bsc nursing msn 3rd year

1. Program: B.Sc Nursing, 3rd Year
BNSG-501 MSN
Unit No.4.
Topic- Abnormalities of Fallopian tubes,Uterus
Lecture No. 6
Dr. Sudharani B Banappagoudar
Professor, SONS/OBG
1
BNSG 501

2. Outline
• Introduction
• Abnormality of uterus and fallopian tubes
• Learning outcomes
• Exercise
• References
2
BNSG 501

3. INTRODUCTION
3
<SELO: 1,3,4,6,8,10,20>
<Reference No.: R1,R3>
BNSG 501
A branch of medicine that specializes in the care of women during pregnancy and childbirth and
in the diagnosis and treatment of diseases of the female reproductive organs. It also specializes in
other women's health issues, such as menopause, hormone problems, contraception (birth
control), and infertility.
OB/GYN: A commonly used abbreviation. ... An obstetrician/gynecologist (OB/GYN) is
therefore a physician who both delivers babies and treats diseases of the female reproductive
organs.

4. Objectives
• The student will be able to Explain
• Abnormality of uterus and fallopian tubes
4
<SELO: 1,3,4,6,8,10,20>
<Reference No.: R1,R2>
BNSG 501

5. The fallopian tubes develop from the unpaired distal ends of the mullerian ducts and extend
outward from the superolateral portion of the uterus.
The fallopian tubes are between 10 and 14 cm long and normally end by curling around the
ovary. Disease may be asymptomatic or may be linked to infertility.
5
<SELO: 1,3,4,6,8,10,20>
<Reference No.: R1,R2>
BNSG 501

6. Congenital anomalies of the fallopian tube include
Aplasia
Atresia
Hypoplasia ( very long or thin)
Accessory horn or ostia and tubal diverticulum
 Complete absence of the fallopian tube
 A number of embryonic cystic remnants.
It may cause infertility or ectopic pregnancy
6
<SELO: 1,3,4,6,8,10,20>
<Reference No.: R1,R2>
BNSG 501

7. The congenital anomaly of the ovaries include congenital absence of ovary and the
development ovarian cyst.
Accessory ovary (division of the original ovary into two) also comes under this condition.
Rarely, supernumerary ovaries may be found in the broad ligament or elsewhere .
7
<SELO: 1,3,4,6,8,10,20>
<Reference No.: R1,R2>
BNSG 501

8. Para ovarian cysts are not actually ovarian, they are usually located alongside
the ovaries or on the fallopian tubes, but they are often hard to distinguish from
the ovarian cysts.
The cyst can grow to be very big and even extend to the upper abdomen. Their
size and systems do not correspond to the hormonal cycle like other ovarian
cysts do.
Para ovarian cysts can tear, bleed, rupture and become infected. It account for
10% to 20% of all adenexal masses and are relatively uncommon in children.
They are more common in women 30-40 years of age.
8
<SELO: 1,3,4,6,8,10,20>
<Reference No.: R1,R2>
BNSG 501

9. Paramesonephric cyst
Hydatid cyst of morgagni
Wolffian cyst
Kobelt cyst
Cyst of the organ of rosenmuller
9
<SELO: 1,3,4,6,8,10,20>
<Reference No.: R1,R2>
BNSG 501

10. 10
<SELO: 1,3,4,6,8,10,20>
<Reference No.: R1,R2>
BNSG 501

11. The outer end of the wolffian (Gartner’s) duct may be pea sized, cystic and pedunculated,
and attached to the outer end of the vaginal tube.
Gartner’s duct cyst are the remnants of the wolffian duct and they are
rarely seen in adulthood .
11
<SELO: 1,3,4,6,8,10,20>
<Reference No.: R1,R2>
BNSG 501

12. 12
<SELO: 1,3,4,6,8,10,20>
<Reference No.: R1,R2>
BNSG 501

13. The paramesonephric duct (or mullerian duct) forms the fallopian tube at
about 9 weeks of gestation.
Multiple invaginations near the ostium of the tube become the fimbriae.
Any secondary invegination that does not connect may form a blind sac
and this enlarges to form a Paramesonephric cyst.
13
<SELO: 1,3,4,6,8,10,20>
<Reference No.: R1,R2>
BNSG 501

14. 14
<SELO: 1,3,4,6,8,10,20>
<Reference No.: R1,R2>
BNSG 501

15. Para ovarian cyst torsion (2%-16%)
Hemorrhage
Rupture
Secondary infection
Neoplastic transformation (2.9%)
Papillary serous cyst adenoma
Endometriod cystadenocarcinoma
Serous cystadenocarcinoma
15
<SELO: 1,3,4,6,8,10,20>
<Reference No.: R1,R2>
BNSG 501

16. Narrow introitus
Septum
Hymen abnormalities
Agenesis
16
<SELO: 1,3,4,6,8,10,20>
<Reference No.: R1,R2>
BNSG 501

17. Narrow introitus condition is revealed after the marriage. The
patient complains about dyspareunia.
Treatment is done by manual stretching under general anaesthesia or by perineoplasty.
17
<SELO: 1,3,4,6,8,10,20>
<Reference No.: R1,R2>
BNSG 501

18. Transverse vaginal septum (TVS) is formed when the tissue between the vaginal plate and
fused mullerian ducts fail to reabsorb.
This anomaly divides the vagina into two segments, reducing its functional length. The most
common locations are the midvagina at rate of 40% and the inferior vagina at a rate of 14%.
The TVS is one of the most rare mullerian duct anomalies, with an appropriate frequency
of one case in 70,000 females.
18
<SELO: 1,3,4,6,8,10,20>
<Reference No.: R1,R2>
BNSG 501

19. 19
<SELO: 1,3,4,6,8,10,20>
<Reference No.: R1,R2>
BNSG 501

20. Diagnosed in utero during third trimester with transabdominal
sonography.
Abdominal ultrasonography of the pelvis can also detect
hydro/mucocolpos.
MRI should also be performed to make a definitive diagnosis.
20
<SELO: 1,3,4,6,8,10,20>
<Reference No.: R1,R2>
BNSG 501

21. Surgical management of TVS fetus, neonates and infants –
When third trimester ultrasonography finding lead to the diagnosis, early delivery and
drainage of the obstructed vagina and uterus are indicated.
In infant, vaginal septum is usually thin and can corrected without extensive procedures.
Surgical excision of the obstructed septum through a perineal approach.
21
<SELO: 1,3,4,6,8,10,20>
<Reference No.: R1,R2>
BNSG 501

22. Preoperative Evaluation
 History
 Physical Examination
 Routine Investigation
 Preoperative Consent
 Preoperative Teaching
 Physical Preparation
 Preoperative Checklist
 Presurgery Medication
22
<SELO: 1,3,4,6,8,10,20>
<Reference No.: R1,R2>
BNSG 501

23. Initial and ongoing assessment of the patient includes-
Level of consciousness
Vital signs
Oxygen saturation
Skin color and temperature
Comfort
Fluid balance
Dressings and drains
23
<SELO: 1,3,4,6,8,10,20>
<Reference No.: R1,R2>
BNSG 501

24. Ongoing postoperative nursing interventions includes
Managing pain
Appropriate positioning
Encouraging deep breathing and coughing exercise
Promoting leg excise and ambulation
Maintain adequate hydration
Promoting urine elimination
Provide bowel care.
Surgical aseptic technique is used when changing dressing on
surgical wound.
Clinical follow–up
24
<SELO: 1,3,4,6,8,10,20>
<Reference No.: R1,R2>
BNSG 501

25. As the vagina is largely derive from the mullerian ducts, lack of fusion of the two ducts
can lead to the formation of a vaginal duplication.
Lack of absorption of the wall between the two ducts will leave a residual septum,
leading to a ‘double vagina’
25
<SELO: 1,3,4,6,8,10,20>
<Reference No.: R1,R2>
BNSG 501

26. 26
<SELO: 1,3,4,6,8,10,20>
<Reference No.: R1,R2>
BNSG 501

27. Physical examination.
Gynecologic ultrasonography.
Pelvic MRI or HSG.
Laparoscopy and /or hysteroscopy may be indicated in some patients, the vaginal
development may be affected.
27
<SELO: 1,3,4,6,8,10,20>
<Reference No.: R1,R2>
BNSG 501

28. Surgical intervention depends on the extent of the individual problem with
a didelphic uterus.
With this a uterine septum can be resected in a simple outpatient procedure
that combines laparoscopy and hysteroscopy.
This procedure greatly decreases the rate of miscarriage for women with
this anomaly.
28
<SELO: 1,3,4,6,8,10,20>
<Reference No.: R1,R2>
BNSG 501

29. EXERCISE
29
BNSG 501
Explain the Abnormality of uterus and fallopian tubes

30. LEARNING OUTCOMES
BNSG 701 30
The student explain about
Abnormality of uterus and fallopian tubes

31. Student effective learning outcome
1.Application of concepts of topic & it’s technological application.
2. Critical and innovative thinking skills
3.Life long learning ability
4.Ability to observe and develop sense making , logical skills for abstract concepts.
5.Ability to understand subject related concepts clearly along with contemporary issues
6.Ability to collaborate
7.Ability to be a lifelong learner
BNSG 501 31

32. REFERENCES
• Sara Howard (2013) Midwifery retrieved April 17, 2014 from www.powershow.com
• CordeliaS.H.(2014) A brief History Of Midwifery in America. Retrieved April 11, 2014 from
wholisticmaternalnewbornhealth.org/professio nal-education/history-of-midwifery
• midwifeinsight.com/articles/a-short-history-of- midwifery/,retrieved April 18,2014.
32
BNSG 501

33. BNSG 501 33