The document discusses the case of a 29 year old pregnant woman with a history of cesarean section who presented with vaginal spotting and was diagnosed with uterine didelphys. She underwent a repeat cesarean section to deliver a healthy baby boy. The document also provides background information on uterine didelphys including associated anomalies, diagnostic methods, surgical treatments, and postoperative care.
This document discusses the acute abdomen in pregnancy. It notes that abdominal pain is difficult to evaluate during pregnancy due to physiological changes from the enlarging uterus and effects of progesterone. It outlines potential causes of abdominal pain including miscarriage, ectopic pregnancy, preeclampsia, placental abruption, uterine rupture, and surgical conditions. It emphasizes that the goal is to identify life-threatening causes requiring intervention while discussing concerns for fetal safety during diagnosis and management. A thorough history, physical exam, lab tests, and imaging can help diagnose the source of pain.
This document reports on a case of a 29-year-old woman admitted to the hospital with vaginal bleeding at 35-36 weeks of pregnancy. She was diagnosed with severe preeclampsia, placenta previa totalis, and was at risk of eclampsia. She underwent an emergency cesarean section to deliver a healthy baby girl weighing 2400 grams. Post-operation, the mother received magnesium sulfate and antihypertensive treatment and recovered well.
This document presents a grand rounds discussion on late complications in pregnancy. It reviews several cases including a woman at 39 weeks presenting with chest pain, shortness of breath, and leg edema, possibly due to pulmonary embolism. It also discusses a woman at 36 weeks presenting with seizures, possibly due to preeclampsia or eclampsia. Another case involves a woman at 37 weeks with painless vaginal bleeding, which could be due to placenta previa, vasa previa, or placental abruption. Management strategies are provided for these complications.
1) A 25-year-old pregnant woman presented with severe lower abdominal pain for 1 day. On examination, she had tenderness all over her abdomen.
2) An ultrasound showed a right ovarian cyst. She underwent surgery where they found an enlarged right ovary with old blood.
3) She was diagnosed with a ruptured ovarian cyst and hospitalized. She recovered well and was discharged after 5 days.
The document discusses various methods for assessing fetal well-being during pregnancy, including clinical evaluation, biochemical tests, and biophysical tests. Clinical evaluation involves monitoring the mother's weight, blood pressure, fetal growth and movement. Biophysical tests examine the fetus's heart rate and movement patterns in response to stimuli. These include the non-stress test (NST), biophysical profile (BPP), and contraction stress test. Ultrasound evaluates fetal anatomy and growth, while Doppler ultrasound assesses blood flow in vessels. Together these tools provide information on the fetus's health and help guide management to improve birth outcomes.
Multidisciplinary case chronic myelogenous leukemia in pregnancyDR MUKESH SAH
Pregnancy and CML
While pregnancy in and of itself does not affect the course of CML, there is a risk for maternal disease progression if CML remains untreated for the duration of pregnancy. Unfortunately, treatment of CML during pregnancy is complicated due to the teratogenic nature of TKIs
This document provides an overview of obstetrics topics including normal pregnancy, prenatal care, fetal monitoring, multiple gestation, medical conditions in pregnancy, antenatal complications, labor and delivery, postpartum care, and drugs contraindicated in pregnancy. It defines key terms, describes maternal physiological changes in pregnancy, outlines investigations for diagnosing pregnancy, and discusses various aspects of prenatal care, fetal monitoring, complications, labor and delivery processes.
This presentation describes approach to a patient presenting with early pregnancy bleeding. It also includes a brief outline about the management of miscarriage, molar pregnancy and ectopic pregnancy.
This document discusses the acute abdomen in pregnancy. It notes that abdominal pain is difficult to evaluate during pregnancy due to physiological changes from the enlarging uterus and effects of progesterone. It outlines potential causes of abdominal pain including miscarriage, ectopic pregnancy, preeclampsia, placental abruption, uterine rupture, and surgical conditions. It emphasizes that the goal is to identify life-threatening causes requiring intervention while discussing concerns for fetal safety during diagnosis and management. A thorough history, physical exam, lab tests, and imaging can help diagnose the source of pain.
This document reports on a case of a 29-year-old woman admitted to the hospital with vaginal bleeding at 35-36 weeks of pregnancy. She was diagnosed with severe preeclampsia, placenta previa totalis, and was at risk of eclampsia. She underwent an emergency cesarean section to deliver a healthy baby girl weighing 2400 grams. Post-operation, the mother received magnesium sulfate and antihypertensive treatment and recovered well.
This document presents a grand rounds discussion on late complications in pregnancy. It reviews several cases including a woman at 39 weeks presenting with chest pain, shortness of breath, and leg edema, possibly due to pulmonary embolism. It also discusses a woman at 36 weeks presenting with seizures, possibly due to preeclampsia or eclampsia. Another case involves a woman at 37 weeks with painless vaginal bleeding, which could be due to placenta previa, vasa previa, or placental abruption. Management strategies are provided for these complications.
1) A 25-year-old pregnant woman presented with severe lower abdominal pain for 1 day. On examination, she had tenderness all over her abdomen.
2) An ultrasound showed a right ovarian cyst. She underwent surgery where they found an enlarged right ovary with old blood.
3) She was diagnosed with a ruptured ovarian cyst and hospitalized. She recovered well and was discharged after 5 days.
The document discusses various methods for assessing fetal well-being during pregnancy, including clinical evaluation, biochemical tests, and biophysical tests. Clinical evaluation involves monitoring the mother's weight, blood pressure, fetal growth and movement. Biophysical tests examine the fetus's heart rate and movement patterns in response to stimuli. These include the non-stress test (NST), biophysical profile (BPP), and contraction stress test. Ultrasound evaluates fetal anatomy and growth, while Doppler ultrasound assesses blood flow in vessels. Together these tools provide information on the fetus's health and help guide management to improve birth outcomes.
Multidisciplinary case chronic myelogenous leukemia in pregnancyDR MUKESH SAH
Pregnancy and CML
While pregnancy in and of itself does not affect the course of CML, there is a risk for maternal disease progression if CML remains untreated for the duration of pregnancy. Unfortunately, treatment of CML during pregnancy is complicated due to the teratogenic nature of TKIs
This document provides an overview of obstetrics topics including normal pregnancy, prenatal care, fetal monitoring, multiple gestation, medical conditions in pregnancy, antenatal complications, labor and delivery, postpartum care, and drugs contraindicated in pregnancy. It defines key terms, describes maternal physiological changes in pregnancy, outlines investigations for diagnosing pregnancy, and discusses various aspects of prenatal care, fetal monitoring, complications, labor and delivery processes.
This presentation describes approach to a patient presenting with early pregnancy bleeding. It also includes a brief outline about the management of miscarriage, molar pregnancy and ectopic pregnancy.
A 23-year-old woman presents to the emergency department with abdominal pain in her right lower quadrant and suprapubic region that began 12 hours ago. Her physical exam reveals tenderness in the right lower quadrant and suprapubic areas. Imaging and labs are ordered which ultimately reveal a ruptured corpus luteum cyst.
Este documento presenta información sobre la valoración del recién nacido sano, incluyendo la escala Apgar y la valoración de Silverman-Anderson. Explica los cuidados inmediatos y evaluaciones que se deben realizar al recién nacido, como la aspiración de secreciones, el pinzamiento y corte del cordón umbilical, y la primera valoración Apgar. También describe las características normales que debe presentar un recién nacido sano y los exámenes físicos requeridos.
- A 46-year-old woman presented with vaginal bleeding and an enlarging abdominal mass. Imaging and biopsy revealed stage IB or IIIC endometrial adenocarcinoma. She underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH-BSO).
- A 43-year-old woman presented with vaginal bleeding, abdominal pain, and masses. She was diagnosed with adenomyosis, pelvic endometriosis, and a ruptured endometrioma of the right ovary. She underwent a TAH-BSO.
- The documents describe two patient cases of women presenting with vaginal bleeding and abdominal masses. Both underwent TAH-B
NEC is a devastating condition affecting premature infants. It involves necrosis of the intestinal tissue. Key factors that increase risk are prematurity, enteral feeding, and circulatory instability in the intestines. Clinically, infants may experience apnea, feeding intolerance, and abdominal distension. Diagnosis involves blood tests showing infection and inflammation as well as imaging showing abnormalities in the intestines. Treatment involves bowel rest, antibiotics, and sometimes surgery. Outcomes depend on severity but mortality can be over 40% in very premature infants and survivors face long-term complications.
Spontaneous rupture of endometriotic cyst in 3rd trimester of pregnancyApollo Hospitals
Endometriosis is a well established cause of female infertility and may be associated with early pregnancy losses. Association of endometriosis with pregnancy is rare. Ruptured endometriotic cyst presenting as acute abdomen in pregnancy is even a rarer presentation.
We present hereby a rare and interesting case, presented in our hospital, of Spontaneous rupture of endometiotic Cyst in 3rd trimester of pregnancy and its subsequent management.
A 25-year-old woman presented with irregular vaginal bleeding following evacuation of a molar pregnancy 6 weeks prior. On examination, she was anemic and her uterus was enlarged to 16 weeks size. Ultrasound and beta-hCG levels confirmed incomplete evacuation of molar tissue. She underwent a second suction and evacuation procedure where a large amount of molar tissue was removed. She was advised follow up monitoring of beta-hCG levels and contraceptive use, and warned to report any symptoms like bleeding or vision changes during recovery.
Management of a pregnant patient presenting with first fit. It includes a review of SLCOG sri lanka guidelines of management of eclampsia in emergency medicine point of view
The document analyzes geographical variations in low-risk primary cesarean section rates across hospitals in California, finding that rates exceed benchmarks in many hospitals especially in Los Angeles County and that reducing rates could save millions in healthcare costs annually while also reducing risks to mothers and infants. Regional data on excess c-section cases and costs are presented to demonstrate the public health implications.
This document provides an overview of current issues in perinatology and preterm birth. It discusses definitions and common causes of preterm birth such as spontaneous preterm labor and preterm premature rupture of membranes. Risk factors for preterm birth include multiple gestations, preeclampsia, and maternal medical conditions. Complications of prematurity are also reviewed such as respiratory distress syndrome and intraventricular hemorrhage. Current tocolytic medications for inhibiting preterm labor are described including beta-agonists, calcium channel blockers, nitric oxide donors, and oxytocin receptor antagonists. The efficacy, maternal and fetal effects, dosing, and contraindications of specific medications like ritodrin and nifed
This document provides information on antenatal care including definitions, aims, criteria for a normal pregnancy, goals, and procedures for the initial and subsequent visits. The key points covered include:
- Antenatal care involves systematic supervision of a pregnant woman including history, examinations, advice, and education.
- The aims are to screen for high-risk cases, prevent/treat complications, provide health education and risk assessment, and discuss delivery plans.
- The objective is to ensure a normal pregnancy and delivery of a healthy baby from a healthy mother.
- Procedures include taking history, physical exams, tests, discussing warning signs, and providing advice on nutrition, rest, travel, immunizations and common symptoms
Athira symposium gynaecology final year mbbs Dr Ritesh Malik
This document provides guidance on evaluating and investigating factors related to infertility that has lasted one year or longer. It outlines the initial evaluation process including taking a history, physical examination, and various tests and investigations. The history focuses on factors like age, menstrual and obstetric history, medical history, and surgeries. The physical exam evaluates various body systems. Investigations are aimed at detecting cervical, tubal, ovarian, and uterine factors through tests of the cervical mucus, hysterosalpingography, laparoscopy, ultrasounds, hormonal studies, and more. The goal is to investigate all potential causes of infertility and counsel the patient.
Case History of Dedifferentiated LiposarcomaVictor Effiom
This document summarizes the case history of a 24-year-old male who presented with abdominal distension, difficulty breathing, and weight loss. Imaging and exploratory surgery revealed a giant intra-abdominal mass weighing 20kg, which was removed. Histopathology determined the mass was a dedifferentiated liposarcoma. The patient required multiple blood transfusions post-operatively to manage anemia, but was eventually discharged and doing well on follow up.
For more information, visit https://www.timberlandmedical.com
Timberland Medical Centre is a private hospital that has been in operation since 1994. We are strategically located at the 3rd Mile roundabout on Jalan Rock, Kuching, Sarawak, East Malaysia. Our hospital is 10 minutes from the Kuching International Airport and 15 minutes from the Central Bus Terminal. We continually seek to improve and upgrade our services and facilities, as we strive to provide the best medical care for our patients and customers.
Sexual differentiation is a complex process involving genetic and hormonal factors that begins with undifferentiated gonads in early fetal development. The presence of the SRY gene on the Y chromosome leads to testis formation while its absence leads to ovary formation. Testes secrete testosterone and MIF which masculinize the internal and external genitalia. In the absence of these, the Mullerian ducts form female internal structures and external genitalia develop along female lines. Disorders of sexual development can occur due to genetic abnormalities, hormonal imbalances, or defects in hormone action or metabolism.
Acute abdomen in pregnancy poses diagnostic and therapeutic challenges due to physiological changes and a need to minimize risk to the fetus. Common causes include appendicitis, cholecystitis, intestinal obstruction, and other non-obstetric issues. A thorough history, physical exam, and focused imaging are important for diagnosis. Treatment priorities include resuscitation, antibiotics if indicated, and timely surgery if conservative measures fail or the fetus is compromised. Laparoscopic and open surgical techniques can both be used to manage many conditions while minimizing risks. Multidisciplinary care is important for optimal maternal and fetal outcomes.
Acute appendicitis and Acute Abdominal Painchaliter
The document discusses a case of a 9-year-old female diagnosed with acute appendicitis. It provides background on appendicitis including that it is the most common acute surgical condition in children, with a peak incidence between ages 10-18. The patient presented with 8 days of hypogastric pain and intermittent fever. Exams showed guarding and tenderness, and tests confirmed leukocytosis. She underwent an emergency appendectomy, was treated with antibiotics, and recovered well.
An Atypical Outcome Of Multifoetal Gestation In Bicornuate UterusSujoy Dasgupta
This paper was presented at the Annual Conference of Bengal Obstetric and Gynaecological Society (BOGSCON) 2012 held at ECOHUB Conclave, Kolkata, January, 2012 and was awarded as the BEST CASE PRESENTATION (1st PRIZE)
Cesarean hysterectomy is really two separate operations: cesarean section and hysterectomy. Cesarean hysterectomy can be accomplished through most abdominal wall incisions. A vertical incision provides best exposure, but often when performed as an emergency a transverse incision has been used and may be adequate.
This document summarizes abnormal menstruation and dysfunctional uterine bleeding (DUB). It discusses the normal menstrual cycle and hormone regulation. DUB is caused by abnormal hormone axis regulation and can be anovulatory or ovulatory. It outlines the clinical manifestations, diagnostic process which excludes other causes, and treatment options for DUB which include progestin, combined estrogen-progestin therapies, and intrauterine devices.
This document discusses strategies for effectively teaching chemistry concepts. It emphasizes that chemistry contains many abstract concepts that are challenging for learners to grasp. It recommends using practical experiments, mathematical concepts, analogies, symbolic representations, visuals, virtual labs, and examples to help explain topics. Maintaining a database of educational resources can provide additional support. Practical experiments are an essential part of learning chemistry. Visual tools like animations and videos can help demonstrate abstract molecular structures and chemical processes.
This document discusses third-trimester bleeding during pregnancy. It can be caused by conditions like abruptio placentae (AP), placenta previa (PP), and vasa previa (VP). AP is the premature separation of the placenta from the uterine wall. PP is the presence of placental tissue over the cervical os. VP occurs when umbilical cord vessels lie in the membranes over the cervical os. These conditions can lead to significant maternal and fetal risks if not properly managed. The document outlines the epidemiology, etiology, complications, diagnosis, and management considerations for each condition.
A 23-year-old woman presents to the emergency department with abdominal pain in her right lower quadrant and suprapubic region that began 12 hours ago. Her physical exam reveals tenderness in the right lower quadrant and suprapubic areas. Imaging and labs are ordered which ultimately reveal a ruptured corpus luteum cyst.
Este documento presenta información sobre la valoración del recién nacido sano, incluyendo la escala Apgar y la valoración de Silverman-Anderson. Explica los cuidados inmediatos y evaluaciones que se deben realizar al recién nacido, como la aspiración de secreciones, el pinzamiento y corte del cordón umbilical, y la primera valoración Apgar. También describe las características normales que debe presentar un recién nacido sano y los exámenes físicos requeridos.
- A 46-year-old woman presented with vaginal bleeding and an enlarging abdominal mass. Imaging and biopsy revealed stage IB or IIIC endometrial adenocarcinoma. She underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH-BSO).
- A 43-year-old woman presented with vaginal bleeding, abdominal pain, and masses. She was diagnosed with adenomyosis, pelvic endometriosis, and a ruptured endometrioma of the right ovary. She underwent a TAH-BSO.
- The documents describe two patient cases of women presenting with vaginal bleeding and abdominal masses. Both underwent TAH-B
NEC is a devastating condition affecting premature infants. It involves necrosis of the intestinal tissue. Key factors that increase risk are prematurity, enteral feeding, and circulatory instability in the intestines. Clinically, infants may experience apnea, feeding intolerance, and abdominal distension. Diagnosis involves blood tests showing infection and inflammation as well as imaging showing abnormalities in the intestines. Treatment involves bowel rest, antibiotics, and sometimes surgery. Outcomes depend on severity but mortality can be over 40% in very premature infants and survivors face long-term complications.
Spontaneous rupture of endometriotic cyst in 3rd trimester of pregnancyApollo Hospitals
Endometriosis is a well established cause of female infertility and may be associated with early pregnancy losses. Association of endometriosis with pregnancy is rare. Ruptured endometriotic cyst presenting as acute abdomen in pregnancy is even a rarer presentation.
We present hereby a rare and interesting case, presented in our hospital, of Spontaneous rupture of endometiotic Cyst in 3rd trimester of pregnancy and its subsequent management.
A 25-year-old woman presented with irregular vaginal bleeding following evacuation of a molar pregnancy 6 weeks prior. On examination, she was anemic and her uterus was enlarged to 16 weeks size. Ultrasound and beta-hCG levels confirmed incomplete evacuation of molar tissue. She underwent a second suction and evacuation procedure where a large amount of molar tissue was removed. She was advised follow up monitoring of beta-hCG levels and contraceptive use, and warned to report any symptoms like bleeding or vision changes during recovery.
Management of a pregnant patient presenting with first fit. It includes a review of SLCOG sri lanka guidelines of management of eclampsia in emergency medicine point of view
The document analyzes geographical variations in low-risk primary cesarean section rates across hospitals in California, finding that rates exceed benchmarks in many hospitals especially in Los Angeles County and that reducing rates could save millions in healthcare costs annually while also reducing risks to mothers and infants. Regional data on excess c-section cases and costs are presented to demonstrate the public health implications.
This document provides an overview of current issues in perinatology and preterm birth. It discusses definitions and common causes of preterm birth such as spontaneous preterm labor and preterm premature rupture of membranes. Risk factors for preterm birth include multiple gestations, preeclampsia, and maternal medical conditions. Complications of prematurity are also reviewed such as respiratory distress syndrome and intraventricular hemorrhage. Current tocolytic medications for inhibiting preterm labor are described including beta-agonists, calcium channel blockers, nitric oxide donors, and oxytocin receptor antagonists. The efficacy, maternal and fetal effects, dosing, and contraindications of specific medications like ritodrin and nifed
This document provides information on antenatal care including definitions, aims, criteria for a normal pregnancy, goals, and procedures for the initial and subsequent visits. The key points covered include:
- Antenatal care involves systematic supervision of a pregnant woman including history, examinations, advice, and education.
- The aims are to screen for high-risk cases, prevent/treat complications, provide health education and risk assessment, and discuss delivery plans.
- The objective is to ensure a normal pregnancy and delivery of a healthy baby from a healthy mother.
- Procedures include taking history, physical exams, tests, discussing warning signs, and providing advice on nutrition, rest, travel, immunizations and common symptoms
Athira symposium gynaecology final year mbbs Dr Ritesh Malik
This document provides guidance on evaluating and investigating factors related to infertility that has lasted one year or longer. It outlines the initial evaluation process including taking a history, physical examination, and various tests and investigations. The history focuses on factors like age, menstrual and obstetric history, medical history, and surgeries. The physical exam evaluates various body systems. Investigations are aimed at detecting cervical, tubal, ovarian, and uterine factors through tests of the cervical mucus, hysterosalpingography, laparoscopy, ultrasounds, hormonal studies, and more. The goal is to investigate all potential causes of infertility and counsel the patient.
Case History of Dedifferentiated LiposarcomaVictor Effiom
This document summarizes the case history of a 24-year-old male who presented with abdominal distension, difficulty breathing, and weight loss. Imaging and exploratory surgery revealed a giant intra-abdominal mass weighing 20kg, which was removed. Histopathology determined the mass was a dedifferentiated liposarcoma. The patient required multiple blood transfusions post-operatively to manage anemia, but was eventually discharged and doing well on follow up.
For more information, visit https://www.timberlandmedical.com
Timberland Medical Centre is a private hospital that has been in operation since 1994. We are strategically located at the 3rd Mile roundabout on Jalan Rock, Kuching, Sarawak, East Malaysia. Our hospital is 10 minutes from the Kuching International Airport and 15 minutes from the Central Bus Terminal. We continually seek to improve and upgrade our services and facilities, as we strive to provide the best medical care for our patients and customers.
Sexual differentiation is a complex process involving genetic and hormonal factors that begins with undifferentiated gonads in early fetal development. The presence of the SRY gene on the Y chromosome leads to testis formation while its absence leads to ovary formation. Testes secrete testosterone and MIF which masculinize the internal and external genitalia. In the absence of these, the Mullerian ducts form female internal structures and external genitalia develop along female lines. Disorders of sexual development can occur due to genetic abnormalities, hormonal imbalances, or defects in hormone action or metabolism.
Acute abdomen in pregnancy poses diagnostic and therapeutic challenges due to physiological changes and a need to minimize risk to the fetus. Common causes include appendicitis, cholecystitis, intestinal obstruction, and other non-obstetric issues. A thorough history, physical exam, and focused imaging are important for diagnosis. Treatment priorities include resuscitation, antibiotics if indicated, and timely surgery if conservative measures fail or the fetus is compromised. Laparoscopic and open surgical techniques can both be used to manage many conditions while minimizing risks. Multidisciplinary care is important for optimal maternal and fetal outcomes.
Acute appendicitis and Acute Abdominal Painchaliter
The document discusses a case of a 9-year-old female diagnosed with acute appendicitis. It provides background on appendicitis including that it is the most common acute surgical condition in children, with a peak incidence between ages 10-18. The patient presented with 8 days of hypogastric pain and intermittent fever. Exams showed guarding and tenderness, and tests confirmed leukocytosis. She underwent an emergency appendectomy, was treated with antibiotics, and recovered well.
An Atypical Outcome Of Multifoetal Gestation In Bicornuate UterusSujoy Dasgupta
This paper was presented at the Annual Conference of Bengal Obstetric and Gynaecological Society (BOGSCON) 2012 held at ECOHUB Conclave, Kolkata, January, 2012 and was awarded as the BEST CASE PRESENTATION (1st PRIZE)
Cesarean hysterectomy is really two separate operations: cesarean section and hysterectomy. Cesarean hysterectomy can be accomplished through most abdominal wall incisions. A vertical incision provides best exposure, but often when performed as an emergency a transverse incision has been used and may be adequate.
This document summarizes abnormal menstruation and dysfunctional uterine bleeding (DUB). It discusses the normal menstrual cycle and hormone regulation. DUB is caused by abnormal hormone axis regulation and can be anovulatory or ovulatory. It outlines the clinical manifestations, diagnostic process which excludes other causes, and treatment options for DUB which include progestin, combined estrogen-progestin therapies, and intrauterine devices.
This document discusses strategies for effectively teaching chemistry concepts. It emphasizes that chemistry contains many abstract concepts that are challenging for learners to grasp. It recommends using practical experiments, mathematical concepts, analogies, symbolic representations, visuals, virtual labs, and examples to help explain topics. Maintaining a database of educational resources can provide additional support. Practical experiments are an essential part of learning chemistry. Visual tools like animations and videos can help demonstrate abstract molecular structures and chemical processes.
This document discusses third-trimester bleeding during pregnancy. It can be caused by conditions like abruptio placentae (AP), placenta previa (PP), and vasa previa (VP). AP is the premature separation of the placenta from the uterine wall. PP is the presence of placental tissue over the cervical os. VP occurs when umbilical cord vessels lie in the membranes over the cervical os. These conditions can lead to significant maternal and fetal risks if not properly managed. The document outlines the epidemiology, etiology, complications, diagnosis, and management considerations for each condition.
The document discusses three case studies of neonates presenting with various medical conditions. For each case, clinical details are provided about the neonate's condition, vital signs, lab results, and treatments administered. The reader is then prompted to indicate the next appropriate action or intervention in each case. The document also reviews various methods for monitoring hemodynamics and end-organ perfusion in neonates.
Placenta previa is a condition where the placenta covers part or all of the cervical os. It can cause significant bleeding during the third trimester. Treatment depends on gestational age and severity of bleeding, and may involve expectant management, cesarean delivery, or in rare cases vaginal delivery. Complications include maternal hemorrhage and fetal issues like prematurity. Proper diagnosis and management are needed to prevent adverse outcomes.
This document summarizes guidelines for vaginal birth after cesarean (VBAC) based on recommendations from the American College of Obstetricians and Gynecologists (ACOG). It states that over 60-80% of women with one previous low transverse cesarean section can successfully have a VBAC, and lists criteria for candidates, including no prior uterine scarring or ruptures. It notes risks of VBAC like uterine rupture are low at 1% but serious, and benefits include shorter recovery over repeat cesarean. The document provides information on risks, benefits and factors to consider for VBAC.
The document discusses placenta accreta, a condition where the placenta invades and attaches abnormally to the uterine wall. It has increased in incidence 10-fold over the past 50 years due to rising cesarean delivery rates. Risk factors include placenta previa, prior uterine surgery, and increasing maternal age and parity. Ultrasound and MRI can be used to diagnose placenta accreta prenatally based on signs like lack of a hypoechoic zone between the placenta and uterus. Management options for severe postpartum hemorrhage from placenta accreta include uterine packing, arterial ligation, hysterectomy, and the B-Lynch compression suture
This document discusses the management of preterm labor in cases of placenta previa and abruption placentae. It describes placenta previa as when the placenta is located over or near the internal os, and notes four degrees. For placenta previa, the expectant management using Macafee-Johnson's regime aims to continue the pregnancy for lung maturity up to 37 weeks without risking maternal health. For abruption placentae, where the placenta prematurely separates, active management through immediate delivery is usually indicated due to risks of further separation and fetal death. Lower segment c-section is often used for placenta previa, while vaginal delivery may be possible if the
Pulmonary tuberculosis is an infectious disease caused by the bacteria Mycobacterium tuberculosis that mainly affects the lungs. It spreads through airborne droplets from the coughs or sneezes of infected individuals. Symptoms may include fatigue, fever, weight loss, and breathing difficulties. Diagnosis involves tests such as tuberculin skin tests, sputum smear and culture, chest x-rays and CT scans to look for signs of infection and damage in the lungs. Tuberculosis has affected humans for centuries and remains a global public health problem.
The document discusses 100 pictures from Microsoft Clip Art that can be used according to the Microsoft Service Agreement. It provides an email address for PowerPoint tips and tricks as well as 50 PowerPoint templates and welcomes comments from Jean-Luc.
Placental abruption is when the placenta separates early from the uterus, in other words separates before childbirth. It occurs most commonly around 25 weeks of pregnancy. Symptoms may include vaginal bleeding, lower abdominal pain, and dangerously low blood pressure.
This case presentation discusses the diagnosis and management of congenital duodenal atresia in a 35-year-old pregnant patient. Prenatal ultrasound revealed signs of duodenal atresia including polyhydramnios. After being admitted in preterm labor at 34 weeks, the patient delivered a baby boy with duodenal atresia who underwent surgery on postnatal day 4. Duodenal atresia results from failure of embryonic development and is often associated with other anomalies. Prenatal diagnosis allows delivery at a center prepared to care for the newborn.
This case report describes a 33-year-old pregnant female (G3P1A1L1) diagnosed with gestational diabetes mellitus and vaginal candidiasis. She presented with complaints of itching, foul smell, and scanty discharge. Her history revealed gestational diabetes diagnosed at 25 weeks currently treated with diet. On examination, she was found to have scanty, curdy white discharge consistent with vaginal moniliasis. The report discusses the patient's history, examination findings, diagnoses of gestational diabetes and vaginal candidiasis, and recommended investigations and treatment.
This document provides definitions, guidelines, and clinical information relevant to obstetrics and gynecology. It includes abbreviations and definitions commonly used in OB/GYN, normal physiological changes in pregnancy, prenatal care guidelines by trimester, common pregnancy complaints/problems, screening tests, complications like ectopic pregnancy and spontaneous abortion, and information on chromosomes and genetic disorders. The document aims to serve as a study guide and clinical survival guide for OB/GYN students and providers.
This document summarizes the pre-operative diagnosis, operative findings, and specimens collected for a patient undergoing an exploratory laparotomy for a suspected ovarian tumor. The 53-year-old patient presented with abdominal distension and discomfort and imaging showed a large pelvic mass arising from the left ovary. During surgery, an extensive left adnexal mass measuring 20x20x22cm was found involving the left pelvic side wall and colon. The uterus, right ovary, and both fallopian tubes were embedded in the mass. Specimens including the uterus with left ovarian tumor, omentum, and appendix were sent for histopathological examination.
This document provides definitions and abbreviations commonly used in OB/GYN. It also summarizes key aspects of pregnancy including diagnosis, prenatal care, routine problems, screening tests, and fetal lung maturity assessments. Normal physiological changes in pregnancy are outlined covering the cardiovascular, pulmonary, gastrointestinal, renal, hematologic, endocrine, musculoskeletal and nutritional systems. Key details on ectopic pregnancy diagnosis and treatment are also included.
1) Early pregnancy ultrasound is used to evaluate normal and abnormal early pregnancies through assessing gestational sac location, structure, viability, dating and number. It can also screen for fetal abnormalities and assist with procedures.
2) Sonographic signs of normal early pregnancy include identifying the gestational sac, yolk sac, embryo/fetus and presence of cardiac activity. Dating is based on mean sac diameter from 5-9 weeks and crown-rump length from 6-12 weeks.
3) Abnormal findings include failed early pregnancy, pregnancy of uncertain viability, pregnancy of unknown location, ectopic pregnancy, molar pregnancy, and retained products of conception. Precise diagnosis requires correlating ultrasound findings with hCG
Ultrasound is useful in the first trimester for evaluating bleeding, pain, gestational sac location and development. A gestational sac is normally visible by 4 weeks ultrasound. The yolk sac appears by 5 weeks and the embryo with cardiac activity by 6 weeks. Abnormal findings include lack of growth, irregular sac shape, large yolk sac size. Doppler can assess blood flow. Ectopic pregnancies can be detected by visualizing an embryo outside the uterus combined with serum hCG levels. Multiple pregnancies are determined by membrane thickness and number of yolk sacs.
This document summarizes the case of a preterm male neonate born at 33 weeks gestation via normal spontaneous vaginal delivery with an Apgar score of 8, 9. During his hospital stay, he was treated for jaundice and suspected sepsis and showed improvement. Blood cultures were negative and he was discharged on his 7th day of life in stable condition.
A 27-year-old woman presented with severe abdominal pain and was found to have a heterotopic pregnancy, with an intrauterine twin gestation and a ruptured right tubal ectopic pregnancy. She underwent laparoscopic salpingectomy for the ectopic pregnancy. Heterotopic pregnancies occur when a simultaneous intrauterine and extrauterine pregnancy occur, with the latter usually being ectopic. Risk factors include assisted reproductive techniques and pelvic inflammatory disease. The presence of an intrauterine pregnancy does not rule out a coexisting ectopic pregnancy. The patient's intrauterine twins were successfully delivered via c-section at 35 weeks.
These three cases describe instances of false positive diagnoses of infantile hypertrophic pyloric stenosis (IHPS) based on abdominal ultrasonography findings. In Case 1, upper GI series found no pyloric stenosis. In Cases 2 and 3, upper GI series also did not confirm the diagnosis of IHPS suggested by ultrasonography. Reliance solely on ultrasonography without considering other clinical evidence can increase the risk of false positive diagnoses of IHPS and unnecessary surgery. A palpable pyloric mass on examination under anesthesia is important for confirming the diagnosis before proceeding with pyloromyotomy.
1) The document summarizes a clinical meeting presentation about conjoined twin infants born at 35 weeks gestation who were attached at the head.
2) On examination, the twins were generally healthy and developing appropriately except for being jaundiced and experiencing intermittent low urine output.
3) Over the course of their hospital stay, their jaundice and urine output were monitored and treated conservatively with phototherapy and IV fluids respectively. Electrolyte abnormalities were also corrected.
This document presents the case of a 21-year-old female admitted for abdominal pain. She has a history of smoking and is diagnosed with pelvic inflammatory disease (PID) based on symptoms of abdominal pain and vaginal discharge. She is treated with antibiotics and blood transfusions and shows improvement. The document also discusses PID, its causes, symptoms, diagnosis and treatment guidelines. It profiles the patient's family and their economic situation.
The document discusses prenatal care, including its importance, definition, objectives, components, and regular visit schedule. The key aspects of prenatal care covered are thorough history taking and physical examination at the first visit, routine tests, assessment of fetal growth and well-being, and advice regarding nutrition, lifestyle, and follow-up visits.
The document describes a case of a 48-year-old Thai woman who presented with abnormal uterine bleeding, anemia, and an abdominal mass found to be multiple uterine fibroids. She underwent a total abdominal hysterectomy with bilateral salpingooophorectomy to treat the fibroids, and her postoperative recovery was uneventful.
This document discusses first trimester ultrasound. It covers confirming intrauterine pregnancy, evaluating growth and complications, and diagnosing ectopic pregnancy and other issues. Problems of early pregnancy like miscarriage, ectopic pregnancy, and gestational trophoblastic disease are described. Miscarriage types like threatened, missed, incomplete and complete abortion are defined. Ectopic pregnancy ultrasound findings and molar pregnancy features are outlined. Ovarian cysts and pregnancies associated with IUCDs are also mentioned.
The document discusses the assessment of maternal and fetal well-being during pregnancy. Maternal assessment includes taking history, general and obstetrical examination, and radiological tests. Fetal assessment includes clinical maneuvers, biophysical tests like fetal movement count and non-stress test, biophysical profile, cardiotocography, and ultrasound. Both maternal and fetal assessments are important to monitor the health and development of the mother and fetus during pregnancy.
This document presents the case of a 26-year-old female, G3P2, who presented with vaginal bleeding. On examination, her cervical os was open and placental tissues were observed. She reported a 3-day history of bleeding. Based on her uterine size and exam findings, she was diagnosed with incomplete abortion at 12 weeks 3 days gestation. She underwent curettage under general anesthesia to complete the abortion procedure. Her bleeding was stabilized with medications and blood transfusion.
Case presentation post caesarean pregnancyymadhu326
A 28-year-old woman, G3P1L1A1 with 9 months of amenorrhea, presented with complaints of abdominal pain for 2 hours. She had a previous cesarean section delivery. On examination, her uterus was enlarged corresponding to 36 weeks gestation with a single live fetus in cephalic presentation. She was diagnosed with 36 weeks gestation with 1 previous cesarean section and scar tenderness. An emergency cesarean section was performed under spinal anesthesia and a live preterm male baby was delivered. The postoperative period was uneventful.
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share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
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8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Mercurius is named after the roman god mercurius, the god of trade and science. The planet mercurius is named after the same god. Mercurius is sometimes called hydrargyrum, means ‘watery silver’. Its shine and colour are very similar to silver, but mercury is a fluid at room temperatures. The name quick silver is a translation of hydrargyrum, where the word quick describes its tendency to scatter away in all directions.
The droplets have a tendency to conglomerate to one big mass, but on being shaken they fall apart into countless little droplets again. It is used to ignite explosives, like mercury fulminate, the explosive character is one of its general themes.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
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4. CHIEF
COMPLAINT
Vaginal
Spotting
LMP: September (2nd wk), 2011
5days X 2-3 pads/day
PMP: August 2011
4-5 days X 2-3 pads/day
5. HISTORY OF PRESENT
ILLNESS
+Irregular, tolerable uterine In the Morning + Tolerable uterine
contractions, +persistent uterine contraction
contraction -Vaginal spotting
+ associated with fetal -no other associated +Routine PNCU
movement symptoms IE= 1cm dilatation
-Vaginal discharges + Routine PNCU
IE=1cm dilatation
(-)signs & symptoms
+Advised admission -admission for
x3 days scheduled CS
-Consultation Metronidazole 500mg/tab
BID
Nifedipines 5mg/tab QID
Duvadilan Tab TID
6. Work up
Admitting Impression: PU 35 2/7 wks AOG, CILP, G2P1 (1001)
A
B
C
ABDOMEN: L1Breech L2Right L3Cephalic
FH: 33cm EFW: 3.03kg FHT: 145-150bpm
Cephalic presentation
INTERAL EXAMINATION:
External Genitalia: Grossly normal Cervix: Length: 3 cm
Vagina: (+) thick whitish vaginal discharge Dilatation: 1 cm
Effacement: Closed %
Posterior
IBOW
Station -3
LABORATORIES: CBC, PC; UA; Gram Stain of Vaginal discharge; BPS
FINAL DIAGNOSIS: PU 35-36 wks AOG, IPTL-Controlled, G2P1 (1001)
Previous CS (Uterine Didelphys)
Bacterial Vaginosis
Fig.1 A) Ultrasound image B) Biophysical Score C) Ultrasound Report
7. ᵜBajada, Davao City
ᵜMarried with 1daughter
ᵜNon-smokers
ᵜEmployed:Certified Public Accountant
ᵜAbove minimum
ᵜNon-smoker
ᵜNon-alcoholic beverage drinker
ᵜNo food preference or special diet regimen.
8. [ + ] HPN (Father – unknown maintenance med)
INTERNAL
[ + ] DM (Father – unknown maintenance med)
[ - ] Heart Diseases
[ - ] Asthma
[ - ] No similar illness to that of the px
9. Medical
(-) HPN (+) Allergies
(-) DM + Meds: NSAIDS
(-) Asthma - Foods
Denies previous hospitalization
Surgical Denies previous surgical operation
Psychiatric No psychiatric history
10. Family Size : 4
Menarche : 18 yo
Coitarche: 21yrs old X 1 sexual partner
OCP: (-) usage
Menstrual cycle: 28-35days X 5days X 3soaking pads/day
OB-Score
Pregnancy Pregnancy Gestation Present
Year Sex Birthweight Complications
Order Outcome Completed Status
G1 LSTCS 2011 FT F 2.85kg Healthy none
G2 -present pregnancy-
11. Present Pregnancy
LMP: September 13, 2011 X 5days X 2-3soaking pads/day
DATE OF QUICKENING : December, 2011 (~3mons AOG)
EDD: June 20, 2012
AOG: 37 6/7 weeks
ULTRASOUND : >5x (1st: October, 2011; ~8weeks AOG)
(last: May 18, 2012; ~35 3/7wks AOG)
PRENATAL VISIT: >x5
HEALTHCARE PROVIDER: OB-Gynecologist
IMMUNIZATION: OCP: (-) Tetanus (-) Hep B (-) others
Total Weight Gain: 65 -52 = 13klg BP: 120/80mmHg
Hgb: 119 g/dL Urine Lab: Normal
Sugar: Normal
12. REVIEW OF
SYSTEM
(-) MB (-) IUGR (+) Premature Labor
(-) Infection LG Tract (-) Infertitlity 12days PTA
(-) HPN (+) Uterine contraction (+) Genitourinary
(-) Cardiac x 1mon 12days PTA
(-) Renal (+) UTI Bacterial Vaginosis
(-) DM/Metabolic 3mons AOG (+) Previous CS
(-) Respiratory Cefalexin 500mg/cap 2011
(-) Fetal wastage 1cap TID x 7days(+)
13. PHYSICAL EXAM
General:
Patient came in per wheelchair.
The patient was examined in lying position.
She was awake, well-groomed, cooperative and
not in respiratory distress
BMI was 21.6, weighing 52kg and 5’1
standing
15. AS, PPC,
-CLAD
[-] Remarkable lesion AP, -murmur
ECE, Resonant, CBS
-Gross deformities
Full range of Motion
No Neurologic deficit
16. PHYSICALAbdomen
EXAM
Abdomen
I : Globular,
[+] Striae gravidarum
[+] Previous CS scar
A: Normal active bowel sound
P: Tympanitic all over
17. PHYSICALAbdomen
EXAM
Abdomen
P : LEOPOLD’s MANUEVER 29 cm
L1= Breech
L2= Right
L3= Cephalic
FH= 29cm
EFW = 2.47klg
FHT= 130-140bpm
18. PHYSICAL EXAM
Internal Examination
Internal Examination
Grossly Normal PELVIMETRY?
(I) : Admits 2 fingers with ease
(C): 1-2cm dilatation
Beginning effacement
Intact bag of water
Station -3
(U) : Enlarged to 8-9 months AOG
(A) : Non-palpable
(D) : No vaginal discharges
19. SALIENT
FEATURES
*29 G P (1001)
2 1
*Vaginal spotting
*Amenorrhea
*Hx of Preterm Labor
PE:
*Gravid abdomen
GenitoUrinary & IE
20. ADMITTING
IMPRESSION
G2P1 (1001),Pregnancy Uterine 37 6/7 weeks Age of
Gestation, Breech in latent phase of Labor
S/P CS (Non-Reassuring Fetal Heart Rate Pattern)
21. Course in the WARD
Course in the WARD
On admission
Please admit
NPO post midnight
Monitor VS q4o
Monitor FHT & POL q4o and record
Schedule for repeat CS tomorrow at 8AM
Baseline EFM
LABS: CBC, PC BT
UA
IVF: D5LR 1L at 120cc/hr
Med: Cefazolin 1grm IVTT (-)ANST
Ranitidine 50grm/amp, 1amp IVTT 1hr Prior to OR
Metoclopramide 10grm/amp, 1amp IVTT
22. Course in the WARD
Course in the WARD
SURGERY: May 28 (1st HD)
VS: 110/70mmHg 36.2oC
78bmp 19cpm
Blood loss: <1000cc
Preoperative Diagnosis:
G2P1 (1001),Pregnancy Uterine 37 6/7 weeks Age of Gestation, Breech in latent
phase of Labor
S/P CS for NRFHRP
Operation Done
10 LSTCS (Right Hemi-Uterus) secondary to Franck breech presentation
23. Course in the WARD
Course in the WARD
Basilio, 2012
Figure 2 . Didelphic uterus after fetal delivery.
24. Course in the WARD
Course in the WARD
1st PostOP
S/O > + minimal vaginal bleeding P>
+ well contracted uterus
+ adequate urine output
+ stable VS
+ Flattus
2nd POSTOP, 19HD
S/O > + minimal vaginal bleeding P>
+ well contracted uterus
+ adequate urine output
+ stable VS
+ Flattus
25. FINAL
1) G P (2002), PUFT DIAGNOSISby 1 LSTCS (Right
2 2 Franck Breech presentation, delivered 0
Hemi-Uterus) to a live birth Baby boy with AS 9,10; BS 38wks; BW 2.85; BL
51cm
2) S/P Cesarean Section (Left Hemi Uterus) secondary to NRFHRP
3) Uterine didelphys
4) Paratubal cyst, Right
35. Columbo reported the first documented
300 case
BC
Strassman 0.1 -3.5 %
et al
1961
Grimbizi
4.3 %
2001
2003-11-3 35
36.
37.
38. Class III- Uterine Didelphys
• Midline fusion of the müllerian ducts is arrested,
• ~
5% of mullerian duct anomalies ( )
• ~11% are didelphys uterus ( )
• Characterized by 2 hemiuteri, 2 endocervical canals
with cervices fused at the lower uterine segment.
40. Reported Association with Other Anomalies
• ~20% Renal agenesis most commonly ( )
• Obstructed unilateral vagina (Wunderlich-Herlyn-
Werner syndrome) ( )
• Bladder exstrophy with or without vaginal hypoplasia
• Congenital vesicovaginal fistula with hypoplastic
kidney ( )
• Cervical agenesis ( )
• Malignancies ( )
41. Reported Association with Other Anomalies
• According to Zhang et al. 2010
Infertility treatment & reproductive performance is poor
• Study of
59 (68.6%) live births
21 (24.4%) preterm deliveries
18 (20.9%) spontaneous abortions
2 (2.3%) ectopics,
42. Diagnosis of Uterine Didelphys
• The most frequent complaint ( ).
Failure of tampons to obstruct menstrual flow. T
Initial pelvic examination
Second-trimester spontaneous abortion
43. Figure 1: Speculum examination reveals a double vagina with two cervices
(the right cervix is partly visible) Bhattacharya et al. 2011
44. Diagnosis of Uterine Didelphys
• Hemivaginal obstruction:
Onset of dysmenorrhea ( )
Progressive pelvic pain ( )
Unilateral pelvic mass ( )
Marked rectal pain and constipation ( )
45. Diagnostic Modalities
3) Ultrasound
2) MRI
1) HSG
4) IVP
Fig Uterus didelphysTransverse fast spin-echo T2-weighted MR images show complete
Fig Fig Uterus didelphys in Ultrasound of two separate degree ofwith opacification of two
.HSG of uterine horns (short arrows),
duplication images show catheterization with partial cervices fusion of adjacent
cervices (longdivergent noncommunicating endometrial cavities (arrow).
widely arrows).
46. Surgical Procedures
•obstructed unilateral vagina Full excision and
marsupialization of the vaginal septum ( )
•Hemihysterectomy with or without salpingo-
oophorectomy ( )
•Strassmann metroplasty ( )
47. PostOperative Management
Vaginal adenosis is a risk after the septum is
removed. Definitive guidelines that monitor
for this condition have not been established,
though some experts recommend serial pap
smears and colposcopy.
50. D-SURGICAL MEASURES
• Musich JR, Behrman SJ. Obsteric outcome before and after
metroplasty in women with uterine anomalies. Obstet
Gynecol.1978;52:63.
• Management and outcome of patients with combined vaginal septum, bifid
uterus, and ipsilateral renal agenesis (Herlyn-Werner-Wunderlich syndrome).
Gholoum S, Puligandla PS, Hui T, Su W, Quiros E, Laberge JM. J Pediatr Surg. 2006
May;41(5):987-92.
• Heinohen PK, Saarikoski S, Pystynen P. Reproductive performance of women with
uterine anomalies. Acta Obstet gynecol Scand 1982;61:157.
Editor's Notes
3weeks PTA + UC X 20-30 sec x moderate
The uterus is a hollow, thick-walled, muscular organ situated deeply in the pelvic cavity between the bladder and rectum. Into its upper part the uterine tubes open, one on either side, while below, its cavity communicates with that of the vagina. When the ova are discharged from the ovaries they are carried to the uterine cavity through the uterine tubes The uterus measures about 7.5 cm. in length, 5 cm. in breadth, at its upper part, and nearly 2.5 cm. in thickness; it weighs from 30 to 40 gm. The fundus ( fundus uteri ) is convex in all directions, and covered by peritoneum continuous with that on the vesical and intestinal surfaces
Body ( corpus uteri ). —The body gradually narrows from the fundus to the isthmus. The vesical or anterior surface ( facies vesicalis ) is flattened and covered by peritoneum, which is reflected on to the bladder to form the vesicouterine excavation. The surface lies in apposition with the bladder. The intestinal or posterior surface ( facies intestinalis ) is convex transversely and is covered by peritoneum, which is continued down on to the cervix and vagina. It is in relation with the sigmoid colon, from which it is usually separated by some coils of small intestine. The lateral margins ( margo lateralis ) are slightly convex. At the upper end of each the uterine tube pierces the uterine wall. Below and in front of this point the round ligament of the uterus is fixed, while behind it is the attachment of the ligament of the ovary
Ligaments. —The ligaments of the uterus are eight in number: one anterior; one posterior; two lateral or broad; two uterosacral; and two round ligaments. The anterior ligament consists of the vesicouterine fold of peritoneum, which is reflected on to the bladder from the front of the uterus, at the junction of the cervix and body. The posterior ligament consists of the rectovaginal fold of peritoneum, which is reflected from the back of the posterior fornix of the vagina on to the front of the rectum. It forms the bottom of a deep pouch called the rectouterine excavation, which is bounded in front by the posterior wall of the uterus, the supravaginal cervix, and the posterior fornix of the vagina; behind, by the rectum; and laterally by two crescentic folds of peritoneum which pass backward from the cervix uteri on either side of the rectum to the posterior wall of the pelvis. These folds are named the sacrogenital or rectouterine folds. They contain a considerable amount of fibrous tissue and non-striped muscular fibers which are attached to the front of the sacrum and constitute the uterosacral ligaments. The two lateral or broad ligaments ( ligamentum latum uteri ) pass from the sides of the uterus to the lateral walls of the pelvis. Together with the uterus they form a septum across the female pelvis, dividing that cavity into two portions. In the anterior part is contained the bladder; in the posterior part the rectum, and in certain conditions some coils of the small intestine and a part of the sigmoid colon. Between the two layers of each broad ligament are contained: (1) the uterine tube superiorly; (2) the round ligament of the uterus; (3) the ovary and its ligament; (4) the epoöphoron and paroöphoron; (5) connective tissue; (6) unstriped muscular fibers; and (7) bloodvessels and nerves. T The portion of the broad ligament which stretches from the uterine tube to the level of the ovary is known by the name of the mesosalpinx. Between the fimbriated extremity of the tube and the lower attachment of the broad ligament is a concave rounded margin, called the infundibulopelvic ligament. 21 The round ligaments ( ligamentum teres uteri ) are two flattened bands between 10 and 12 cm. in length, situated between the layers of the broad ligament in front of and below the uterine tubes. Commencing on either side at the lateral angle of the uterus, this ligament is directed forward, upward, and lateralward over the external iliac vessels. It then passes through the abdominal inguinal ring and along the inguinal canal to the labium majus, in which it becomes lost. The round ligaments consists principally of muscular tissue, prolonged from the uterus; also of some fibrous and areolar tissue, besides bloodvessels, lymphatics; and nerves, enclosed in a duplicature of peritoneum, which, in the fetus, is prolonged in the form of a tubular process for a short distance into the inguinal canal. This process is called the canal of Nuck. It is generally obliterated in the adult, but sometimes remains pervious even in advanced life. It is analogous to the saccus vaginalis, which precedes the descent of the testis. 22 In addition to the ligaments just described, there is a band named the ligamentum transversalis colli (Mackenrodt) on either side of the cervix uteri. It is attached to the side of the cervix uteri and to the vault and lateral fornix of the vagina, and is continuous externally with the fibrous tissue which surrounds the pelvic bloodvessels.
Vessels and Nerves. —The arteries of the uterus are the uterine, from the hypogastric; and the ovarian, from the abdominal aorta They are remarkable for their tortuous course in the substance of the organ, and for their frequent anastomoses. The termination of the ovarian artery meets that of the uterine artery, and forms an anastomotic trunk from which branches are given off to supply the uterus, their disposition being circular. The veins are of large size, and correspond with the arteries. They end in the uterine plexuses. In the impregnated uterus the arteries carry the blood to, and the veins convey it away from, the intervillous space of the placenta (see page 63). The lymphatics are described on page 714. The nerves are derived from the hypogastric and ovarian plexuses, and from the third and fourth sacral nerves. 39
Embryology In a female foetus, the uterus starts out as two small tubes - the mullerian ducts. As the development occurs, the tubes normally join to create one larger, hollow organ — the uterus
References regarding the existence of müllerian defects date back to antiquity, around 300 BC. Columbo reported the first documented case of vaginal agenesis (uterus and vagina) in the 16th century. Steinmetz GP. Formation of artificial vagina. West J Surg . 1940;48:169-3. Our knowledge of their epidemiology has not paralleled the technical advances involved in their diagnoses and treatment Studies of Strassman et al 19611: showed ncidence rates vary widely and depend on the study. Most authors report incidences of 0.1-3.5%.In 2001, Grimbizis and colleagues reported that the mean incidence of uterine malformations was 4.3% for the general population and/or for fertile women
References regarding the existence of müllerian defects date back to antiquity, around 300 BC. Columbo reported the first documented case of vaginal agenesis (uterus and vagina) in the 16th century. Steinmetz GP. Formation of artificial vagina. West J Surg . 1940;48:169-3. Our knowledge of their epidemiology has not paralleled the technical advances involved in their diagnoses and treatment Studies of Strassman et al 19611: showed I ncidence rates vary widely and depend on the study. Most authors report incidences of 0.1-3.5%.In 2001, Grimbizis and colleagues reported that the mean incidence of uterine malformations was 4.3% for the general population and/or for fertile women
Didelphys uterus arises when midline fusion of the müllerian ducts is arrested, either completely or incompletely. Approximately 11% of uterine malformations are didelphys uterus. [ which constitutes approximately 5% of müllerian duct anomalies, is the result of nearly complete failure of fusion of the müllerian ducts.
Each müllerian duct develops its own hemiuterus and cervix and demonstrates normal zonal anatomy with a minor degree of fusion at the level of the cervices. No communication is present between the duplicated endometrial cavities. A longitudinal vaginal septum is associated in 75% of these anomalies (71) Each hemiuteri is associated with one fallopian tube. Ovarian malposition may also be present. [126] The vagina may be single or double, with duplication a frequent component. The double vagina manifests as a longitudinal (horizontal) septum that extends either completely (complete septum) or partially (partial septum) from the cervices to the introitus. A complete longitudinal vaginal septum occurs in 75% of these anomalies, although vaginal septa can also coexist with other müllerian duct anomalies. [83, 108, 113] In some cases obstruction can be due to transverse vaginal septa.
The low incidence of uterine didelphys is reflected in the literature by the paucity of data regarding reproductive performance. Compiled data from 2 studies that included didelphys uterus anomaly revealed the following outcomes for 86 pregnancies: 21 (24.4%) preterm deliveries; 59 (68.6%) live births; 2 (2.3%) ectopics, and 18 (20.9%) spontaneous abortions. [111] The poor reproductive outcomes are thought to be due to diminished uterine volumes and decreased perfusion of each hemiuteri
Nonobstructive uterus didelphys is usually asymptomatic until menarche. The most frequent complaint is failure of tampons to obstruct menstrual flow. The diagnosis is often rendered during the initial pelvic examination, when 2 cervices are identified. A history of second-trimester spontaneous abortion is often a clue to this condition.
In hemivaginal obstruction, the clinical presentations are variable and depend on the degree of obstruction and whether the obstruction has an opening. The most common presenting symptoms are onset of dysmenorrhea within the first years following menarche and progressive pelvic pain. A unilateral pelvic mass is detected on examination with the right affected nearly twice as frequently as the left. Presenting symptoms of marked rectal pain and constipation, secondary to hematocolpos impingement, have been reported in 1 case. [131]
Diagnostic modalities are similar to those used for unicornuate uterus. Workup should include 1)HSG Uterus didelphys. HSG demonstrates two separate endocervical canals that open into separate fusiform endometrial cavities, with no communication between the two horns. Each endometrial cavity ends in a solitary fallopian tube. However, if the anomaly is associated with an obstructed longitudinal vaginal septum, only one cervical os may be depicted, and it may be cannulated with the endometrial configuration mimicking a unicornuate uterus HSG images show catheterization of two separate cervices with opacification of two widely divergent noncommunicating endometrial cavities (arrow). 2) MRI, MR imaging demonstrates two separate uteri with widely divergent apices, two separate cervices, and usually an upper vaginal longitudinal septum. In each uterus, the endometrial-to-myometrial width and ratio are preserved, as is normal uterine zonal anatomy (34,35,42). An obstructed unilateral vaginal septum may cause apparent marked deformity of the uterus according to the degree of associated hematometrocolpos IVP to confirm or exclude associated urinary tract anomalies. MRI reveals 2 widely separated uterine horns, and 2 cervices are typically identified. The intercornual angle is >60°. The zonal anatomy is preserved within each hemiuterus. [117, 118] A TVS is usually observed. [73] Obstructions are represented by variable dilation of the vaginal component and diminished endometrial dilation. [147] Ultrasonography may be a valuable adjunct. [148, 149, 45, 71]
Surgical techniques Uterine didelphys with obstructed unilateral vagina Full excision and marsupialization of the vaginal septum is the preferred approach and is performed as a single procedure. After the septum has been excised, laparoscopy can be performed for potential treatment of associated endometriosis, adhesions, or both. [151] Excision of an obstructed vaginal septum during pregnancy requires leaving a generous pedicle to help minimize potential bleeding should the vaginal mucosa retract. [108] Hemihysterectomy with or without salpingo-oophorectomy is rarely indicated and should be avoided to provide the best opportunity for a successful reproductive outcome. Uterus didelphys, nonobstructed As previously stated, indications for septum resection in the nonobstructed didelphys uterus are limited. These patients are not candidates for surgical unification. Fortunately, few fertility-associated problems occur in this group. If the woman carries a pregnancy to term, obstetric complications are usually minimal. The decision to perform metroplasty should be individualized, and only selected patients may benefit from surgical reconstruction. Most reports of metroplasty in this setting are anecdotal and the apparent benefits of surgery are not clear. This stated, the recommended procedure is the Strassmann metroplasty. [5] This method unifies the uterine cavities at the fundus, while the cervices are left intact. This procedure is detailed further in Surgical techniques for bicornuate uterus below.