Cervical Erosion
Dr. Yashika
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
Pregnancy
Pill user
Persistent ectopy
complcations of third stage of labour, includes PPH, Inversion of uterus, retained placenta, placenta accreta, increta, percreta, amniotic fluid embolism
Dilatation and curettage (D & C) is a procedure to remove tissue from inside the uterus. Doctors perform D & C to diagnose and treat certain uterine conditions — such as a heavy bleeding — or to clear the uterine lining after an abortion or miscarriage.
Cervical Erosion
Dr. Yashika
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
Pregnancy
Pill user
Persistent ectopy
complcations of third stage of labour, includes PPH, Inversion of uterus, retained placenta, placenta accreta, increta, percreta, amniotic fluid embolism
Dilatation and curettage (D & C) is a procedure to remove tissue from inside the uterus. Doctors perform D & C to diagnose and treat certain uterine conditions — such as a heavy bleeding — or to clear the uterine lining after an abortion or miscarriage.
LAS REPARACIONES QUIRURGICAS DE LOS SEGMENTOS ANTERIOR Y POSTERIOR DEBEN REALIZARSE SIEMPRE RESTAURANDO SU UNION AL SEGMENTO APICAL. LA VAGINA TIENE UNA BIOMECANICA EN TRES DIMENSIONES QUE DEBE RECORDARSE. SE MUESTRA UN MODELO 3D QUE GRAFICA LOS MECANISMOS DETRAS DE LOS CISTOCELES DONDE EL SEGMENTO APICAL TIENE UNA IMPORTANCIA CRUCIAL.
Clarifying pelvic organ prolapse reality vs misconceptions to substantiate POP incidence, understand women’s pelvic health issues, evolve clinician best practices, and generate early detection.
Ahmad mukhtar
MD.,M.B.B.Ch., M.Sc Obstetrics and GynecologyConsultant and Lecturer of Obstetrics and Gynecology, Faculty of
MEDICINE, Zagazig University.
Pelvic organ prolapse
Etiology of pelvic organ prolapse
Vaginal vault prolapse
Etiological factors of vault prolapse
Signs and symptoms of vaginal vault prolapse
Diagnosis of vaginal vault prolapse
Treatment measures
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
1. الرحيم الرحمن ا بسمالرحيم الرحمن ا بسم
International University of AfricaInternational University of Africa
Faculty of MedicineFaculty of Medicine
and Health Sciencesand Health Sciences
Genital prolapseGenital prolapse
Presented by:Presented by:
Dr. Alwaleed M.AlfakiDr. Alwaleed M.Alfaki
Gya. & Obs.Gya. & Obs.
www.doctor.sdwww.doctor.sd
2. Genital ProlapseGenital Prolapse
--Genital prolapse is a herniaGenital prolapse is a hernia
--It is defined as a protrusion of a pelvic organ orIt is defined as a protrusion of a pelvic organ or
structure beyond its normal anatomicalstructure beyond its normal anatomical
boundariesboundaries..
TypesTypes:-:-
11..Uterine prolapseUterine prolapse
22..Vaginal prolapseVaginal prolapse
33..Vault prolapseVault prolapse
www.doctor.sdwww.doctor.sd
3. Uterine prolapseUterine prolapse:-:-
- Descent of the uterus & the cervix .Descent of the uterus & the cervix .
- Usually due to weakness of the cervicalUsually due to weakness of the cervical
ligament.ligament.
- 3degrees of uterine descent are recognized .3degrees of uterine descent are recognized .
a)a) First degree :-First degree :-
Slight descent of the uterus but the cervix remainSlight descent of the uterus but the cervix remain
with in the vagina .with in the vagina .
www.doctor.sdwww.doctor.sd
4. b) Second degreeb) Second degree:-:-
The cervix projects through the vulva on startingThe cervix projects through the vulva on starting
or standingor standing..
c) Third degree (procidentiac) Third degree (procidentia((
The entire uterus prolapse out side the vulvaThe entire uterus prolapse out side the vulva..
The whole vagina or at least the whole of itsThe whole vagina or at least the whole of its
anterior wall is invertedanterior wall is inverted..
22..Vaginal prolapseVaginal prolapse:-:-
Divided to anterior wall prolapse & posterior wallDivided to anterior wall prolapse & posterior wall
prolapseprolapse..
www.doctor.sdwww.doctor.sd
5. i) Anterior wall prolapsei) Anterior wall prolapse
a) Cystocele :-a) Cystocele :-
- the bladder base descends with the upper 2/3 of- the bladder base descends with the upper 2/3 of
the anterior vaginal wall .the anterior vaginal wall .
- It represents a weakness in the investing fascia .It represents a weakness in the investing fascia .
b) Urethrocele :-b) Urethrocele :-
- The urethra descends with the lower third of theThe urethra descends with the lower third of the
anterior vaginal wall.anterior vaginal wall.
- Usually due to loss of support by the puboUsually due to loss of support by the pubo
cervical fascia & more important the posteriorcervical fascia & more important the posterior
pubourethral ligament .pubourethral ligament .
www.doctor.sdwww.doctor.sd
6. ii) Posterior vaginal wallii) Posterior vaginal wall
prolapseprolapse
- It can affect the upper or lower vagina .It can affect the upper or lower vagina .
- It represents increased hiatus between the leftIt represents increased hiatus between the left
& right portion of the levator ani muscle .& right portion of the levator ani muscle .
a) Enterocele :-a) Enterocele :-
due to upper posterior wall prolapse & Usuallydue to upper posterior wall prolapse & Usually
associated with herniation of pouch of douglasassociated with herniation of pouch of douglas
& its content (bowel & omentum) .& its content (bowel & omentum) .
www.doctor.sdwww.doctor.sd
7. b) Rectoceleb) Rectocele:-:-
prolapse of the rectum through the lowerprolapse of the rectum through the lower
posterior vaginal wallposterior vaginal wall..
c) Vault prolapsec) Vault prolapse:-:-
prolapse of the vaginal vault afterprolapse of the vaginal vault after
hysterectomy (inversion of the vaginahysterectomy (inversion of the vagina( .( .
www.doctor.sdwww.doctor.sd
8. AetiologyAetiology:-:-
It is due to failure of one or more of the supportsIt is due to failure of one or more of the supports
of the uterus & vagina .of the uterus & vagina .
Predisposing factors :-Predisposing factors :-
1) Congenital weakness of uterine & vaginal1) Congenital weakness of uterine & vaginal
supports .supports .
- Operates in both nulliparous & multiparousOperates in both nulliparous & multiparous
prolapse .prolapse .
- Nulliparous prolapse is very rare & usuallyNulliparous prolapse is very rare & usually
associated with spina bifida (detects inassociated with spina bifida (detects in
innervation)innervation) www.doctor.sdwww.doctor.sd
9. 2. Injury sustained during child birth repeaetd2. Injury sustained during child birth repeaetd
delivery leads to over stretching anddelivery leads to over stretching and
denervation of the supporting tissue .denervation of the supporting tissue .
3. Atrophy of the supporting tissue at the3. Atrophy of the supporting tissue at the
menopause due to defficency of oestrogen.menopause due to defficency of oestrogen.
Activating orprecipitating factors :-Activating orprecipitating factors :-
If aweakness is present the circumstanles likelyIf aweakness is present the circumstanles likely
to precipitate the onset of prolapse one .to precipitate the onset of prolapse one .
* Increase intra-abdominal press caused by* Increase intra-abdominal press caused by
chronic cough Ascites , straining at stoolchronic cough Ascites , straining at stool
,lifting heavy weights .,lifting heavy weights .
*Traction of the uterus by large cervical polyps.*Traction of the uterus by large cervical polyps.
www.doctor.sdwww.doctor.sd
10. PresentationPresentation:-:-
Symptoms:-Symptoms:-
Dragging discomfort and a feeling of someDragging discomfort and a feeling of some
thing coming down . The swelling may be thething coming down . The swelling may be the
cervix , cystocele or rectocele or all the three .cervix , cystocele or rectocele or all the three .
Also a feeling of bearing down sensation .Also a feeling of bearing down sensation .
A cystocele or cystourethrocele can also presentsA cystocele or cystourethrocele can also presents
with urinary symptoms such as stress inwith urinary symptoms such as stress in
continence , urgency & frequency , &continence , urgency & frequency , &
difficulty in emptying the bladderdifficulty in emptying the bladder
necessitating digital pressure .necessitating digital pressure .
www.doctor.sdwww.doctor.sd
11. In severe utro-vaginal prolapse the urethra mayIn severe utro-vaginal prolapse the urethra may
becomes so acutely angled that retention ofbecomes so acutely angled that retention of
urine results .urine results .
Rectocele can also presents with backache &Rectocele can also presents with backache &
difficulty in emptying the rectum (the boweldifficulty in emptying the rectum (the bowel
evacuated by helding back the rectoceleevacuated by helding back the rectocele
digitally) .digitally) .
Uterine descend also can presents with backacheUterine descend also can presents with backache
which is relived by lying down & by bloodwhich is relived by lying down & by blood
stained vaginal discharge when there is astained vaginal discharge when there is a
decubital ulceration .decubital ulceration .
www.doctor.sdwww.doctor.sd
12. ExaminationExamination:-:-
**Examination is best carried out with the patientExamination is best carried out with the patient
in the left lateral position or sims position usingin the left lateral position or sims position using
sims speculumsims speculum..
**The presence , type & extent of prolapse &The presence , type & extent of prolapse &
presence of stress incontinence if any canpresence of stress incontinence if any can
usually be determined by asking the patient tousually be determined by asking the patient to
bear down or to cough during examinationbear down or to cough during examination..
**If there is doubt the patient should be asked toIf there is doubt the patient should be asked to
stand or walk for some time beforestand or walk for some time before
examinationexamination.. www.doctor.sdwww.doctor.sd
13. **Occasionally it is necessary to test for uterineOccasionally it is necessary to test for uterine
descent by pulling the cervix with volsellumdescent by pulling the cervix with volsellum..
Hazards of prolapseHazards of prolapse:-:-
Provided that there is no urinaryProvided that there is no urinary tract obstructiontract obstruction
or infection prolapse carries no risk to life.or infection prolapse carries no risk to life.
PreventionPrevention:-:-
--Avoidance of obesity & cigaretteAvoidance of obesity & cigarette smokingsmoking..
--Appropriate use of hormone replacement therapyAppropriate use of hormone replacement therapy..
--Encourage postnatal pelvic floor exerciseEncourage postnatal pelvic floor exercise..
--Avoid long second stage of labour by doingAvoid long second stage of labour by doing
Episiotomy .with low forceps ,ventouse whenEpisiotomy .with low forceps ,ventouse when
neededneeded www.doctor.sdwww.doctor.sd
14. Treatment:-Treatment:-
1/Pessary treatment1/Pessary treatment:-:-
--Ring pessaries are made of inert plastic , are ofRing pessaries are made of inert plastic , are of
different size , can be left in place for up to onedifferent size , can be left in place for up to one
yearyear..
--Shelf pessaries are helpful in severe utrovaginalShelf pessaries are helpful in severe utrovaginal
prolapseprolapse..
--The two main complication of pessaries areThe two main complication of pessaries are
vaginal ulceration & incarceration leading tovaginal ulceration & incarceration leading to
discharge & bleedingdischarge & bleeding..
www.doctor.sdwww.doctor.sd
15. --Indication of pessaries treatment areIndication of pessaries treatment are:-:-
During & after pregnancy awaiting involutionDuring & after pregnancy awaiting involution
of tissues .of tissues .
As a therapeutic test to confirm that surgeryAs a therapeutic test to confirm that surgery
might help .might help .
When the patient is medically unfit or refusesWhen the patient is medically unfit or refuses
surgery .surgery .
for relief of symptom while the patient isfor relief of symptom while the patient is
awaiting surgery .awaiting surgery .
www.doctor.sdwww.doctor.sd
16. Surgical Treatment:-Surgical Treatment:-
prolapse is not life threating condition but surgeryprolapse is not life threating condition but surgery
has its mortality & morbidity .has its mortality & morbidity .
a) Anterior repair (anterior colporrhaphy):-a) Anterior repair (anterior colporrhaphy):-
- Correct cystocele or cystourethrocele .Correct cystocele or cystourethrocele .
- The vaginal skin is divided in the midline , theThe vaginal skin is divided in the midline , the
bladder is reflected upwards & the pubocervicalbladder is reflected upwards & the pubocervical
fascia on either side inforced with interruptedfascia on either side inforced with interrupted
stutures , redundant vaginal skin is excised &stutures , redundant vaginal skin is excised &
vaginal skin is closed .vaginal skin is closed .
- Postoperative urinary retention is common .Postoperative urinary retention is common .www.doctor.sdwww.doctor.sd
17. b)b) Posterior repair(colpo-perineorrhaphyPosterior repair(colpo-perineorrhaphy
- Correct rectoceleCorrect rectocele
- A vertical posterior vaginal wall incisionA vertical posterior vaginal wall incision
is used to descet the posterior vaginalis used to descet the posterior vaginal
wall from the rectum , the edges of thewall from the rectum , the edges of the
levator ani muscles are sutured togetherlevator ani muscles are sutured together
in the midline & the posterior vaginalin the midline & the posterior vaginal
skin is closed .skin is closed .
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18. c) Vaginal hysterectomy with repairc) Vaginal hysterectomy with repair:-:-
- It is now the standard operation for utro-It is now the standard operation for utro-
vaginal prolapse .vaginal prolapse .
- It is also the operation of choice when anIt is also the operation of choice when an
enterocele present .enterocele present .
- Best well when there is procidentia .Best well when there is procidentia .
d) Manchester (fothergill) repair :-d) Manchester (fothergill) repair :-
- Appropriate for the small number of women- Appropriate for the small number of women
with severe utro-vaginal prolapse who wish towith severe utro-vaginal prolapse who wish to
have further children .have further children .
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19. -- It combines shortening of the transverseIt combines shortening of the transverse
cervicalcervical ligament with amputation of theligament with amputation of the
cervix & anterior colporraphy .cervix & anterior colporraphy .
-full amputation of the cervix may not be-full amputation of the cervix may not be
necessary in less severe cases .necessary in less severe cases .
-Caesarean section is necessary in any-Caesarean section is necessary in any
subsequent pregnancy .subsequent pregnancy .
e) Leefort operatione) Leefort operation
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20. Support of the uterusSupport of the uterus:-:-
The uterus is held in position ofThe uterus is held in position of
anteflection and anteversion by its wieghtanteflection and anteversion by its wieght
, by the round ligaments which hold the, by the round ligaments which hold the
fundus forwards and the uteroscaralfundus forwards and the uteroscaral
ligaments which keep the supra vaginalligaments which keep the supra vaginal
cervix far back in the pelvis while thecervix far back in the pelvis while the
transverse cervical ligament prevent itstransverse cervical ligament prevent its
descent .descent .
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21. Support of the vaginaSupport of the vagina
In its upper part it is supported by the lowerIn its upper part it is supported by the lower
components of the transverse cervicalcomponents of the transverse cervical
ligament which fuse with its fascial sheath .ligament which fuse with its fascial sheath .
- Below this it is held by the fibres of the levator- Below this it is held by the fibres of the levator
ani which are inserted into its side walls by theani which are inserted into its side walls by the
urogenital diaphram and by the perinealurogenital diaphram and by the perineal
muscle .muscle .
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