nursing lecture

2. Obstetrics and Gynecology
• branch in medicine that deals with woman’s
health
Ø Non-pregnant status = Gynecology
Ø Preconception status
Ø Pregnancy ,Labour & Puerperium =
Obstetrics

3. Gynecological presentations
• Pelvic Pain
• Vaginal Bleeding (AUB)
• Vaginal Discharge (infection)
• Inability to conceive (Infertility)
• Want Contraception

4. Infertility
• inability to conceive following unprotected sexual
intercourse for 1 year (age < 35)
• Affects 15% of reproductive couples
• Primary infertility:
a couple that has never conceived
• Secondary infertility :
infertility that occurs after previous pregnancy

5. Conception rates for fertile couples
0
10
20
30
40
50
60
70
80
90
100
0 6 12 18 24
Months of Treatment (cycles)
Percent
of
Couples
Conceiving

6. Requirements for Conception
• Production of healthy egg and sperm
• Unblocked tubes ( allow sperm to reach the egg)
• sperms ability to penetrate and fertilize the egg
• Implantation of the embryo into the uterus

7. Causes of Infertility
• Anovulation
• Male factor (sperm production & transport)
• Anatomic defects of the female genital tract
(fallopian tube-uterus)
• Unexplained (infertile couples will have a completely normal workup)

8. Evaluation of the Infertile couple
• History and Physical exam
• Semen analysis
• Determination of ovulation
– Serum progesterone (regular cycle)
– FSH-LH-PRL-TSH (Irregular cycle)
• Uterus evaluation :
– TVS
– Hysteroscopy
• Fallopian tube
– Hysterosalpingogram
– laparoscopy

9. Male Factor
• 40% of the cause for infertility
• Sperm is constantly produced by the germinal
epithelium of the testicle
– Sperm generation time 73 days
– Sperm production is thermoregulated
• 1° F less than body temperature
• Both men and women can produce anti-sperm
antibodies which interfere with the penetration of
the cervical mucus

10. Semen Analysis (SA)
– Volume : ≥1.5 ml
– Viscosity : Liquification in 30-60 min
– pH : ≥ 7.2
– Sperm Count :≥15 million/ml
– Motility :≥40%
– Morphology : ≥4% normal forms
– WBC : <1 million/ml

11. Abnormal Semen Analysis
• Abnormal volume
• Azospermia (no sperms)
• Oligospermia (<15mil/ml)
• Athenospermia (weak)
• Necrospermia (dead)
• Teratospermia (abnormal)
treatment :
Referral to urology/andrology

12. Causes for Abnormal SA
• No sperm
– Klinefelter’s syndrome
– Sertoli only syndrome
– Ductal obstruction
– Hypogonadotropic-
hypogonadism
• Few sperm
– Genetic disorder
– Endocrinopathies
– Varicocele
– Exogenous (e.g., Heat)
Abnormal Count

13. Cont. causes for abnormal SA
• Abnormal Morphology
– Varicocele
– Stress
– Infection (mumps)
• Abnormal Motility
– Immunologic factors
– Infection
– Defect in sperm structure
– Poor liquefaction
– Varicocele
• Abnormal Volume
– No ejaculate
• Ductal obstruction
• Retrograde ejaculation
• Ejaculatory failure
• Hypogonadism
– Low Volume
• Obstruction of ducts
• Absence of vas deferens
• Absence of seminal vesicle
• Partial retrograde
ejaculation
• Infection

16. Treatment of female factor:
• Anovulation :
stimulates the ovary to make follicles(Clomide – FSH)
• Anatomic Abnormalities
adhesolysis –Septoplasty-Tuboplasty-Myomectomy
• If the fallopian tubes are beyond repair :(IVF)

17. GENITAL INFECTIONS
• Vaginal/vulval /cervical Infections
• Pelvic Inflammatory Disease
( uterus/F.tube)

18. Monilia Vaginitis (Candidiasis)
• Organism:
– Candida albicans causes 90% of cases.
– C. tropicalis and C. glabrata cause 10% of cases.
• Mode of infections:
May be present in the vagina and flourish with predisposing factors
­­ vaginal acidity or suppression of other vaginal flora.

19. Predisposing factors:
• Antibiotics → ¯ the lactobacilli that ¯ Candida growth
• Oral contraceptives →­ glycogen
• Pregnancy high oestrogen level →­ glycogen
• Steroids and immunosuppressives lower immunity
• Diabetes →­ glycogen deposition and low immunity
• Lack of proper hygiene

20. • Symptoms:
– Discharge: thick, scanty, white, curd-like, adherent
– Itching and scratching sensation on the vulva.
– VulvoVaginitis
• Investigation:
– Fresh drop with added 10% KOH: G+ve spores and
hyphae
– Stained film with methylene blue
– Treatment :
Antifungal preparations:
clotrimazole, miconazole, tioconazole,Fluconazole;
Ketoconazole;

21. Trichomonas Vaginitis
• Organism: Trichomonas vaginalis
• Mode of infection: Sexual intercourse -
Contaminated towels and instruments
• Presentation:
• Profuse yellowish, frothy malodorous vaginal
discharge
•Pruritis vulvae
• Investigation:
qFresh smear: organism and leucocytes
qStained film: Giemsa stain
• Treatment: Metronidazole - Sexual partner treated

22. BACTERIAL VAGINOSIS
(Non-specific Vaginitis, Gardnerella Vaginitis)
• Organism: Alternation of normal flora; decrease lactobacilli and
increase Gardnerella and anaerobes.
• Mode of infection: Sexual transmission
• presentation:
– thin excessive greyish frothy malodorous Discharge
– Pruritis
– Vulvovaginitis
– Investigation :
Fresh drop: Clue cells
Whiff test: Discharge + 10% KOH → fishy odour
– Treatment: Clindamycin -Metronidazole
Sexual partner should be treated

24. Cervicitis
• inflammation of the endocervical glands
• Cause: Gonococcal –Chlamydial
• Symptoms:
Mucopurulent discharge
Mild fever
Dyspareunia and backache
• Signs:
The cervix is red swollen
mucopurulent discharge
Marked tenderness on moving the cervix
• Investigations: Culture and sensitivity of the discharge
• Treatment: Antibiotics ( according to organism)