Peritubal adhesions and unsuspected endometriosis can be diagnosed.• Indicated in patients with blocked fallopian tubes prior to tubal microsurgery.• Advantage – can proceed with therapeutic procedure.
  15. 15. SONOSALPINGOGRAPHY• Less side effects.• Good technique to detect submucous fibroid polyp and intrauterine lesions. PROCEDURE Under ultrasound scanning slow injection of 200ml of physiological saline through Foleys catheter.
  16. 16. HYSTEROSCOPY AND FALLOSCOPY• To study the interstitial end of fallopian tube.• ADVANTAGES - Mucus plug or inspissated material can be flushed out. - Polypus can be removed. - Synechiae can be broken.
  17. 17. AMPULLARY AND FIMBRIAL SALPINGOSCOPY• To study the mucosa of fallopian tube.
  18. 18. DILATATION AND INSUFFLATION• Also known as RUBINS TEST• Performed 2days after menstruation stops.• PROCEDURE – air or carbondioxide is pushed transcervically under pressure .• Not commonly done now.
  19. 19. TESTS OF OVULATION• BASAL BODY TEMPERATURE• ENDOMETRIAL BIOPSY• FERN TEST• ULTRASOUND• HORMONAL STUDY
  20. 20. BASAL BODY TEMPERATURE• Falls at time of ovulation by 0.5 F.• In progestational half temperature is raised above preovulatory level by 0.5 – 1 F.• Presumptive evidence of functional corpus luteum.• Has now become obselete .
  21. 21. ENDOMETRIAL BIOPSY• Curetting small pieces of endometrium 1 or 2 days before onset of menstruation.• Histological scrutiny done after fixation in formalin saline• Subjected to culture – rule out genital TB• Not done routinely
  22. 22. FERN TEST• Specimen of cervical mucus spread on slide and viewed under low power microscope .• Oestrogenic phase – fern formation.• After ovulation ferning disappears.• At ovulation – ovulation cascade and spinnbarkeit or thread test .• Secretory phase – spinnbarkeit disappears and tack appears.• Insler scoring system
  23. 23. ULTRASOUND• Standard procedure for monitoring maturation of graafian follicle .• ADVANTAGES Non invasive accurate and safe. Pelvic pathology can be picked up . Endometrial thickness can be measured .
  24. 24. HORMONAL STUDY• PLASMA PROGESTERONE• LUTEINIZING HORMONE• HYPERPROLACTINAEMIA• FOLLICLE STIMULATING HORMONE• THYROID TESTS
  25. 25. Ovarian disordersInfrequent menses Signs ofSigns of decreased High day 3 FSH hyperandrogenism estrogenization Abnormal CCCT Oligomenorrhoea High FSH , LH Advanced age AnovulationPremature ovarian Decreased ovarian Polycystic ovarian failure reserve syndrome Assess for and Brief trials of Ovulation treat secondary superovulation or induction causes IVF ART ART
  26. 26. INVESTIGATIONS FOR UTERINE FACTORS
  27. 27. THANK YOU A presentation by - Athira P.A (final year: JUGGERNAUTS)

×