POP.pptx
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Pelvic organ prolapse Pelvic Organ Prolapse Most common gynaecological problem. Amongst parous women. A form of hernia. Anatomy of Uterus Anteversion and anteflexion position. Lies between rectum and bladder. Cervix pierces the vagina at the right angle to the axis of vagina. Supports of Uterus Uterus is held in position by 3 tier support system. Upper tier Middle tier Inferior tier. Upper tier Primarily, maintains the uterus in anteverted position. The structures responsible are: Endopelvic fascia. Round ligaments. Broad ligaments. Middle tier Constitutes the strongest support of uterus. Responsible structures are: Pericervical ring. Pelvic cellular tissues. Inferior tier Indirect support of uterus. Responsible structures are pelvic floor muscles including: Levator ani Endopelvic fascia Levator plate Perineal body Urogenital diaphragm Anatomical Factors Gravitational stress. Parturition stress. Pelvic floor weakness. Inherent weakness of supporting structures. Acquired Predisposing Factors Trauma of vaginal delivery causing injury : Ligaments Endopelvic fascia Levator muscle Perineal body Pudendal nerve and muscle damage due to repeated child birth. Congenital Predisposing Factors Inborn weakness of supporting structure. Aggravating factors Post menopausal atrophy Poor collagen tissue repair with age. Increased intra abdominal pressure. Occupational hazards Asthenia Obesity Fibroid/Polyp Clinical Degrees Of Uterine Prolapse Symptoms Feeling of something coming out per vaginum. Backache or dragging pain in pelvis Dyspareunia Urinary symptoms Bowel symptoms Clinical examination Inspection and palpation. General examination. Pelvic examination Uterine prolapse Management of Prolapse Preventive Conservative Surgery Preventive Measures Pelvic floor exercise during puerperium. Avoid strenuous activities. Avoiding prolonged cough. Avoiding constipation. Avoiding heavy weight lifting. Avoiding future pregnancy too early. Conservative Management Indications : Asymptomatic women Mild degree prolapse POP in early pregnancy Treatment : Oestrogen replacement therapy. Kegel exercise Pessary treatment Surgical Management of Prolapse Restorative Extirpative Obliterative
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ENDOMETRITIS
Explains the inflammatory process of endometrium,its causes and its two clinical variants as acute and chronic endometritis.
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Antepartum haemorhage
Antepartum haemorrhage (APH) refers to bleeding from the vagina during pregnancy after 24 weeks of gestation until delivery. The main causes of APH are placental abnormalities like placenta previa or abruption, as well as genital tract infections or trauma. Management involves resuscitation, monitoring for fetal distress, and delivery depending on the severity of bleeding and gestational age. Outcomes can be poor if APH is severe or left untreated, with risks of maternal and fetal death.
Obstetric fistulae
An obstetric fistula is an abnormal connection between the vagina and bladder or rectum, usually caused by prolonged labor without prompt medical care. Symptoms include constant urinary or fecal incontinence. Management involves initial catheterization followed by surgical repair once tissues have healed, usually 3 months later. Surgical techniques depend on the location and complexity of the fistula. Post-operative care focuses on drainage and preventing infection to allow healing.
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INVERSION OF THE UTERUS .pptx
inversion of uterus- Complication of third stage labor
Introduction
It is an extremely rare but a life threatening complication in third stage in which the uterus is turned inside out partially or completely.
The incidence is about 1 in 20,000 deliveries.
The obstetric inversion is almost always an acute one and usually complete.
Types or degrees
First degree
There is dimpling of the fundus which still remains above the level of internal os.
Second degree
The fundus passes through the cervix but lies inside the vagina.
Third degree (complete)
The endometrium with or without the attached placenta is visible outside the vulva. The cervix and part of the vagina may also be involved in the process
Etiology
First degree
There is dimpling of the fundus which still remains above the level of internal os.
Second degree
The fundus passes through the cervix but lies inside the vagina.
Third degree (complete)
The endometrium with or without the attached placenta is visible outside the vulva. The cervix and part of the vagina may also be involved in the process
Risk factors
Uterine over enlargement
Prolonged labour
Fetal macrosomia
Uterine malformations
Morbid adherent placenta
Short umbilical cord
Pathogenesis
The underlying pathophysiologic mechanism is unknown
It has been attributed to use of
excessive cord traction and
fundal pressure
atonic uterus
fundal implantation of the placenta
Clinical features
Diagnosis
Management
Complications
Adenomyosis
This power point describes in nut shell hte definition, etiopathogenesis, clinical features, gross , histological and MRI findings in adenomyosis and its management
Ectopic pregnancy
This document discusses ectopic pregnancy, which occurs when a fertilized egg implants outside the uterus, usually in a fallopian tube. It presents risks to a woman's health. Ectopic pregnancies are often caused by factors that delay the transit of the fertilized egg through the fallopian tubes. Diagnosis can be made through a combination of clinical history, examination, and investigations like ultrasound and blood tests. Early diagnosis through increased awareness and diagnostic tests has lowered the risks associated with ectopic pregnancies.
Investigations in gynaecology
This document provides an overview of common investigations in gynecology, including blood tests, urine analysis, cervical and vaginal discharge collection and examination, exfoliative cytology (Pap smear), colposcopy, culdocentesis, hormonal assays, and imaging techniques. The key points covered include how various samples are collected, what they are tested for, and what normal and abnormal results may indicate.
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Explains the inflammatory process of endometrium,its causes and its two clinical variants as acute and chronic endometritis.
Describes the pathology of its two types with histologic perspective.
Antepartum haemorhage
Antepartum haemorrhage (APH) refers to bleeding from the vagina during pregnancy after 24 weeks of gestation until delivery. The main causes of APH are placental abnormalities like placenta previa or abruption, as well as genital tract infections or trauma. Management involves resuscitation, monitoring for fetal distress, and delivery depending on the severity of bleeding and gestational age. Outcomes can be poor if APH is severe or left untreated, with risks of maternal and fetal death.
Obstetric fistulae
An obstetric fistula is an abnormal connection between the vagina and bladder or rectum, usually caused by prolonged labor without prompt medical care. Symptoms include constant urinary or fecal incontinence. Management involves initial catheterization followed by surgical repair once tissues have healed, usually 3 months later. Surgical techniques depend on the location and complexity of the fistula. Post-operative care focuses on drainage and preventing infection to allow healing.
adenomyosis
The document discusses adenomyosis, a benign condition where endometrial tissue grows within the uterine wall. It defines adenomyosis and describes associated symptoms like pelvic pain and abnormal bleeding. Diagnosis can only be confirmed by pathology after hysterectomy, though other imaging methods like ultrasound and MRI can provide clues. TVUS shows heterogeneous myometrial texture while MRI may detect increased thickness or consistency changes in the myometrium.
INVERSION OF THE UTERUS .pptx
inversion of uterus- Complication of third stage labor
Introduction
It is an extremely rare but a life threatening complication in third stage in which the uterus is turned inside out partially or completely.
The incidence is about 1 in 20,000 deliveries.
The obstetric inversion is almost always an acute one and usually complete.
Types or degrees
First degree
There is dimpling of the fundus which still remains above the level of internal os.
Second degree
The fundus passes through the cervix but lies inside the vagina.
Third degree (complete)
The endometrium with or without the attached placenta is visible outside the vulva. The cervix and part of the vagina may also be involved in the process
Etiology
First degree
There is dimpling of the fundus which still remains above the level of internal os.
Second degree
The fundus passes through the cervix but lies inside the vagina.
Third degree (complete)
The endometrium with or without the attached placenta is visible outside the vulva. The cervix and part of the vagina may also be involved in the process
Risk factors
Uterine over enlargement
Prolonged labour
Fetal macrosomia
Uterine malformations
Morbid adherent placenta
Short umbilical cord
Pathogenesis
The underlying pathophysiologic mechanism is unknown
It has been attributed to use of
excessive cord traction and
fundal pressure
atonic uterus
fundal implantation of the placenta
Clinical features
Diagnosis
Management
Complications
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This power point describes in nut shell hte definition, etiopathogenesis, clinical features, gross , histological and MRI findings in adenomyosis and its management
Ectopic pregnancy
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This document discusses endometriosis, which is a condition where cells similar to the endometrium grow outside the uterus, most often on the ovaries and surrounding tissues. It affects 6-10% of women and can cause pain, infertility, and other issues. The cause is unknown but theories include retrograde menstruation and genetic factors. Diagnosis involves a medical history, physical exam, ultrasound, and laparoscopy. Treatment options include pain medications, hormonal therapy to suppress menstruation, and surgery to remove lesions and restore anatomy. Left untreated, it can progress in severity over time.
Female genital fistula
This document discusses genitourinary and rectovaginal fistulas. It defines fistulas as abnormal communications between organs and classifies them by number, level, and complexity. Diagnosis involves patient history, symptoms of incontinence or infection, and tests like methylene blue dye. Treatment depends on the fistula type and may involve vaginal or abdominal surgical approaches and flap splitting, sacculation, or grafting to repair the abnormal connection. Postoperative care focuses on rest, fluids, antibiotics, and local wound management.
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Abnormal labor or dystocia can be caused by problems with uterine contractions (uterine dysfunction), issues with the baby's size or position (fetopelvic disproportion), or a narrow pelvis (contracted pelvis). Common types include protracted or arrested dilation, shoulder dystocia, and breech presentation. Obstructed labor occurs when progress stalls despite adequate contractions, typically due to a mechanical obstruction, and can lead to serious maternal complications if not addressed. Management may involve resuscitation, expedited delivery depending on fetal/maternal status, and transfer to a higher level facility for those in advanced labor.
Imperforate Hymen
The hymen is a membrane partially covering the external vaginal opening. Its elasticity and condition can vary depending on factors like sexual intercourse, disease, injury, or exercise. An imperforate hymen is a congenital condition where the hymen completely obstructs the vagina without an opening. It occurs in around 1 in 1000 births and is usually diagnosed when menstrual blood accumulates in adolescent girls. Surgical incision of the hymen is required to treat an imperforate hymen and relieve symptoms like pelvic pain and menstrual retention. Complications can include infections if not treated.
Obstetric fistula
Obstetric fistula is an abnormal connection between the vagina and bladder or rectum caused by prolonged obstructed labor without timely medical intervention. Nigeria accounts for 40% of global fistula cases with around 20,000 new cases annually. Risk factors include poverty, early marriage, and lack of access to emergency obstetric care. Clinical presentation includes urinary or fecal incontinence. Treatment involves surgical repair once inflammation subsides, while prevention focuses on girl child education, empowerment, antenatal care, and emergency obstetric services.
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Bartholian cyst
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Endometritis
This document discusses endometritis, including acute, chronic, and atrophic types. Acute endometritis usually occurs after abortion or childbirth and is caused by various bacteria. Chronic endometritis results from a persistent infection in the uterine cavity caused by things like IUDs or retained products. Atrophic endometritis occurs in postmenopausal women due to loss of estrogen protection. Clinical features include vaginal discharge and abdominal or pelvic pain. Diagnosis involves tests like cervical smears, ultrasounds, and endometrial biopsies. Treatment involves removing the infection source and using antibiotics.
Inversion Of Uterus
Uterine inversion occurs when the uterus turns inside out, most commonly during the third stage of labor due to excessive traction on the umbilical cord or fundal pressure. It can be incomplete, with just the fundus inverted, or complete, with the entire uterus emerging from the vagina or outside the body. Symptoms include hemorrhage, abdominal pain, and shock. Treatment involves immediate manual repositioning of the uterus if diagnosed early, or the O'Sullivan hydrostatic method using saline if delayed. Prevention relies on avoiding excessive fundal pressure or cord traction during delivery of the placenta.
Shoulder dystocia
Shoulder dystocia occurs when the baby's shoulders become stuck after delivery of the head. It has a low incidence rate of 0.2-1% and risk factors include fetal macrosomia, obesity, diabetes and others. Diagnosis is made when normal maneuvers by the midwife fail to deliver the baby. Management involves calling for help, clearing the baby's airways, and performing maneuvers like McRoberts and Rubin's to rotate the shoulders and decrease their diameter in order to allow delivery. More invasive maneuvers like cleidotomy may be needed if these fail to deliver the anterior shoulder.
Pelvic organ prolapse
This document provides an overview of pelvic organ prolapse. It defines prolapse as the descent of pelvic organs, like the bladder, bowel or uterus, into the vagina due to weakness in their supporting structures. It discusses the epidemiology, relevant anatomy, risk factors, classification, clinical features and management. Conservative options include lifestyle changes, pelvic floor exercises and pessaries. Surgical management ranges from repairs to more radical procedures like hysterectomy, depending on the severity of prolapse and patient factors. The goal of treatment is to relieve symptoms and support the pelvic organs in their proper anatomical position.
Utero vaginal prolapse
Uterine prolapse was first documented in ancient Egypt. The first successful vaginal hysterectomy to treat uterine prolapse was self-performed in 1670. Pelvic organ prolapse has a lifetime risk of around 11% requiring surgery. The uterus is normally supported by the endopelvic fascia, ligaments, and pelvic floor muscles. Prolapse can involve the bladder, uterus, rectum, or vagina descending from their normal positions. Conservative treatment includes pessaries while surgical repair is also used to manage uterine prolapse.
Incisional hernia
1) Incisional hernias occur when the abdominal muscles and fascia separate, allowing organs or fatty tissue to protrude through weaknesses in the abdominal wall. They commonly form around surgical incision sites.
2) Risk factors include obesity, pregnancy, ascites, procedures that increase abdominal pressure, and surgical factors like wound infection or improper closure technique.
3) Clinical features include swelling, pain, and visible or palpable bulging that increases with straining. Diagnosis is usually made through physical exam.
4) Treatment involves repairing the defect through primary closure for small defects or use of prosthetic mesh for larger defects to reinforce the abdominal wall. Preventing postoperative complications and weight control can help
Asherman's syndrome
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Please find the power point on Utero-Vaginal Prolapse. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Medical Management of Fibroids
1. Ulipristal acetate is a selective progesterone receptor modulator approved for treatment of uterine fibroids. It binds to progesterone receptors and blocks their action, reducing fibroid size and symptoms without affecting estrogen levels.
2. Studies showed ulipristal acetate effectively controlled bleeding and reduced fibroid volumes more rapidly than leuprolide acetate. It maintained fertility without significant safety issues.
3. Long term treatment with ulipristal acetate provided sustained control of bleeding and pain, with shrinkage of fibroid volumes maintained during off treatment periods. Quality of life was improved.
Pelvic organ prolapse gynaecology ppt
genital prolapse uterine prolapse cystocele rectocele urethrocele anterior middle posterior compartments management sacroclopopexy ward mayos repair fothergills repair urogynaecology vaginal hysterectomy perineorrhaphy anterior colpopexy mesh repair khannas sling procedure pessaries
pelvic organ prolapse.pptx
This document discusses displacement of the uterus. It begins by defining version and flexion of the uterus. It then discusses genital prolapse, describing the three levels of support for the uterus. It outlines the clinical types of genital organ prolapse including anterior and posterior vaginal wall prolapse as well as vault prolapse. It discusses the etiology, symptoms, diagnostic approach, and treatment options which include pessary, physiotherapy, and various surgical procedures. Ayurvedic view on pathogenesis and treatment involving local application of ghrita, swedana, and bandaging is also summarized.
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Endometriosis
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Female genital fistula
This document discusses genitourinary and rectovaginal fistulas. It defines fistulas as abnormal communications between organs and classifies them by number, level, and complexity. Diagnosis involves patient history, symptoms of incontinence or infection, and tests like methylene blue dye. Treatment depends on the fistula type and may involve vaginal or abdominal surgical approaches and flap splitting, sacculation, or grafting to repair the abnormal connection. Postoperative care focuses on rest, fluids, antibiotics, and local wound management.
Abnormal labor
Abnormal labor or dystocia can be caused by problems with uterine contractions (uterine dysfunction), issues with the baby's size or position (fetopelvic disproportion), or a narrow pelvis (contracted pelvis). Common types include protracted or arrested dilation, shoulder dystocia, and breech presentation. Obstructed labor occurs when progress stalls despite adequate contractions, typically due to a mechanical obstruction, and can lead to serious maternal complications if not addressed. Management may involve resuscitation, expedited delivery depending on fetal/maternal status, and transfer to a higher level facility for those in advanced labor.
Imperforate Hymen
The hymen is a membrane partially covering the external vaginal opening. Its elasticity and condition can vary depending on factors like sexual intercourse, disease, injury, or exercise. An imperforate hymen is a congenital condition where the hymen completely obstructs the vagina without an opening. It occurs in around 1 in 1000 births and is usually diagnosed when menstrual blood accumulates in adolescent girls. Surgical incision of the hymen is required to treat an imperforate hymen and relieve symptoms like pelvic pain and menstrual retention. Complications can include infections if not treated.
Obstetric fistula
Obstetric fistula is an abnormal connection between the vagina and bladder or rectum caused by prolonged obstructed labor without timely medical intervention. Nigeria accounts for 40% of global fistula cases with around 20,000 new cases annually. Risk factors include poverty, early marriage, and lack of access to emergency obstetric care. Clinical presentation includes urinary or fecal incontinence. Treatment involves surgical repair once inflammation subsides, while prevention focuses on girl child education, empowerment, antenatal care, and emergency obstetric services.
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Bartholian cyst
A Bartholin's cyst is a fluid-filled sac within the Bartholin's gland of the vagina. Bartholin's cysts typically occur in nulliparous women of child-bearing age and other risk factors include a personal history of Bartholin's cyst, being sexually active, or a history of vulval surgery. Bartholin's cysts can cause vulvar pain, dyspareunia, and may rupture spontaneously, relieving pain. Treatment options include incision and drainage with placement of a Word catheter or marsupialization to prevent reaccumulation of fluid.
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Endometritis
This document discusses endometritis, including acute, chronic, and atrophic types. Acute endometritis usually occurs after abortion or childbirth and is caused by various bacteria. Chronic endometritis results from a persistent infection in the uterine cavity caused by things like IUDs or retained products. Atrophic endometritis occurs in postmenopausal women due to loss of estrogen protection. Clinical features include vaginal discharge and abdominal or pelvic pain. Diagnosis involves tests like cervical smears, ultrasounds, and endometrial biopsies. Treatment involves removing the infection source and using antibiotics.
Inversion Of Uterus
Uterine inversion occurs when the uterus turns inside out, most commonly during the third stage of labor due to excessive traction on the umbilical cord or fundal pressure. It can be incomplete, with just the fundus inverted, or complete, with the entire uterus emerging from the vagina or outside the body. Symptoms include hemorrhage, abdominal pain, and shock. Treatment involves immediate manual repositioning of the uterus if diagnosed early, or the O'Sullivan hydrostatic method using saline if delayed. Prevention relies on avoiding excessive fundal pressure or cord traction during delivery of the placenta.
Shoulder dystocia
Shoulder dystocia occurs when the baby's shoulders become stuck after delivery of the head. It has a low incidence rate of 0.2-1% and risk factors include fetal macrosomia, obesity, diabetes and others. Diagnosis is made when normal maneuvers by the midwife fail to deliver the baby. Management involves calling for help, clearing the baby's airways, and performing maneuvers like McRoberts and Rubin's to rotate the shoulders and decrease their diameter in order to allow delivery. More invasive maneuvers like cleidotomy may be needed if these fail to deliver the anterior shoulder.
Pelvic organ prolapse
This document provides an overview of pelvic organ prolapse. It defines prolapse as the descent of pelvic organs, like the bladder, bowel or uterus, into the vagina due to weakness in their supporting structures. It discusses the epidemiology, relevant anatomy, risk factors, classification, clinical features and management. Conservative options include lifestyle changes, pelvic floor exercises and pessaries. Surgical management ranges from repairs to more radical procedures like hysterectomy, depending on the severity of prolapse and patient factors. The goal of treatment is to relieve symptoms and support the pelvic organs in their proper anatomical position.
Utero vaginal prolapse
Uterine prolapse was first documented in ancient Egypt. The first successful vaginal hysterectomy to treat uterine prolapse was self-performed in 1670. Pelvic organ prolapse has a lifetime risk of around 11% requiring surgery. The uterus is normally supported by the endopelvic fascia, ligaments, and pelvic floor muscles. Prolapse can involve the bladder, uterus, rectum, or vagina descending from their normal positions. Conservative treatment includes pessaries while surgical repair is also used to manage uterine prolapse.
Incisional hernia
1) Incisional hernias occur when the abdominal muscles and fascia separate, allowing organs or fatty tissue to protrude through weaknesses in the abdominal wall. They commonly form around surgical incision sites.
2) Risk factors include obesity, pregnancy, ascites, procedures that increase abdominal pressure, and surgical factors like wound infection or improper closure technique.
3) Clinical features include swelling, pain, and visible or palpable bulging that increases with straining. Diagnosis is usually made through physical exam.
4) Treatment involves repairing the defect through primary closure for small defects or use of prosthetic mesh for larger defects to reinforce the abdominal wall. Preventing postoperative complications and weight control can help
Asherman's syndrome
Asherman's syndrome is a condition characterized by fibrosis and/or adhesions of the endometrium that can also involve the myometrium. It is most commonly caused by overzealous postpartum curettage. Clinical features include menstrual disturbances, infertility, recurrent pregnancy loss, and pregnancy complications. Diagnosis is made through hysterosalpingography or hysteroscopy. Treatment involves hysteroscopic lysis of adhesions followed by use of balloon catheters or IUDs to separate endometrial walls and exogenous estrogen to promote re-epithelialization.
Utero-Vaginal Prolapse by Sunil Kumar Daha
Please find the power point on Utero-Vaginal Prolapse. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Medical Management of Fibroids
1. Ulipristal acetate is a selective progesterone receptor modulator approved for treatment of uterine fibroids. It binds to progesterone receptors and blocks their action, reducing fibroid size and symptoms without affecting estrogen levels.
2. Studies showed ulipristal acetate effectively controlled bleeding and reduced fibroid volumes more rapidly than leuprolide acetate. It maintained fertility without significant safety issues.
3. Long term treatment with ulipristal acetate provided sustained control of bleeding and pain, with shrinkage of fibroid volumes maintained during off treatment periods. Quality of life was improved.
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pelvic organ prolapse.pptx
This document discusses displacement of the uterus. It begins by defining version and flexion of the uterus. It then discusses genital prolapse, describing the three levels of support for the uterus. It outlines the clinical types of genital organ prolapse including anterior and posterior vaginal wall prolapse as well as vault prolapse. It discusses the etiology, symptoms, diagnostic approach, and treatment options which include pessary, physiotherapy, and various surgical procedures. Ayurvedic view on pathogenesis and treatment involving local application of ghrita, swedana, and bandaging is also summarized.
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The document provides an overview of pelvic floor anatomy and pelvic organ prolapse. It discusses the structures that support the pelvic organs, including the levator ani muscles, endopelvic fascia, and pelvic ligaments. Common types of pelvic organ prolapse are described such as cystocele, rectocele, and uterine prolapse. The document outlines how these defects are evaluated based on their location and stage. Treatment options are also summarized, including pelvic floor muscle exercises, pessaries, and various surgical repair techniques aimed at reconstructing the pelvic floor.
Displacement of uterus
Uterine prolapse occurs when the uterus descends from its normal position in the pelvis due to weakening of the pelvic muscles and ligaments that support it. It is a common condition seen primarily in post-menopausal women with a history of one or more vaginal deliveries. Symptoms include a feeling of pressure or fullness in the pelvis, back pain, difficulty emptying the bladder or bowels fully, and the visible protrusion of the uterus from the vagina. Management involves pelvic floor exercises, pessary devices, and surgery depending on the severity of the prolapse. Surgery such as vaginal hysterectomy is often used to correct uterine prolapse.
Pelvic organ prolapse
Pelvic organ prolapse occurs when pelvic organs bulge into or protrude from the vagina. It is caused by weakness or damage to the muscles and ligaments that support the pelvis. Risk factors include vaginal childbirth, menopause, obesity, and connective tissue disorders. Symptoms include a bulge sensation, pressure, and urinary or bowel issues. Diagnosis involves examination of the vagina and pelvis. Treatment options include pelvic floor exercises, pessaries, and surgery to repair damaged tissues. Surgery is considered if conservative methods fail or for severe prolapse.
Uterovaginal prolapse by Dr zarkaish
A 58-year-old woman presents with pelvic heaviness and sensation of something protruding from her vagina that worsens with exertion. She sometimes feels and sees a bulge from her vagina and needs to push it back in to empty her bladder fully. The most likely diagnosis is pelvic organ prolapse. The doctor will examine her with a speculum while straining to determine the degree of prolapse. Conservative management with pelvic floor exercises and potentially a pessary will be recommended initially, with surgery as an option if symptoms persist or worsen.
Genital prolapse by daniel rawand
This document discusses genital prolapse, which is the descent of one or more genital organs through the pelvic floor. It describes the different types of prolapse including vaginal, uterine, and vault prolapse. Factors that can influence pelvic floor support like childbirth injury, age, and endocrine factors are examined. Symptoms and examination findings are outlined. Treatment options discussed include conservative measures like pessaries as well as various surgical repair techniques for the anterior vaginal wall, posterior vaginal wall, and uterus.
Genital prolapse
1. The document discusses pelvic organ prolapse, including the supporting ligaments, muscles, and fascia of the vagina. It describes different types of prolapse such as cystocele, rectocele, and uterine prolapse.
2. Risk factors for prolapse are discussed, including childbirth, increased abdominal pressure, and menopause. Symptoms vary depending on the type of prolapse but may include pressure, pain, urinary or bowel issues.
3. Treatment options are presented, ranging from pelvic floor exercises to pessaries to various surgical procedures to repair damaged tissues and support the pelvic organs.
Utero vaginal prolapse
This document discusses uterovaginal prolapse (UVP), including its anatomy, causes, symptoms, diagnosis, and treatment options. The main supports of the uterus and vagina are the cardinal and uterosacral ligaments. UVP is usually caused by weakening of these supports due to childbirth, menopause, or congenital factors. Common symptoms include a feeling of something coming out of the vagina and urinary or bowel issues. Treatment involves pelvic floor exercises, pessaries, or surgery depending on the severity of prolapse. Surgery is the only curative treatment for UVP.
Pelvic organ prolapse
Pelvic organ prolapse is the descent of pelvic organs from their normal position. It is caused by weakness in the pelvic floor muscles and supporting tissues. Prolapse can affect the bladder, uterus, rectum, or small intestine and is graded based on the degree of descent. Risk factors include childbirth, age, obesity, and chronic coughing. Symptoms vary depending on the affected organ but may include pressure, pain, urinary issues, or bowel dysfunction. Treatment ranges from pelvic floor exercises to pessaries to surgery based on severity. Surgical options aim to restore anatomy and support the pelvic organs.
PPT Prolapse.ppt
Utero-vaginal prolapse occurs when the uterus and vagina descend from their normal positions due to weakness of the pelvic floor muscles and supporting tissues. The document defines the normal positions of the uterus and different degrees of uterine descent. It describes examinations used to evaluate pelvic organ prolapse and discusses various surgical procedures to correct prolapse of the uterus, vagina, and vaginal vault after hysterectomy. Conservative measures including pessaries and pelvic floor exercises are also outlined.
maam.pdf
Uterine prolapse is the downward displacement of the uterus into the vaginal canal. It is caused by weakness or damage to the ligaments and fascia that support the uterus and vagina. Risk factors include multiple vaginal births, menopause, chronic coughing, and genetic factors. Symptoms include a feeling of something falling out of the vagina, pressure, pain, and urinary or bowel issues. Treatment options include pelvic floor exercises, pessaries, and surgery such as hysterectomy, anterior and posterior colporrhaphy, or sacrocolpopexy depending on the severity of prolapse and patient factors. Surgical treatment is generally very effective but some risk of recurrence or incontin
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database.pptx
1) The document discusses various databases related to Ayurveda including literature databases containing Samhitas and other Ayurvedic texts, manuscript databases, herbal databases containing information on medicinal plants from sources like the Flora of India and the Wealth of India series, the Traditional Knowledge Digital Library, clinical trials registry, Cochrane library, and dissertation repository Shodhganga.
2) It also mentions databases containing information on Ayurvedic pharmaceutical companies and their products, the national pharmacovigilance program and database, patent databases, gemological and minerals databases, and mobile apps databases.
3) Several national organizations that maintain important Ayurveda databases are discussed, including the National Institute of
uterine fibroid.pptx
Uterine fibroids are benign tumors that develop in the uterus. They are composed of smooth muscle and connective tissue and are the most common tumors found in females. The highest prevalence occurs in women between ages 35-45. While the exact cause is unclear, genetic and hormonal factors likely play a role. Fibroids can be asymptomatic but may cause heavy periods, pelvic pain, infertility, or pregnancy complications. Diagnosis involves ultrasound, MRI, or other imaging. Treatment options include medication, myomectomy (surgical removal of fibroids), hysterectomy (removal of the uterus), or embolization (blocking the blood supply).
Trichomonas vaginitis.pptx
Introduction
Causative agent : Trichomonas vaginalis
Transmission : Sexual contact
Incubation period : 3 – 28 days.
Clinical features
Sudden profuse and offensive vaginal discharge.
Severe irritation and itching around introitus.
Dysuria and increased frequency of urine.
Examination:
Thin, greenish yellow frothy offensive vaginal discharge.
Inflammed vulva
Vaginal examination may be painful.
Diagnosis:
Culture of discharge :
Diamonds TYM or Feinberg
Whittington medium.
Treatment:
DOC : Metronidazole
200mg TDS x 1 week.
Tinidazole
syphilis.pptx
Introduction
Causative agent : Treponema pallidium
Transmission : Abraded skin / mucosal surface.
Spreads through direct contact.
Incubation period : 9 -90 days.
Clinical features
Phases of syphilis :
Primary syphilis
Lesion / Chancre : Single/ Multiple
Site : Labia, fourchette, anus, cervix or
nipples.
Small papule gets eroded into an ulcer. The margins of ulcer are raised and floor is smooth and shiny.
Healing of primary chancre takes place in 1-8 weeks.
Secondary Syphilis
Secondary syphilis is evident in form of Condyloma lata in vulva.
Condyloma lata : coarse, flat topped, moist, necrotic lesions.
Maculopapular rashes : Palms and soles.
Alopecia, lymphadenopathy, mucosal ulcers.
Latent Syphilis
Quiescence phase.
Duration : 2 -20 years.
Tertiary Syphilis
Progression of tertiary syphilis occurs only in condition of untreated syphilis.
Damages CNS, CVS, Musculoskeletal system.
Cranial nerve palsies III, VI, VII and VIII.
Gummatous ulcer : deep punched ulcer with rolled out margins. Painless with moist leather base.
Diagnosis
History of exposure.
Identification of organism.
Serological test
VDRL (Venereal disease research laboratory)
TPHA (Treponoma pallidum haemagglutination)
EIA (Enzyme immunoassay)
FTA (Fluorescent treponomal Antibody)
TPI (Treponoma pallidum immobilisation)
Treatment
Benzathine penicillin IM
Tetracycline 500 mg
Doxycycline 100 mg
Serological test should be performed 1, 3, 6 and 12
month after treatment of syphilis.
pruritis vulvae.pptx
Pruritis vulvae
Etiology:
1. Vaginal discharge : Trichomonas vaginalis, Candida albicans
2. Local skin lesion: Psoriasis, Dermatitis
3. Vulvar infection: Fungal, Viral, Parasitic, STD
4. Medical disorders: Glycosuria
5. Deficiency: Fe, Folic acid, Vit B12 Vit A
6. Psychosomatic causes
Investigations
Age of onset
Intensity of itching
Duration
Vaginal discharge
Contraceptive practice
Allergy- nylon, soap, detergent.
DM
Liver disorder
Thyroid
Hematological disorder
Special Investigations
Microscopic examination: Vaginal discharge / vulval scarping
Urine examination: Sugar, Protein and pus cells.
Blood examination: CBC, Thyroid profile, Glucose, LFT, RFT
Stool examination: Ova, Parasite, Cyst.
Treatment
Maintain local hygiene.
Loose fitting clothing
Local topical application: antibiotics/ clobetasol propionate
Treat specific disease
Surgery: Neoplasia invasion
pid.pptx
Definition
PID is a disease of the upper genital tract.
It is a spectrum of infection and inflammation of the upper genital tract organs typically involving the uterus (endometrium), fallopian tubes, ovaries, pelvic peritoneum and surrounding structures.
Epidemiology
Occurs both in the developed and developing
countries.
85 per cent are spontaneous infection in sexually active females of reproductive age.
The remaining 15 per cent follow procedures, which favors the organisms to ascend up.
Two-thirds are restricted to young women of less than 25 years and the remaining one-third limited among 30 years or older.
Risk factors
Menstruating teenagers.
Multiple sexual partners.
Absence of contraceptive pill use.
Previous history of acute PID.
IUD users.
Area with high prevalence of sexually transmitted diseases.
Protective factors
Contraceptive practice
Barrier methods
Oral steroidal contraceptives
Monogamy / Vasectomy
Others
Pregnancy
Menopause
Vaccines
CLINICAL FEATURES
Bilateral lower abdominal and pelvic pain dull in nature.
Fever, lassitude and headache.
Irregular and excessive vaginal bleeding .
Abnormal vaginal discharge (purulent or copious)
Nausea and vomiting.
Dyspareunia.
Pain and discomfort in the right hypochondrium.
Signs
Temperature >38.3°C.
Abdominal palpation
(1) Tenderness on both the quadrants of lower abdomen.
(2) The liver may be enlarged and tender.
Vaginal examination
(1) Abnormal vaginal discharge (purulent).
(2) Congested external urethral meatus or openings of Bartholin’s ducts through which pus may be seen escaping out on pressure.
(3) Speculum examination shows congested cervix with purulent discharge from the canal.
Clinical diagnostic criteria of PID (CDC-2006)
Minimum Criteria
Lower abdominal tenderness.
Adnexal tenderness.
Cervical motion tenderness.
Additional Criteria
Oral temperature > 38.3°C.
Mucopurulent cervical or vaginal discharge.
Raised C-reactive protein and/or ESR.
Definitive Criteria
Histopathologic evidence of endometritis on biopsy.
Imaging study (TVS/MRI) evidence of tubo-ovarian complex.
Laparoscopic evidence of PID
Investigations
Identification of organisms
Blood: Leucocyte count shows leucocytosis to more than 10,000 per cu mm and an elevated ESR value of more than 15 mm per hour.
Laparoscopy
Complications Of Pid
Immediate
Pelvic peritonitis or even generalized
Septicemia
Late
Dyspareunia
Infertility
Chronic pelvic inflammation
Formation of adhesions or hydrosalpinx or pyosalpinx and tubo-ovarian abscess.
Chronic pelvic pain and ill health.
Ambulatory Management Of Acute PID (CDC-2006)
Patient should have oral therapy for 14 days
Regimen A
Levofloxacin 500 mg (or, ofloxacin 400 mg) PO
Metronidazole 500 PO bid
Regimen B
Ceftriaxone 250 mg IM single dose
Doxycycline 100 mg PO BID with or without
Metronidazole 500 mg PO BID for 14
hsg.pptx
Hysterosalpingography (HSG)
Hystero + Salpingo + Graphy
HSG is a radiological procedure done to assess the interior anatomy of the uterine cavity and the shape and patency of the fallopian tubes.
It is a radiographic study using fluorescent dye to visualise the anatomy of uterus and fallopian tubes.
Indications:
Assessment of tubal patency.
Detection of uterine malformation.
Diagnosis of cervical incompetence.
Detection of translocated IUD.
Diagnosis of uterine synechiae.
Diagnosis of uterine fibroid , uterine polyp.
Diagnosis of abdominal pregnancy.
Uterine Malformation
Steps of operation
The patient is asked to remain empty bladder.
Operation is done under general anaesthesia.
The patient is placed in lithotomy position.
Local antiseptic cleaning is done.
Posterior vaginal speculum is introduced.
Anterior lip of cervix is grasped with Allis tissue forcep.
HSG cannula is fitted with a syringe containing radio opaque dye. About 5- 10 ml of dye is slowly introduced.
The passage of the dye is observed by using X-ray intensifier and a video display unit.
Two radiographic X-rays are taken. First one to show the filling of uterine cavity and other one 10-15 mins after the completion of procedure.
Timing of procedure :
HSG is done between D6 and D10 of cycle.
Antibiotics are given one day prior the procedure up to 5 days.
Contrast media
Complications
Peritoneal irritation.
Pelvic pain.
Vasovagal attack.
Intravasation of dye into the venous or lymphatic channels.
Flaring up of pelvic infections.
endo.pptx
Definition
Presence of functioning endometrium (glands and stroma) in sites other than uterine mucosa is called endometriosis.
It is a benign but it is locally invasive.
Prevalence
The real one is due to delayed marriage, postponement of first conception and adoption of small family norm.
The apparent one is due to increased use of diagnostic laparoscopy as well as hightened awareness of this disease complex amongst the gynecologists
Sites
Abdominal: Usually confined to the abdominal structures below the level of umbilicus.
Extra-abdominal: Common sites are abdominal scar of hysterotomy, cesarean section, tubectomy and myomectomy, umbilicus, episiotomy scar, vagina and cervix.
Remote
Pathology
Naked Eye Appearance: The appearance of the lesion depends on the organs involved, extent of lesion and reaction of the surrounding tissues.
Pelvic endometriosis: Small black dots, called ‘powder burns’ seen on the uterosacral ligaments and pouch of Douglas.
Fibrosis and scarring
Symptoms
Dysmenorrhea (70%)
Abnormal menstruation (20%)
Infertility (40–60%)
Dyspareunia (20–40%)
Chronic Pelvic Pain
Abdominal Pain
Urinary— frequency, dysuria, back pain or even hematuria.
Sigmoid colon and rectum—painful defecation (dyschezia), diarrhea, constipation, rectal bleeding or even melena.
Chronic fatigue, perimenstrual symptoms (bowel, bladder).
Hemoptysis (rarely), chest pain.
Surgical scars—cyclical pain and bleeding.
Examination
Abdominal palpation
A mass may be felt in the lower abdomen arising from the enlarged tubo-ovarian mass due to endometriotic adhesions. The mass is tender with restricted mobility.
Pelvic Examination
Pelvic tenderness, nodules in the pouch of Douglas, nodular feel of the uterosacral ligaments, fixed uterus or unilateral or bilateral adnexal mass of varying sizes
Diagnosis
Bichemical parameters:
Serum CA 125
Monocyte Chemotactic Protein (MCP-1)
Imaging:
TVS - ovarian endometriomas
Endorectal USG - Rectosigmoid endometriosis
MRI - deep infiltrating endometriosis.
Colonoscopy, rectosigmoidoscopy and cystoscopy
Differential Diagnosis
Chronic pelvic infection / symptomatic endometriosis. Laparoscopy is helpful in actual diagnosis.
Ovarian endometrioma / benign ovarian tumor / malignant ovarian.
Ultrasonography or Laparoscopy
Rupture of the chocolate cyst / torsion or rupture of the ovarian tumour, disturbed ectopic pregnancy, appendicitis or diverticulitis.
Complications
Endocrinopathy
Rupture of chocolate cyst
Infection of chocolate cyst
Obstructive features:
Intestinal obstruction
Ureteral obstruction → hydroureter
hydronephrosis → renal infection
Endocrinopathy in Endometriosis
Corpus luteum insufficiency
Luteolysis due to ↑ PGF.
Luteinized unruptured follicle (LUF)
Anovulation
Elevated prolactin level
Double LH peak.
Staging
Endometrios is should be staged appropriately.
To predict prognosis.
To choose therapy.
To evaluate the treatment protocol.
The stage is determined by adding specific points given to each.
contraception.pptx
Contraception
Contraception is defined as the intentional prevention of conception through the use of various devices, sexual practices, chemicals, drugs or surgical procedures.
The preventive methods to help women avoid unwanted pregnancies are called contraceptive methods.
Need for contraception
• To avoid unwanted pregnancies.
• To regulate the timing of pregnancy.
• To regulate the interval between pregnancy.
Ideal Contraceptive
• Safe
• Effective
• Acceptable
• Reversible
• Inexpensive
• Long lasting
• Requires little or no medical supervision
Contraceptive methods
Spacing methods
Natural
Barrier
IUDs
Emergency contraception
Terminal methods
Male fertilisation
Female fertilisation
Natural Methods
Coitus inteyrruptus / withdrawal
Rhythm Method
Lactational Amenorrhoea
Barrier Methods
Mechanical
Male : Condom
Female : Condom, Diaphragm, Cervical cap
Chemical
Creams - Deleen
Jelly – Koromex, Volpar paste
Foam tablets – Aerosol foams, Chlorimin T or Contab
Combination
Combined use of Chemical and Mechanical methods.
Male condom
• Most commonly known and used contraceptive.
• Better known in India as NIRODH.
Female condom
Femidom
Diaphragm
Spermicides
Spermicides are surface active agents which attach
themselves to spermatozoa and kill them.
Available in various forms like
Intrauterine Contraceptive Devices
Cu T200
T shaped device Polyethylene frame.
215 mm2 surface area of Cu wire.
Contains 124 mg of copper
Cu is lost at the rate of 50 µg/day.
Polyethylene monofilament tied at vertical stem.
Cu is radio opaque so additionally barium is
incorporated in the device.
Supplied in a sterilised sealed packet.
Lifetime 4 years.
Cu T 380A
380 mm square surface area of copper wire.
Replacement 10 years.
Multiload Cu 250
60-100 ug/day
Replacement 3 years
Multiload - 375
Mode of action
Biochemical and histological changes in endometrium.
Increased tubal motility.
Endometrial inflammatory response.
Prevents implantation.
Contraindication for insertion of IUCD
Presence of pelvic infection
Genital tract bleeding (undiagnosed)
Suspected pregnancy
Uterine fibroid
Severe dysmenorrhoea
Ectopic pregnancy history
Caesarean section
Cu allergy
Time of insertion
Interval
2-3 days after menstrual phase.
During lactational amenorrhoea.
Postabortal
Done immediately following termination of pregnancy.
Postpartum
After 6 weeks of delivery.
Postplacental delivery
Post delivery of placenta.
Method of Insertion
Preliminary steps:
History taking and examination
Patient is informed and consent is obtained.
Insertion is done in OPD aseptic conditions.
Placement of device in inserter.
Steps of operation
The patient is asked to remain empty bladder.
The patient is placed in lithotomy position.
Local antiseptic cleaning is done.
Posterior vaginal speculum is introduced.
Anterior lip of cervix is grasped with Allis tissue forcep.
The device is placed in the inserter and introduced through cervical
BARTHOLINS.pptx
Bartholin's glands are paired oval-shaped glands located on each side of the vaginal opening that produce lubricating secretions. Bartholin's gland infection, or Bartholinitis, can be caused by various bacteria and may result in complete resolution, recurrence, abscess formation, or cyst formation. A Bartholin's abscess is an infection of one of the glands that causes severe pain and swelling. Treatment involves antibiotics, sitz baths, and draining the abscess. A Bartholin's cyst is a fluid-filled sac that can cause discomfort and dyspareunia, and treatment is marsupialization to remove the cyst.
Moniliasis(Candida vaginitis)
Candida vaginitis is caused by the fungus Candida albicans. It presents with intense vulvovaginal discharge, dyspareunia, and a thick, curdy white discharge on examination that resembles cottage cheese and adheres to the vaginal walls. Diagnosis is made via wet smear, and treatment involves removing predisposing factors as well as using local and oral antifungal creams, ointments, pessaries, or single dose therapies like fluconazole or itraconazole.
Lgv (Lymphogranuloma Venereum)
Lymphogranuloma Venereum
Dr. Yashika
Causative agent : Chlamydia trachomatis
Incubation period: 3-30 days
Clinical features :
Initial phase:
Painless papule, pustule or ulcer in vulva, urethra,
rectum or cervix.
Involved inguinal nodes feels rubbery.
Acute lumphangitis and lymphadenitis.
Necrosed glands and abscess formation.
Rupture of abscess occurs within 7-15 days.
Sinus and fistula formation.
Intense fibrosis with lymphatic drainage.
Secondary phase : Painful adenopathy.
Classical clinical sign:
Groove sign
A depression between the groups of inflammed nodes.
Complication:
Vulval elephantiasis
Perineal scarring
Rectal stricture
Sinus and fistula formation.
Diagnosis
Culture and isolation
Detection of LGV
Treatment:
Doxycycline 100 mg BID x 21days.
Azithromycin 1 gm PO weekly x 3 weeks
Abscess aspiration
Leucorrhoea
Leucorrhoea
Dr. Yashika
Abnormal Vaginal Discharge
Frequent complaint.
Discharge may vary from excess to normal.
Discharge may be blood-stained / contaminated with urine or stool.
Characteristics of normal vaginal fluid
Nature - watery
Colour - white
Odour - Odourless
pH - 4.0
Microscopically - Squamous epithelial cells,
Leucorrhoea
Leucorrhoea is defined as excessive normal vaginal discharge.
Features of vaginal discharge in leucorrhoea :
Excess secretion.
Non purulent
Non offensive
Non irritant
Never causes pruritis.
Etiology :
Physiological excess
Cervical causes
Vaginal causes
Physiologic excess
Puberty
Menstrual Cycle
Pregnancy
Sexual excitement
Cervical causes:
Cervicitis
Cervical ectopy
Cervical polyp
Treatment
General health improvement
Surgical treatment of cervical factors
Pill users are asked to stop pill immediately
Local hygiene
Hysterectomy
HYSTERECTOMY
Hysterectomy
Hysterectomy
Term origin:
hyster + ectomy
uterus surgical removal
Definition:
Hysterectomy is defined as the surgical removal of uterus.
Routes for Hysterectomy
Abdominal Hysterectomy
Vaginal Hysterectomy
Laparoscopic Hysterectomy
Caesarean Hysterectomy
Types of Hysterectomy
Total Hysterectomy
Removal of entire uterus.
Subtotal Hysterectomy
Removal of body or corpus leaves behind the cervix.
Panhysterectomy / Hysterectomy with bilateral salpingo oophorectomy
Removal of uterus along with tubes and ovaries of
both sides.
Indications
Hsv Herpes Genitalis
Herpes Genitalis
Dr. Yashika
Introduction
Causative organism : Herpes Simplex virus type 1 and 2
Transmission : Orogenital contact
Incubation period : 2 – 14 days.
Clinical features:
First attack with 7 days of sexual contact.
Red painful inflammatory area around clitoris, labia, vestibule, vagina, cervix and perineum.
Appearance of multiple vesicles which progress into ulcers then heals up by crusting
Lymphadenopathy
Fever, malaise and headache.
Diagnosis:
Virus tissue culture and isolation
ELISA
Fluorescent method
PCR test
Treatment
Specific treatment is yet to b explored.
Acyclovir 200 mg 5 times x 5days.
Saline water bath.
Hsg
Hysterosalpingography
Dr. Yashika
Hysterosalpingography (HSG)
Hystero + Salpingo + Graphy
HSG is a radiological procedure done to assess the interior anatomy of the uterine cavity and the shape and patency of the fallopian tubes.
It is a radiographic study using fluorescent dye to visualise the anatomy of uterus and fallopian tubes.
Indications:
Assessment of tubal patency.
Detection of uterine malformation.
Diagnosis of cervical incompetence.
Detection of translocated IUD.
Diagnosis of uterine synechiae.
Diagnosis of uterine fibroid , uterine polyp.
Diagnosis of abdominal pregnancy.
Uterine Malformation
Steps of operation
The patient is asked to remain empty bladder.
Operation is done under general anaesthesia.
The patient is placed in lithotomy position.
Local antiseptic cleaning is done.
Posterior vaginal speculum is introduced.
Anterior lip of cervix is grasped with Allis tissue forcep.
HSG cannula is fitted with a syringe containing radio opaque dye. About 5- 10 ml of dye is slowly introduced.
The passage of the dye is observed by using X-ray intensifier and a video display unit.
Two radiographic X-rays are taken. First one to show the filling of uterine cavity and other one 10-15 mins after the completion of procedure.
Timing of procedure :
HSG is done between D6 and D10 of cycle.
Antibiotics are given one day prior the procedure up to 5 days.
Contrast media
Complications
Peritoneal irritation.
Pelvic pain.
Vasovagal attack.
Intravasation of dye into the venous or lymphatic channels.
Flaring up of pelvic infections.
Human Immunodeficiency Virus - Acquired Immuno Deficiency Disease
AIDS
Dr. Yashika
Introduction
Causative agent : Human Immunodeficiency Viruses (HIV)
HIV belongs to retrovirus family (double stranded RNA).
Mode of transmission
Sexual intercourse
IV drug abusers
Blood transfusion
Use of contaminated needles
Breastfeeding
Perinatal transmission
Immunopathogenesis
Immunological Markers
CD4 T lymphocyte count
RT-PCR
Raised P-24 antigen titre
Raised serum β2 microglobulin
Clinical Presentation
Development of Ab marks the stage of seroconversion aka flu-like syndrome.
Acute infection syndrome characterized by fever, skin rash, arthralgia, lymphadenopathy and diarrhoea. This is called seroconversion illness lasts upto 2-3 weeks and gets resolved itself spontaneously.
Gynaecological Symptoms
Infections of genital tract.
Neoplasm of genital tract.
Menstrual abnormalities.
Fertility and pregnancy are not affected.
Diagnosis
Detection of IgG antibody.
ELISA
Western blot
PCR
Treatment
Gonorrhoea
GONORRHOEA
Dr. Yashika
Introduction
Causative agent : Neisseria gonorrhoea (gram negative diplococcus).
Incubation period : 3-7 days.
Site of invasion : columnar and transitional epithelium of the genitourinary tract.
Primary sites of infection : endocervix, urethra and Bartholins gland.
Other sites of infection : Oropharynx, anorectal and conjuctiva.
Clinical features :
Local:
Excessive irritant vaginal discharge
Dysuria
Acute unilateral pain
Swelling over labia.
Pharyngeal infection
Intermenstrual bleeding.
Rectal discomfort.
Signs :
Swollen labia and inflammed.
Mucopurulent vaginal discharge.
Speculum examination reveals congested endocervix.
Distant symptoms :
Perihepatitis
Septicaemia
Complications:
PID
Infertility
Ectopic pregnancy
Chronic pelvic pain
Tubo ovarian mass
Bartholins gland abscess.
Diagnosis
Nucleic acid amplification test (NAAT)
urine culture
Drug sensitivity test.
Treatment
Adequate therapy for gonococcal infection.
To treat both the partner simultaneously.
To avoid multiple sex partner.
To use condom till free from disease.
Dilatation and Insufflation
Dilatation and Insufflation
Dr. Yashika
Dilatation and Insufflation (D&I)
Also known as Rubin’s test.
Operation for dilatation of cervix and insufflation of air (CO2) in to the uterine cavity to know the patency of fallopian tubes.
Indications of D&I
Investigation for fertility.
Following tuboplasty.
Contraindication : Pelvic infections.
Steps of operation
The patient is asked to remain empty bladder.
Operation is done under general anaesthesia.
The patient is placed in lithotomic position
Local antiseptic cleaning is done.
Posterior vaginal speculum is introduced.
Anterior lip of cervix is grasped with Allis tissue forceps.
7. Uterine sound is introduced to confirm the position and to note the length of cervical canal.
Cervical canal is dilated with graduated dilators.
After the desired dilatation, the insufflation cannula is introduced into the cervical canal.
10. Air is introduced in the uterus and the hissing sound is auscultated over the flanks.
Test
Positive Test:
An audible hissing sound on the flanks due to exit of air.
Patient complains of shoulder painon sitting.
Negative Test:
No hissing sound over the flanks.
Complications
Complications
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- 1. Pelvic Organ Prolapse Dr. Yashika
- 2. Pelvic Organ Prolapse • Most common gynaecological problem. • Amongst parous women. • A form of hernia.
- 3. Anatomy of Uterus • Anteversion and anteflexion position. • Lies between rectum and bladder. • Cervix pierces the vagina at the right angle to the axis of vagina.
- 6. Supports of Uterus Uterus is held in position by 3 tier support system. 1. Upper tier 2. Middle tier 3. Inferior tier.
- 7. Upper tier Primarily, maintains the uterus in anteverted position. The structures responsible are: 1. Endopelvic fascia. 2. Round ligaments. 3. Broad ligaments.
- 8. Middle tier Constitutes the strongest support of uterus. Responsible structures are: 1. Pericervical ring. 2. Pelvic cellular tissues.
- 9. Inferior tier Indirect support of uterus. Responsible structures are pelvic floor muscles including: 1. Levator ani 2. Endopelvic fascia 3. Levator plate 4. Perineal body 5. Urogenital diaphragm
- 10. Aetiology of POP Anatomical Clinical Predisposing Acquired Congenital Aggravating
- 11. Anatomical Factors • Gravitational stress. • Parturition stress. • Pelvic floor weakness. • Inherent weakness of supporting structures.
- 12. Acquired Predisposing Factors Trauma of vaginal delivery causing injury : 1. Ligaments 2. Endopelvic fascia 3. Levator muscle 4. Perineal body 5. Pudendal nerve and muscle damage due to repeated child birth.
- 13. Congenital Predisposing Factors • Inborn weakness of supporting structure.
- 14. Aggravating factors • Post menopausal atrophy • Poor collagen tissue repair with age. • Increased intra abdominal pressure. • Occupational hazards • Asthenia • Obesity • Fibroid/Polyp
- 15. Types of POP Vaginal Prolapse Anterior wall Posterior wall Uterine Prolapse Uterovaginal prolapse Congenital prolapse
- 16. Vaginal Prolapse Anterior wall Cystocele Urethrocele Posterior wall Relaxed perineu m Rectocele Vault Prolapse
- 18. Clinical Degrees Of Uterine Prolapse
- 19. Symptoms • Feeling of something coming out per vaginum. • Backache or dragging pain in pelvis • Dyspareunia • Urinary symptoms • Bowel symptoms
- 20. Clinical examination • Inspection and palpation. • General examination. • Pelvic examination
- 21. Cystocele • Bulging of anterior vaginal wall which increases when the patient is asked to strain. Cystoureth rocele • Bulging of anterior vaginal wall including lower one third also. Rectocele • Bulging of the middle third of posterior vaginal wall. Enterocele • Bulging of upper third of posterior vaginal wall.
- 22. Uterine prolapse First degree • Descent of cervix below the level of ischial spine on straining. Second/ Third degree • A protruding mass out through the introitus.
- 23. Management of Prolapse • Preventive • Conservative • Surgery
- 24. Preventive Measures • Pelvic floor exercise during puerperium. • Avoid strenuous activities. • Avoiding prolonged cough. • Avoiding constipation. • Avoiding heavy weight lifting. • Avoiding future pregnancy too early.
- 25. Conservative Management Indications : a. Asymptomatic women b. Mild degree prolapse c. POP in early pregnancy Treatment : a. Oestrogen replacement therapy. b. Kegel exercise c. Pessary treatment
- 26. Surgical Management of Prolapse A. Restorative B. Extirpative C. Obliterative