Dilatation and Insufflation
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Dilatation and Insufflation Dr. Yashika Dilatation and Insufflation (D&I) Also known as Rubin’s test. Operation for dilatation of cervix and insufflation of air (CO2) in to the uterine cavity to know the patency of fallopian tubes. Indications of D&I Investigation for fertility. Following tuboplasty. Contraindication : Pelvic infections. Steps of operation The patient is asked to remain empty bladder. Operation is done under general anaesthesia. The patient is placed in lithotomic position Local antiseptic cleaning is done. Posterior vaginal speculum is introduced. Anterior lip of cervix is grasped with Allis tissue forceps. 7. Uterine sound is introduced to confirm the position and to note the length of cervical canal. Cervical canal is dilated with graduated dilators. After the desired dilatation, the insufflation cannula is introduced into the cervical canal. 10. Air is introduced in the uterus and the hissing sound is auscultated over the flanks. Test Positive Test: An audible hissing sound on the flanks due to exit of air. Patient complains of shoulder painon sitting. Negative Test: No hissing sound over the flanks. Complications Complications
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Definition
Cervical erosion is a condition where the squamous epithelium of the ectocervix is replaced by columnar epithelium which is continuous with endocervix.
Aetiology
Congenital
Acquired
Clinical features
Symptoms :
Vaginal discharge
Contact bleeding
Associated cervicitis
SIGNS :
Diagnosis
Ectropion
Early carcinoma
Primary Lesion (Chancre)
Tubercular ulcer
Management
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Pill user
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- The technique for nasogastric intubation including positioning, measuring tube length, lubricating the tube, and having the patient swallow to advance the tube into the stomach.
Gastrointestinal-Intubation-1.pptx
This document discusses gastrointestinal intubation, including:
- Types of gastrointestinal intubation like orogastric, nasogastric, and nasointestinal tubes.
- Common uses of gastrointestinal intubation like administering medications, sampling sections for diagnostics, and performing lavage.
- Types of tubes used like orogastric, nasogastric, and nasointestinal tubes which can have single or double lumens.
- The technique for nasogastric intubation including positioning, measuring tube length, lubricating the tube, and slowly advancing the tube while the patient swallows until the desired length is reached.
DNC Presentation.pptx
Dilatation and curettage (D&C) is a surgical procedure involving dilating the cervical canal and scraping the uterine lining. It is commonly performed for diagnostic and therapeutic purposes such as abnormal bleeding, infertility, incomplete abortion, and uterine polyps. The procedure requires dilating the cervix using dilators of increasing size followed by scraping the uterine walls with a curette. Postoperative care focuses on monitoring for bleeding and complications like infection, uterine perforation, or cervical injury.
Vaginal Hysterectomy: Revival
This document discusses reviving the technique of vaginal hysterectomy and implementing it safely to avoid post-operative vaginal vault prolapse. The key steps of the technique include: 1) carefully opening the pouch of Douglas and applying the first clamp as close to the uterus as possible; 2) securing the first pedicle to the lateral vaginal angle for support; and 3) using a "step-ladder" approach to ligate and approximate all pedicles together before closing, which aids hemostasis and support of the vaginal vault. The author argues this technique minimizes risks compared to abdominal or laparoscopic hysterectomy and can lower costs while maintaining good postoperative outcomes when performed by trained surgeons on appropriately selected patients.
Tracheo Esophageal Fistula and Anesthesia
The document discusses tracheo-esophageal fistula, a birth defect where the trachea and esophagus are connected by an abnormal passageway. It describes the embryology, classification, clinical presentation including signs, anesthetic considerations for repair surgery, surgical repair techniques including conventional open and endoscopic methods, risks, and postoperative care. The prognosis is guarded as recurrent fistulas and long-term complications like esophageal stricture and lung disease are common.
Tonsillectomy ENT for undergrad
A tonsillectomy is a surgical procedure to remove the tonsils. It is usually performed under general anesthesia with the patient in the Rose's position. The surgery involves using a mouth gag, grasping the tonsil with forceps, and dissecting it from the surrounding tissue using scissors or a dissector. A wire snare is then used to ligate and remove the tonsil. Post-operative care includes monitoring for bleeding, a soft diet, oral hygiene, analgesics and antibiotics. Complications can include bleeding, injury to nearby structures, infection, or scarring.
Epiphrenic diverticulum
This case presentation describes a patient with a long history of regurgitation and dysphagia who was ultimately diagnosed with achalasia and an associated epiphrenic diverticulum. The patient underwent surgery involving mobilization and resection of the diverticulum followed by an esophageal myotomy and Dor fundoplication. Post-operatively, the patient's symptoms resolved and he was discharged after a few days on a soft diet.
Endotracheal intubation nursing procedure
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Surgical Operations Matary 2021 -extracted.pdf
This document provides information on several surgical procedures:
1) It describes the steps for a submandibular sialoadenectomy to remove the submandibular salivary gland, including making an incision below the mandible, ligating vessels, and removing the gland.
2) It explains tracheostomy procedures for creating an opening into the windpipe to provide an airway, including different types of incisions and tracheostomy tube placements.
3) It provides details on gastrostomy tube insertion and care, including indications for temporary or permanent feeding tubes placed into the stomach through endoscopy or surgery.
Tonsillectomy
Tonsillectomy is commonly performed to treat recurrent throat infections. Absolute indications for tonsillectomy include recurrent infections, peritonsillar abscesses, tonsillitis causing seizures, tonsil hypertrophy causing obstruction, and suspicion of malignancy. Relative indications include being a carrier of diphtheria or streptococcus. The operation is usually done under general anesthesia with the patient in Rose's position. The tonsils are grasped, dissected from surrounding tissue, and removed using a wire snare. Post-operative care involves pain management, oral hygiene, diet progression, and antibiotics to prevent infection. Potential complications include bleeding, infection, and scarring.
Ppt on diagnostic in respiratory mahi
The document summarizes various diagnostic tests used for respiratory system problems. It divides tests into non-invasive and invasive categories. Non-invasive tests discussed include physical examination techniques (inspection, palpation, percussion, auscultation), sputum culture, pulse oximetry, spirometry, pulmonary function tests, bronchoscopy, and radiological imaging like chest X-ray, CT scan, MRI, and PET scan. Invasive tests mentioned are skin tests, arterial blood gas analysis, lung biopsy, pulmonary angiography, thoracentesis, and lung scan. Nursing considerations for selected tests are also provided.
Rigid endoscopies
Rigid esophagoscopy, bronchoscopy, and direct laryngoscopy are generally performed under general anesthesia for both diagnostic and therapeutic reasons. These procedures allow examination and biopsy of the larynx, lungs, and esophagus. Rigid esophagoscopy uses a 25cm rigid scope to examine the esophagus for tumors, strictures, or foreign bodies. Rigid bronchoscopy requires passing a rigid tube between the vocal cords into the trachea and main bronchi to remove foreign bodies or biopsy lung lesions. Direct laryngoscopy examines the larynx using small or large laryngoscopes inserted through the mouth. These procedures have risks of injury, bleeding, perforation, or other complications if not performed carefully.
Choanal atresia
Here are 10 potential nursing diagnoses for a patient with choanal atresia:
1. Ineffective airway clearance related to nasal obstruction as evidenced by difficulty breathing, increased work of breathing, cyanosis with feeding.
2. Risk for aspiration related to inability to coordinate suck, swallow and breathe during feeding as evidenced by cyanosis with feeding.
3. Impaired gas exchange related to obstruction of nasal passages and inability to breathe through nose as evidenced by respiratory distress and hypoxemia.
4. Activity intolerance related to respiratory distress and effort of breathing as evidenced by fatigue with feeding and activity.
5. Risk for infection related to impaired airway clearance and retention of secretions as evidenced by nasal discharge
Prolapse management
This document discusses the management of pelvic organ prolapse. It begins by outlining when treatment is recommended, which is when prolapse causes symptoms that interfere with daily activities. Conservative management includes pelvic floor exercises and pessary use for mild cases. Surgical management is considered for more severe prolapse and involves procedures to repair defects in the anterior, apical, and posterior compartments of the pelvis. Common surgeries described are anterior colporrhaphy, paravaginal repair, posterior colporrhaphy, and vaginal hysterectomy with pelvic floor repair.
Hysterectomy
1. Hysterectomy is a surgical procedure to remove the uterus and sometimes other reproductive organs. It can be performed abdominally through an incision in the abdomen, vaginally through the vagina, or laparoscopically through small incisions using specialized instruments.
2. Over 600,000 hysterectomies are performed annually in the US, most commonly to treat benign conditions like fibroids, endometriosis, or uterine prolapse. The preferred method is vaginal hysterectomy when possible due to faster recovery.
3. Risks of hysterectomy include earlier menopause, increased risks of cardiovascular disease and osteoporosis, as well as potential short-term risks like infection,
Magnet ingestion leading to multiple Intestinal perforations.pptx
Acute abdominal pain, diagnostic laparoscopy showed multiple Intestinal perforation. During the surgery it was seen that the cause was multiple magnets conglomeration causing ischemia in the intestinal wall and perforation.
The patient did not revieled the ingestion of foreign bodies.
Similar to Dilatation and Insufflation (20)
Magnet ingestion leading to multiple Intestinal perforations.pptx
Magnet ingestion leading to multiple Intestinal perforations.pptx
More from yashikasingh37
database.pptx
1) The document discusses various databases related to Ayurveda including literature databases containing Samhitas and other Ayurvedic texts, manuscript databases, herbal databases containing information on medicinal plants from sources like the Flora of India and the Wealth of India series, the Traditional Knowledge Digital Library, clinical trials registry, Cochrane library, and dissertation repository Shodhganga.
2) It also mentions databases containing information on Ayurvedic pharmaceutical companies and their products, the national pharmacovigilance program and database, patent databases, gemological and minerals databases, and mobile apps databases.
3) Several national organizations that maintain important Ayurveda databases are discussed, including the National Institute of
uterine fibroid.pptx
Uterine fibroids are benign tumors that develop in the uterus. They are composed of smooth muscle and connective tissue and are the most common tumors found in females. The highest prevalence occurs in women between ages 35-45. While the exact cause is unclear, genetic and hormonal factors likely play a role. Fibroids can be asymptomatic but may cause heavy periods, pelvic pain, infertility, or pregnancy complications. Diagnosis involves ultrasound, MRI, or other imaging. Treatment options include medication, myomectomy (surgical removal of fibroids), hysterectomy (removal of the uterus), or embolization (blocking the blood supply).
Trichomonas vaginitis.pptx
Introduction
Causative agent : Trichomonas vaginalis
Transmission : Sexual contact
Incubation period : 3 – 28 days.
Clinical features
Sudden profuse and offensive vaginal discharge.
Severe irritation and itching around introitus.
Dysuria and increased frequency of urine.
Examination:
Thin, greenish yellow frothy offensive vaginal discharge.
Inflammed vulva
Vaginal examination may be painful.
Diagnosis:
Culture of discharge :
Diamonds TYM or Feinberg
Whittington medium.
Treatment:
DOC : Metronidazole
200mg TDS x 1 week.
Tinidazole
syphilis.pptx
Introduction
Causative agent : Treponema pallidium
Transmission : Abraded skin / mucosal surface.
Spreads through direct contact.
Incubation period : 9 -90 days.
Clinical features
Phases of syphilis :
Primary syphilis
Lesion / Chancre : Single/ Multiple
Site : Labia, fourchette, anus, cervix or
nipples.
Small papule gets eroded into an ulcer. The margins of ulcer are raised and floor is smooth and shiny.
Healing of primary chancre takes place in 1-8 weeks.
Secondary Syphilis
Secondary syphilis is evident in form of Condyloma lata in vulva.
Condyloma lata : coarse, flat topped, moist, necrotic lesions.
Maculopapular rashes : Palms and soles.
Alopecia, lymphadenopathy, mucosal ulcers.
Latent Syphilis
Quiescence phase.
Duration : 2 -20 years.
Tertiary Syphilis
Progression of tertiary syphilis occurs only in condition of untreated syphilis.
Damages CNS, CVS, Musculoskeletal system.
Cranial nerve palsies III, VI, VII and VIII.
Gummatous ulcer : deep punched ulcer with rolled out margins. Painless with moist leather base.
Diagnosis
History of exposure.
Identification of organism.
Serological test
VDRL (Venereal disease research laboratory)
TPHA (Treponoma pallidum haemagglutination)
EIA (Enzyme immunoassay)
FTA (Fluorescent treponomal Antibody)
TPI (Treponoma pallidum immobilisation)
Treatment
Benzathine penicillin IM
Tetracycline 500 mg
Doxycycline 100 mg
Serological test should be performed 1, 3, 6 and 12
month after treatment of syphilis.
POP.pptx
Pelvic organ prolapse
Pelvic Organ Prolapse
Most common gynaecological problem.
Amongst parous women.
A form of hernia.
Anatomy of Uterus
Anteversion and anteflexion position.
Lies between rectum and bladder.
Cervix pierces the vagina at the right angle to the axis of vagina.
Supports of Uterus
Uterus is held in position by 3 tier support system.
Upper tier
Middle tier
Inferior tier.
Upper tier
Primarily, maintains the uterus in anteverted position.
The structures responsible are:
Endopelvic fascia.
Round ligaments.
Broad ligaments.
Middle tier
Constitutes the strongest support of uterus.
Responsible structures are:
Pericervical ring.
Pelvic cellular tissues.
Inferior tier
Indirect support of uterus.
Responsible structures are pelvic floor muscles including:
Levator ani
Endopelvic fascia
Levator plate
Perineal body
Urogenital diaphragm
Anatomical Factors
Gravitational stress.
Parturition stress.
Pelvic floor weakness.
Inherent weakness of supporting structures.
Acquired Predisposing Factors
Trauma of vaginal delivery causing injury :
Ligaments
Endopelvic fascia
Levator muscle
Perineal body
Pudendal nerve and muscle damage due to
repeated child birth.
Congenital Predisposing Factors
Inborn weakness of supporting structure.
Aggravating factors
Post menopausal atrophy
Poor collagen tissue repair with age.
Increased intra abdominal pressure.
Occupational hazards
Asthenia
Obesity
Fibroid/Polyp
Clinical Degrees Of Uterine Prolapse
Symptoms
Feeling of something coming out per vaginum.
Backache or dragging pain in pelvis
Dyspareunia
Urinary symptoms
Bowel symptoms
Clinical examination
Inspection and palpation.
General examination.
Pelvic examination
Uterine prolapse
Management of Prolapse
Preventive
Conservative
Surgery
Preventive Measures
Pelvic floor exercise during puerperium.
Avoid strenuous activities.
Avoiding prolonged cough.
Avoiding constipation.
Avoiding heavy weight lifting.
Avoiding future pregnancy too early.
Conservative Management
Indications :
Asymptomatic women
Mild degree prolapse
POP in early pregnancy
Treatment :
Oestrogen replacement therapy.
Kegel exercise
Pessary treatment
Surgical Management of Prolapse
Restorative
Extirpative
Obliterative
pid.pptx
Definition
PID is a disease of the upper genital tract.
It is a spectrum of infection and inflammation of the upper genital tract organs typically involving the uterus (endometrium), fallopian tubes, ovaries, pelvic peritoneum and surrounding structures.
Epidemiology
Occurs both in the developed and developing
countries.
85 per cent are spontaneous infection in sexually active females of reproductive age.
The remaining 15 per cent follow procedures, which favors the organisms to ascend up.
Two-thirds are restricted to young women of less than 25 years and the remaining one-third limited among 30 years or older.
Risk factors
Menstruating teenagers.
Multiple sexual partners.
Absence of contraceptive pill use.
Previous history of acute PID.
IUD users.
Area with high prevalence of sexually transmitted diseases.
Protective factors
Contraceptive practice
Barrier methods
Oral steroidal contraceptives
Monogamy / Vasectomy
Others
Pregnancy
Menopause
Vaccines
CLINICAL FEATURES
Bilateral lower abdominal and pelvic pain dull in nature.
Fever, lassitude and headache.
Irregular and excessive vaginal bleeding .
Abnormal vaginal discharge (purulent or copious)
Nausea and vomiting.
Dyspareunia.
Pain and discomfort in the right hypochondrium.
Signs
Temperature >38.3°C.
Abdominal palpation
(1) Tenderness on both the quadrants of lower abdomen.
(2) The liver may be enlarged and tender.
Vaginal examination
(1) Abnormal vaginal discharge (purulent).
(2) Congested external urethral meatus or openings of Bartholin’s ducts through which pus may be seen escaping out on pressure.
(3) Speculum examination shows congested cervix with purulent discharge from the canal.
Clinical diagnostic criteria of PID (CDC-2006)
Minimum Criteria
Lower abdominal tenderness.
Adnexal tenderness.
Cervical motion tenderness.
Additional Criteria
Oral temperature > 38.3°C.
Mucopurulent cervical or vaginal discharge.
Raised C-reactive protein and/or ESR.
Definitive Criteria
Histopathologic evidence of endometritis on biopsy.
Imaging study (TVS/MRI) evidence of tubo-ovarian complex.
Laparoscopic evidence of PID
Investigations
Identification of organisms
Blood: Leucocyte count shows leucocytosis to more than 10,000 per cu mm and an elevated ESR value of more than 15 mm per hour.
Laparoscopy
Complications Of Pid
Immediate
Pelvic peritonitis or even generalized
Septicemia
Late
Dyspareunia
Infertility
Chronic pelvic inflammation
Formation of adhesions or hydrosalpinx or pyosalpinx and tubo-ovarian abscess.
Chronic pelvic pain and ill health.
Ambulatory Management Of Acute PID (CDC-2006)
Patient should have oral therapy for 14 days
Regimen A
Levofloxacin 500 mg (or, ofloxacin 400 mg) PO
Metronidazole 500 PO bid
Regimen B
Ceftriaxone 250 mg IM single dose
Doxycycline 100 mg PO BID with or without
Metronidazole 500 mg PO BID for 14
hsg.pptx
Hysterosalpingography (HSG)
Hystero + Salpingo + Graphy
HSG is a radiological procedure done to assess the interior anatomy of the uterine cavity and the shape and patency of the fallopian tubes.
It is a radiographic study using fluorescent dye to visualise the anatomy of uterus and fallopian tubes.
Indications:
Assessment of tubal patency.
Detection of uterine malformation.
Diagnosis of cervical incompetence.
Detection of translocated IUD.
Diagnosis of uterine synechiae.
Diagnosis of uterine fibroid , uterine polyp.
Diagnosis of abdominal pregnancy.
Uterine Malformation
Steps of operation
The patient is asked to remain empty bladder.
Operation is done under general anaesthesia.
The patient is placed in lithotomy position.
Local antiseptic cleaning is done.
Posterior vaginal speculum is introduced.
Anterior lip of cervix is grasped with Allis tissue forcep.
HSG cannula is fitted with a syringe containing radio opaque dye. About 5- 10 ml of dye is slowly introduced.
The passage of the dye is observed by using X-ray intensifier and a video display unit.
Two radiographic X-rays are taken. First one to show the filling of uterine cavity and other one 10-15 mins after the completion of procedure.
Timing of procedure :
HSG is done between D6 and D10 of cycle.
Antibiotics are given one day prior the procedure up to 5 days.
Contrast media
Complications
Peritoneal irritation.
Pelvic pain.
Vasovagal attack.
Intravasation of dye into the venous or lymphatic channels.
Flaring up of pelvic infections.
endo.pptx
Definition
Presence of functioning endometrium (glands and stroma) in sites other than uterine mucosa is called endometriosis.
It is a benign but it is locally invasive.
Prevalence
The real one is due to delayed marriage, postponement of first conception and adoption of small family norm.
The apparent one is due to increased use of diagnostic laparoscopy as well as hightened awareness of this disease complex amongst the gynecologists
Sites
Abdominal: Usually confined to the abdominal structures below the level of umbilicus.
Extra-abdominal: Common sites are abdominal scar of hysterotomy, cesarean section, tubectomy and myomectomy, umbilicus, episiotomy scar, vagina and cervix.
Remote
Pathology
Naked Eye Appearance: The appearance of the lesion depends on the organs involved, extent of lesion and reaction of the surrounding tissues.
Pelvic endometriosis: Small black dots, called ‘powder burns’ seen on the uterosacral ligaments and pouch of Douglas.
Fibrosis and scarring
Symptoms
Dysmenorrhea (70%)
Abnormal menstruation (20%)
Infertility (40–60%)
Dyspareunia (20–40%)
Chronic Pelvic Pain
Abdominal Pain
Urinary— frequency, dysuria, back pain or even hematuria.
Sigmoid colon and rectum—painful defecation (dyschezia), diarrhea, constipation, rectal bleeding or even melena.
Chronic fatigue, perimenstrual symptoms (bowel, bladder).
Hemoptysis (rarely), chest pain.
Surgical scars—cyclical pain and bleeding.
Examination
Abdominal palpation
A mass may be felt in the lower abdomen arising from the enlarged tubo-ovarian mass due to endometriotic adhesions. The mass is tender with restricted mobility.
Pelvic Examination
Pelvic tenderness, nodules in the pouch of Douglas, nodular feel of the uterosacral ligaments, fixed uterus or unilateral or bilateral adnexal mass of varying sizes
Diagnosis
Bichemical parameters:
Serum CA 125
Monocyte Chemotactic Protein (MCP-1)
Imaging:
TVS - ovarian endometriomas
Endorectal USG - Rectosigmoid endometriosis
MRI - deep infiltrating endometriosis.
Colonoscopy, rectosigmoidoscopy and cystoscopy
Differential Diagnosis
Chronic pelvic infection / symptomatic endometriosis. Laparoscopy is helpful in actual diagnosis.
Ovarian endometrioma / benign ovarian tumor / malignant ovarian.
Ultrasonography or Laparoscopy
Rupture of the chocolate cyst / torsion or rupture of the ovarian tumour, disturbed ectopic pregnancy, appendicitis or diverticulitis.
Complications
Endocrinopathy
Rupture of chocolate cyst
Infection of chocolate cyst
Obstructive features:
Intestinal obstruction
Ureteral obstruction → hydroureter
hydronephrosis → renal infection
Endocrinopathy in Endometriosis
Corpus luteum insufficiency
Luteolysis due to ↑ PGF.
Luteinized unruptured follicle (LUF)
Anovulation
Elevated prolactin level
Double LH peak.
Staging
Endometrios is should be staged appropriately.
To predict prognosis.
To choose therapy.
To evaluate the treatment protocol.
The stage is determined by adding specific points given to each.
contraception.pptx
Contraception
Contraception is defined as the intentional prevention of conception through the use of various devices, sexual practices, chemicals, drugs or surgical procedures.
The preventive methods to help women avoid unwanted pregnancies are called contraceptive methods.
Need for contraception
• To avoid unwanted pregnancies.
• To regulate the timing of pregnancy.
• To regulate the interval between pregnancy.
Ideal Contraceptive
• Safe
• Effective
• Acceptable
• Reversible
• Inexpensive
• Long lasting
• Requires little or no medical supervision
Contraceptive methods
Spacing methods
Natural
Barrier
IUDs
Emergency contraception
Terminal methods
Male fertilisation
Female fertilisation
Natural Methods
Coitus inteyrruptus / withdrawal
Rhythm Method
Lactational Amenorrhoea
Barrier Methods
Mechanical
Male : Condom
Female : Condom, Diaphragm, Cervical cap
Chemical
Creams - Deleen
Jelly – Koromex, Volpar paste
Foam tablets – Aerosol foams, Chlorimin T or Contab
Combination
Combined use of Chemical and Mechanical methods.
Male condom
• Most commonly known and used contraceptive.
• Better known in India as NIRODH.
Female condom
Femidom
Diaphragm
Spermicides
Spermicides are surface active agents which attach
themselves to spermatozoa and kill them.
Available in various forms like
Intrauterine Contraceptive Devices
Cu T200
T shaped device Polyethylene frame.
215 mm2 surface area of Cu wire.
Contains 124 mg of copper
Cu is lost at the rate of 50 µg/day.
Polyethylene monofilament tied at vertical stem.
Cu is radio opaque so additionally barium is
incorporated in the device.
Supplied in a sterilised sealed packet.
Lifetime 4 years.
Cu T 380A
380 mm square surface area of copper wire.
Replacement 10 years.
Multiload Cu 250
60-100 ug/day
Replacement 3 years
Multiload - 375
Mode of action
Biochemical and histological changes in endometrium.
Increased tubal motility.
Endometrial inflammatory response.
Prevents implantation.
Contraindication for insertion of IUCD
Presence of pelvic infection
Genital tract bleeding (undiagnosed)
Suspected pregnancy
Uterine fibroid
Severe dysmenorrhoea
Ectopic pregnancy history
Caesarean section
Cu allergy
Time of insertion
Interval
2-3 days after menstrual phase.
During lactational amenorrhoea.
Postabortal
Done immediately following termination of pregnancy.
Postpartum
After 6 weeks of delivery.
Postplacental delivery
Post delivery of placenta.
Method of Insertion
Preliminary steps:
History taking and examination
Patient is informed and consent is obtained.
Insertion is done in OPD aseptic conditions.
Placement of device in inserter.
Steps of operation
The patient is asked to remain empty bladder.
The patient is placed in lithotomy position.
Local antiseptic cleaning is done.
Posterior vaginal speculum is introduced.
Anterior lip of cervix is grasped with Allis tissue forcep.
The device is placed in the inserter and introduced through cervical
BARTHOLINS.pptx
Bartholin's glands are paired oval-shaped glands located on each side of the vaginal opening that produce lubricating secretions. Bartholin's gland infection, or Bartholinitis, can be caused by various bacteria and may result in complete resolution, recurrence, abscess formation, or cyst formation. A Bartholin's abscess is an infection of one of the glands that causes severe pain and swelling. Treatment involves antibiotics, sitz baths, and draining the abscess. A Bartholin's cyst is a fluid-filled sac that can cause discomfort and dyspareunia, and treatment is marsupialization to remove the cyst.
Moniliasis(Candida vaginitis)
Candida vaginitis is caused by the fungus Candida albicans. It presents with intense vulvovaginal discharge, dyspareunia, and a thick, curdy white discharge on examination that resembles cottage cheese and adheres to the vaginal walls. Diagnosis is made via wet smear, and treatment involves removing predisposing factors as well as using local and oral antifungal creams, ointments, pessaries, or single dose therapies like fluconazole or itraconazole.
Lgv (Lymphogranuloma Venereum)
Lymphogranuloma Venereum
Dr. Yashika
Causative agent : Chlamydia trachomatis
Incubation period: 3-30 days
Clinical features :
Initial phase:
Painless papule, pustule or ulcer in vulva, urethra,
rectum or cervix.
Involved inguinal nodes feels rubbery.
Acute lumphangitis and lymphadenitis.
Necrosed glands and abscess formation.
Rupture of abscess occurs within 7-15 days.
Sinus and fistula formation.
Intense fibrosis with lymphatic drainage.
Secondary phase : Painful adenopathy.
Classical clinical sign:
Groove sign
A depression between the groups of inflammed nodes.
Complication:
Vulval elephantiasis
Perineal scarring
Rectal stricture
Sinus and fistula formation.
Diagnosis
Culture and isolation
Detection of LGV
Treatment:
Doxycycline 100 mg BID x 21days.
Azithromycin 1 gm PO weekly x 3 weeks
Abscess aspiration
Leucorrhoea
Leucorrhoea
Dr. Yashika
Abnormal Vaginal Discharge
Frequent complaint.
Discharge may vary from excess to normal.
Discharge may be blood-stained / contaminated with urine or stool.
Characteristics of normal vaginal fluid
Nature - watery
Colour - white
Odour - Odourless
pH - 4.0
Microscopically - Squamous epithelial cells,
Leucorrhoea
Leucorrhoea is defined as excessive normal vaginal discharge.
Features of vaginal discharge in leucorrhoea :
Excess secretion.
Non purulent
Non offensive
Non irritant
Never causes pruritis.
Etiology :
Physiological excess
Cervical causes
Vaginal causes
Physiologic excess
Puberty
Menstrual Cycle
Pregnancy
Sexual excitement
Cervical causes:
Cervicitis
Cervical ectopy
Cervical polyp
Treatment
General health improvement
Surgical treatment of cervical factors
Pill users are asked to stop pill immediately
Local hygiene
Hsv Herpes Genitalis
Herpes Genitalis
Dr. Yashika
Introduction
Causative organism : Herpes Simplex virus type 1 and 2
Transmission : Orogenital contact
Incubation period : 2 – 14 days.
Clinical features:
First attack with 7 days of sexual contact.
Red painful inflammatory area around clitoris, labia, vestibule, vagina, cervix and perineum.
Appearance of multiple vesicles which progress into ulcers then heals up by crusting
Lymphadenopathy
Fever, malaise and headache.
Diagnosis:
Virus tissue culture and isolation
ELISA
Fluorescent method
PCR test
Treatment
Specific treatment is yet to b explored.
Acyclovir 200 mg 5 times x 5days.
Saline water bath.
Hsg
Hysterosalpingography
Dr. Yashika
Hysterosalpingography (HSG)
Hystero + Salpingo + Graphy
HSG is a radiological procedure done to assess the interior anatomy of the uterine cavity and the shape and patency of the fallopian tubes.
It is a radiographic study using fluorescent dye to visualise the anatomy of uterus and fallopian tubes.
Indications:
Assessment of tubal patency.
Detection of uterine malformation.
Diagnosis of cervical incompetence.
Detection of translocated IUD.
Diagnosis of uterine synechiae.
Diagnosis of uterine fibroid , uterine polyp.
Diagnosis of abdominal pregnancy.
Uterine Malformation
Steps of operation
The patient is asked to remain empty bladder.
Operation is done under general anaesthesia.
The patient is placed in lithotomy position.
Local antiseptic cleaning is done.
Posterior vaginal speculum is introduced.
Anterior lip of cervix is grasped with Allis tissue forcep.
HSG cannula is fitted with a syringe containing radio opaque dye. About 5- 10 ml of dye is slowly introduced.
The passage of the dye is observed by using X-ray intensifier and a video display unit.
Two radiographic X-rays are taken. First one to show the filling of uterine cavity and other one 10-15 mins after the completion of procedure.
Timing of procedure :
HSG is done between D6 and D10 of cycle.
Antibiotics are given one day prior the procedure up to 5 days.
Contrast media
Complications
Peritoneal irritation.
Pelvic pain.
Vasovagal attack.
Intravasation of dye into the venous or lymphatic channels.
Flaring up of pelvic infections.
Human Immunodeficiency Virus - Acquired Immuno Deficiency Disease
AIDS
Dr. Yashika
Introduction
Causative agent : Human Immunodeficiency Viruses (HIV)
HIV belongs to retrovirus family (double stranded RNA).
Mode of transmission
Sexual intercourse
IV drug abusers
Blood transfusion
Use of contaminated needles
Breastfeeding
Perinatal transmission
Immunopathogenesis
Immunological Markers
CD4 T lymphocyte count
RT-PCR
Raised P-24 antigen titre
Raised serum β2 microglobulin
Clinical Presentation
Development of Ab marks the stage of seroconversion aka flu-like syndrome.
Acute infection syndrome characterized by fever, skin rash, arthralgia, lymphadenopathy and diarrhoea. This is called seroconversion illness lasts upto 2-3 weeks and gets resolved itself spontaneously.
Gynaecological Symptoms
Infections of genital tract.
Neoplasm of genital tract.
Menstrual abnormalities.
Fertility and pregnancy are not affected.
Diagnosis
Detection of IgG antibody.
ELISA
Western blot
PCR
Treatment
Gonorrhoea
GONORRHOEA
Dr. Yashika
Introduction
Causative agent : Neisseria gonorrhoea (gram negative diplococcus).
Incubation period : 3-7 days.
Site of invasion : columnar and transitional epithelium of the genitourinary tract.
Primary sites of infection : endocervix, urethra and Bartholins gland.
Other sites of infection : Oropharynx, anorectal and conjuctiva.
Clinical features :
Local:
Excessive irritant vaginal discharge
Dysuria
Acute unilateral pain
Swelling over labia.
Pharyngeal infection
Intermenstrual bleeding.
Rectal discomfort.
Signs :
Swollen labia and inflammed.
Mucopurulent vaginal discharge.
Speculum examination reveals congested endocervix.
Distant symptoms :
Perihepatitis
Septicaemia
Complications:
PID
Infertility
Ectopic pregnancy
Chronic pelvic pain
Tubo ovarian mass
Bartholins gland abscess.
Diagnosis
Nucleic acid amplification test (NAAT)
urine culture
Drug sensitivity test.
Treatment
Adequate therapy for gonococcal infection.
To treat both the partner simultaneously.
To avoid multiple sex partner.
To use condom till free from disease.
Cervical biopsy
Cervix Anatomy
Lowermost part of uterus
Cylindrical shape
Diameter and length are 2.5 cm.
Parts Supravaginal
Infravaginal
Extends from histological internal os to anatomical external os.
Nulliparous - Pin hole cervix
Parous - Bilateral slit
Cervical Biopsy
Punch Biopsy
Wedge Biopsy
Ring Biopsy
Whole of squamo-columnar junction area of the cervix is excised with a special knife.
The tissue is subjected to serial section to detect cervical intraepithelial neoplasia (CIN) or early invasive carcinoma.
Cone Biopsy - Conization
Complications
Thank you
Bacterial vaginosis
Bacterial Vaginosis
Dr. Yashika
Causative agent : Gardnerella vaginalis
Clinical features:
Malodorous vaginal discharge.
(Homogenous, greyish white, adherent to vaginal wall)
No vaginal inflammation.
During pregnancy
preterm membrane rupture,
preterm labour,
chorioamnionitis.
Complications:
Recurrent infection leads to PID.
Development of PID following abortion.
Vaginal cuff cellulitis following hysterectomy.
Pregnancy complications.
Diagnosis
Amsel’s criteria :
Homogenous vaginal discharge
Vaginal discharge > 4.5
Positive whiff’s test
Presence of clue cells > 20% of cells.
Whiffs test:
Appearance of fishy (amine) odour when a drop of discharge is mixed with 10% solution of KOH.
Clue cells:
Presence of stippled epithelial cells.
Treatment:
Metronidazole 200 mg TDS x 7 days.
Clindamycin cream.
Metronidazole gel.
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Dilatation and Insufflation
- 1. Dilatation and Insufflation Dr. Yashika
- 2. Dilatation and Insufflation (D&I) • AlsoknownasRubin’s test. • Operation for dilatation of cervix and insufflation of air(CO2) in totheuterine cavity toknowthepatency offallopiantubes.
- 3. Indications of D&I • Investigationforfertility. • Followingtuboplasty. Contraindication:Pelvicinfections.
- 4. Steps of operation 1. The patient is asked to remain empty bladder. 2. Operation is done under general anaesthesia. 3. The patient is placed in lithotomic position 4. Local antiseptic cleaning is done. 5. Posterior vaginal speculum is introduced. 6. Anterior lip of cervix is grasped with Allis tissue forceps.
- 5. 7. Uterine sound is introduced to confirm the position and to note the length of cervical canal. 8. Cervical canal is dilated with graduated dilators. 9. After the desired dilatation, the insufflation cannula is introduced into the cervical canal. 10. Air is introduced in the uterus and the hissing sound is auscultated over the flanks.
- 6. Test • PositiveTest: 1. Anaudiblehissingsoundontheflanksduetoexitofair. 2. Patientcomplainsofshoulderpainonsitting. • NegativeTest: 1. Nohissingsoundovertheflanks.
- 7. Complications Immediate • Injury to Cervix • Injury to gut • Uterine perforation • Infection Remote • Cervical incompetence • Uterine synechiae
- 8. Complications Immediate • Air embolism • Rupture of tubes • Flaring up of pre existing pelvic infection. Remote • Pelvic endometriosis.
- 9. Thank You