eastzonemedico.in

1. Laurel Ob/Gyn. Below you will find some of the most common disorders we evaluate and
treatments we perform. If you have a question regarding a subject which is not listed,
 Abnormal bleeding and
discharge
 Adnexal and ovarian
masses and diseases
 Adolescent care
 Breast disease
 Contraceptive
counseling
 Diaphragm fitting
 Dysplasia of the cervix
 Endometrial ablation
 Endometriosis
 Hysterectomy
 Hysteroscopy
 Hormonal management
 Implanon insertion and
removal
 Infertility
 IUD insertion
 Laparoscopic Surgery
 Minimally invasive
surgery
 Menopausal symptoms
 Osteoporosis screening
and treatment
 Pain with intercourse
 Pelvic prolapsed
 Perimenopausal
symptoms
 Pessary fitting
 Sexual dysfunction
 Sterilization/tubal
ligations
 Well woman care
 STD screening
 Urinary incontinence
 Vulvar, Vaginal, and
Cervical Infections and
Disorders
 Vulvar pain
Post Procedure Instructions
Below are some of our post procedural instructions. If you do not see your procedure listed, or if
you have any questions regarding these instructions and /or your symptoms, to reach a physician
or nurse for advice. These instructions are not intended to replace the need for you to receive
medical advice about your condition. As always, if you are having a true medical emergency,
please dial 911 for assistance.
After Colpo
If a biopsy was taken, the results will be available in about two weeks. Make sure to schedule a
follow-up appointment.
Do not douche, use tampons, or have sex for one week.
You may experience some cramping or slight bleeding. You may also notice a black, yellow,
gritty, and/or particulate discharge from the medication used after the procedure.
Please call if:
 You develop a temperature greater than 100°F
 You experience any heavy bleeding (one pad per hour or more)
 You have abdominal pain
 You have any questions or concerns
After LEEP
Do not have sexual intercourse or place anything in the vagina for four weeks.
Do not use tampons for four weeks
You may experience some cramping or slight bleeding. You may also notice a black, yellow,
gritty, and/or particulate discharge from the medication used after the procedure. This can also be
watery at times.
Please call if:

2.  You develop a temperature greater than 100°F
 You experience any heavy bleeding (one pad per hour or more)
 You have abdominal pain
 You have any questions or concerns
After Endometrial Biopsy
If a biopsy was taken, the results will be available in about two weeks. Make sure to schedule a
follow-up appointment. You may experience some cramping or slight bleeding. You may also
notice a black discharge.
Please call if:
 You develop a temperature greater than 100°F
 You experience any heavy bleeding (one pad per hour or more)
 You have abdominal pain
 You have any questions or concerns
After Saline Infusion Ultrasound
Do not douche, use tampons, or have sex for one week.
You may experience some cramping or slight bleeding. You may also notice a watery, blood-
tinged discharge.
Please call if:
 You develop a temperature greater than 100°F
 You experience any heavy bleeding (one pad per hour or more)
 You have abdominal pain
 You have any questions or concerns
After Biopsy or Excision at the Vulva, Vagina, Perineum
 A shallow bath with Epson salt 2 to 3 times a day may help with the healing process.
 Diluting your urine with a water bottle as it passes the urethra may decrease irritation at
the biopsy site.
 Please do not wipe the biopsy area. Keep the area clean by using warm soapy water or a
baby/toilet wipe and blot the area only. Wiping me cause more bleeding.
 Tucks or witch hazel pads may be used and can be soothing.
 Your doctor may have specific instructions depending on the reason for the biopsy, the
location of the biopsy, and the method used to perform the biopsy. You and your doctor
should discuss when and if sutures need to be removed or if a dressing should be
changed.
Please call if:
 You develop a temperature greater than 100°F
 You experience any heavy bleeding (one pad per hour or more)

3.  You have redness, swelling, or increasing pain at the biopsy site
 You have any questions or concerns
After Biopsy or Excision of a Lesion on the Skin
Your doctor may have specific instructions depending on the reason for the biopsy, the location
of the biopsy, and the method used to perform the biopsy. You and your doctor should discuss
when and if sutures need to be removed or if a dressing should be changed.
Please do not soak the incision site and keep the area as dry as possible when bathing.
Please call if:
 You have redness, swelling, or increasing pain at the biopsy site
 You have any questions or concerns
After Surgery (Laparoscopy, Hysteroscopy, Abdominal, or Vaginal Surgery)
After most gynecologic surgery, the following will apply. However, your doctor may have
specific instructions for you. Please feel free to call with any questions.
Activity:
 No heavy lifting (nothing greater than 10-15 pounds) for the first 2 weeks.
 Do not soak your incision(s); shower for the first 2 weeks.
 No driving while requiring pain medications and until you can wear a seatbelt
comfortably and react as needed.
 No intercourse or tampons or anything in the vagina for 6 weeks.
 You may increase your activity as tolerated and gradually each day. It is okay to climb
stairs; however, you may have to rest.
Incision Care:
No soaking the incisions, as mentioned, for the first 2 weeks. If steri-strips are in place, you will
need to try to keep them there until your follow-up appointment. It is important to clean the
incisions daily with soap water and then plain water. You should pat the incision dry. You should
avoid wiping the incision both when washing and drying as this can disrupt the incision.
Follow-up:
Most follow-up appointments are scheduled 2 weeks from the post operative period. However,
you may need to be seen sooner.
Precautions:
Please call if you experience vaginal bleeding greater than 1 pad/hour, a temperature greater than
100.5°F, nausea, vomiting, chills, increasing abdominal pain, malodorous discharge, pain with
urination, chest pain, shortness of breath, sudden edema or pain at your extremities, back pain,
redness or drainage at your incision site, or onset of any worrisome signs or symptoms.
Hepatic disorders in pregnancy may be

4.  Unique to pregnancy
 Preexisting
 Coincident with pregnancy and possibly exacerbated by pregnancy
Jaundice
Jaundice may result from nonobstetric or obstetric conditions.
Nonobstetric causes include
 Acute viral hepatitis (most common)
 Drugs
 Acute cholecystitis
 Biliary obstruction by gallstones
Gallstones appear to be more common during pregnancy, probably because bile lithogenicity is
increased and gallbladder contractility is impaired.
Obstetric causes include
 Hyperemesis gravidarum (usually causing mild jaundice)
 Septic abortion
Both cause hepatocellular injury and hemolysis.
Acute viral hepatitis
The most common cause of jaundice during pregnancy is acute viral hepatitis. Pregnancy does
not affect the course of most types of viral hepatitis (A, B, C, D); however, hepatitis E may be
more severe during pregnancy.
Acute viral hepatitis may predispose to preterm delivery but does not appear to be teratogenic.
Hepatitis B virus may be transmitted to the neonate immediately after delivery or, less often, to
the fetus transplacentally. Transmission is particularly likely if women are e-antigen–positive
and are chronic carriers of hepatitis B surface antigen (HBsAg) or if they contract hepatitis
during the 3rd trimester. Affected neonates are more likely to develop subclinical hepatic
dysfunction and become carriers than to develop clinical hepatitis. All pregnant women are
tested for HBsAg to determine whether precautions against vertical transmission are needed (for
prenatal prophylaxis with immune globulin and vaccination for neonates exposed to hepatitis B
virus
Chronic hepatitis

5. Chronic hepatitis, especially with cirrhosis, impairs fertility. When pregnancy occurs, risk of
spontaneous abortion and prematurity is increased, but risk of maternal mortality is not.
Despite standard immunoprophylaxis, many neonates of women with a high viral load are
infected with hepatitis B virus. Data suggest that antiviral drugs given during the 3rd trimester
may prevent immunoprophylaxis failure. Fetal exposure should be minimized by using antiviral
drugs only when women have advanced hepatitis or hepatic decompensation is a risk.
Lamivudine, telbivudine, or tenofovir are most commonly used.
Corticosteroids given to treat chronic autoimmune hepatitis before pregnancy can be continued
during pregnancy because fetal risks due to corticosteroids have not been proved to exceed those
due to maternal chronic hepatitis. Azathioprine and other immunosuppressants, despite fetal
risks, are sometimes indicated for severe disease.
Intrahepatic cholestasis (pruritus) of pregnancy
This relatively common disorder apparently results from idiosyncratic exaggeration of normal
bile stasis due to hormonal changes. Incidence varies based on ethnicity and is highest in Bolivia
and Chile.
Consequences include increased risk of fetal prematurity, stillbirth, and respiratory distress
syndrome.
Intense pruritus, the earliest symptom, develops during the 2nd or 3rd trimester; dark urine and
jaundice sometimes follow. Acute pain and systemic symptoms are absent. The disorder usually
resolves after delivery but tends to recur with each pregnancy or with use of oral contraceptives.
The disorder is suspected based on symptoms. The most sensitive and specific laboratory finding
is a fasting total serum bile acid level of > 10 mmol/L. This finding may be the only biochemical
abnormality present. Fetal demise is more likely when the fasting total bile acid level is > 40
mmol/L.
Ursodeoxycholic acid (UDCA) 5 mg/kg po bid or tid (or up to 7.5 mg/kg bid) is the drug of
choice. It helps lessen the severity of symptoms and normalize biochemical markers of liver
function; however, it does not decrease the incidence of fetal complications.
Fatty liver of pregnancy
This rare, poorly understood disorder occurs near term, sometimes with preeclampsia. Patients
may have an inherited defect in mitochondrial fatty acid β-oxidation (which provides energy for
skeletal and cardiac muscle); risk of fatty liver of pregnancy is 20 times higher in women with a
mutation affecting long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD), particularly the
G1528C mutation on one or both alleles (autosomally inherited).

6. Symptoms include acute nausea and vomiting, abdominal discomfort, and jaundice, followed in
severe cases by rapidly progressive hepatocellular failure. Maternal and fetal mortality rates are
high in severe cases.
A seemingly identical disorder may develop at any stage of pregnancy if high doses of
tetracyclines are given IV.
Clinical and laboratory findings resemble those of fulminant viral hepatitis except that
aminotransferase levels may be < 500 units/L and hyperuricemia may be present.
Diagnosis is based on clinical criteria, liver function tests, hepatitis serologic tests, and liver
biopsy. Biopsy shows diffuse small droplets of fat in hepatocytes, usually with minimal apparent
necrosis, but in some cases, findings are indistinguishable from viral hepatitis.
Affected women and their infants should be tested for known genetic variants of LCHAD.
Depending on gestational age, prompt delivery or termination of pregnancy is usually advised,
although whether either alters maternal outcome is unclear. Survivors recover completely and
have no recurrences.
Preeclampsia
Severe preeclampsia can cause liver problems with hepatic fibrin deposition, necrosis, and
hemorrhage that can result in abdominal pain, nausea, vomiting, and mild jaundice.
Subcapsular hematoma with intra-abdominal hemorrhage occasionally occurs, most often in
women with preeclampsia that progresses to the HELLP syndrome (hemolysis, elevated liver
enzymes, and low platelet count). Rarely, the hematoma causes the liver to rupture
spontaneously; rupture is life threatening, and pathogenesis is unknown.
Chronic hepatic disorders
Pregnancy may temporarily worsen cholestasis in primary biliary cirrhosis and other chronic
cholestatic disorders, and the increased plasma volume during the 3rd trimester slightly increases
risk of variceal hemorrhage in women with cirrhosis. However, pregnancy usually does not harm
women with a chronic hepatic disorder.
Symptoms of thrombophlebitis or their absence does not accurately predict the diagnosis, disease
severity, or risk of embolization. Thromboembolic disorders can occur without symptoms, with
only minimal symptoms, or with significant symptoms. Also, calf edema, cramping, and
tenderness, which may occur normally during pregnancy, may simulate Homans sign.
Diagnosis
 Doppler ultrasonography or sometimes CT with contrast for DVT

7.  Helical CT for PE
Diagnosis of DVT is usually by Doppler ultrasonography. In the postpartum period, if Doppler
ultrasonography and plethysmography are normal but iliac, ovarian, or other pelvic venous
thrombosis is suspected, CT with contrast is used.
Diagnosis of PE is increasingly being made by helical CT rather than ventilation-perfusion
scanning because CT involves less radiation and is equally sensitive. If the diagnosis of PE is
uncertain, pulmonary angiography is required.
Treatment
 Similar to that in nonpregnant patients, except for avoidance of warfarin
 For women with increased risk, prophylactic low molecular weight heparin throughout
pregnancy and for 6 wk postpartum
If DVT or PE is detected during pregnancy, the anticoagulant of choice is a low molecular
weight heparin (LMWH). LMWH, because of its molecular size, does not cross the placenta. It
does not cause maternal osteoporosis and may be less likely to cause thrombocytopenia, which
can result from prolonged (≥ 6 mo) use of unfractionated heparin. Warfarin crosses the placenta
and may cause fetal abnormalities or death (Indications for thrombolysis during pregnancy are
the same as for patients who are not pregnant.
If PE recurs despite effective anticoagulation, surgery, usually placement of an inferior vena
cava filter just distal to the renal vessels, is indicated.
If women developed DVT or PE during a previous pregnancy or have an underlying
thrombophilic disorder, they are treated with prophylactic LMWH (eg, enoxaparin 40 mg sc
once/day) beginning when pregnancy is first diagnosed and continuing until 6 wk postpartum.