Gynecology and Obstetrics Anatomy and physiology What are
Gynecology and Obstetrics Anatomy and physiology What are the organs of the female reproductive system? What do they look like - size and shape How are they connected? Birger Breum, MD, OB/GYN. 14/10 -2010
Gynecology and Obstetrics Anatomy and physiology Birger Breum, MD, OB/GYN. 14/10 -2010
Gynecology and Obstetrics Anatomy and physiology Birger Breum, MD, OB/GYN. 14/10 -2010
Gynecology and Obstetrics Anatomy and physiology What is the purpose of the uterus? What is the purpose of the ovaries? How does the egg (secondary oocyte) get to the uterus? Where does the egg meet the sperm cells? What happens after fertilisation? Birger Breum, MD, OB/GYN. 14/10 -2010
Gynecology and Obstetrics Anatomy and physiology Birger Breum, MD, OB/GYN. 14/10 -2010
Gynecology and Obstetrics Birger Breum, MD, OB/GYN. 14/10 -2010
Gynecology and Obstetrics Birth Control Guess (hopefully qualified) what we see in this video. Female Sterilization What other forms of birth control do you know? Male condom, female condom, diaphragm, spermacides (gel, foam. . . ). birth controll pill, nuvaring, IUD, injectable contraception (solid og fluid). . . Birger Breum, MD, OB/GYN. 14/10 -2010
Gynecology and Obstetrics Pathology - what can go wrong? Cancer Infection Cysts Torsion Fibroma Polyps. . . Pregnancy related Bleeding Pain Nausia Abortion (&missed abortion) Ectopic pregnancy Birger Breum, MD, OB/GYN. 14/10 -2010
Gynecology and Obstetrics A clinical case 22 year old female, goes to the ER due to abdominal pain. What do we want to know? Description of pain. Where in the cycle? Is she pregnant? Is she (or has she been) sexually active? Temperature? Urinetest for (HCG, Leukocytes, Nitrate) Birger Breum, MD, OB/GYN. 14/10 -2010
Gynecology and Obstetrics A clinical case 22 year old female, goes to the ER due to abdominal pain. Case 1 Pain started suddenly, 20 hours ago, varies, pain gets worse when moving around, started diffusely, now worst in lower right abdominal quadrant. Period 2 weeks ago. She has not been sexually active for the last three months. Temperature 38, 4 C. Urinetest: HCG negative, 2+ Leukocytes, Nitrate negative) Appendicitis, Cystitis or PID? Birger Breum, MD, OB/GYN. 14/10 -2010
Gynecology and Obstetrics A clinical case 22 year old female, goes to the ER due to abdominal pain. Case 2 Pain started slowly, a few days ago, varies, pain gets worse when moving around, low in the middle og the abdomen. Period 2 weeks ago. She has not been sexually active for the last three months. Temperature 38, 4 C. Urinetest: HCG negative, 2+ Leukocytes, Nitrate positive) Cystitis! Birger Breum, MD, OB/GYN. 14/10 -2010
Gynecology and Obstetrics A clinical case 22 year old female, goes to the ER due to abdominal pain. Case 3 Pain started suddenly, 20 hours ago, varies, pain gets worse when moving around, started diffusely, now worst in lower right abdominal quadrant. Trying to get pregnant, but started to bleed around 3 weeks late (usually has irregular menstruation), the bleeding was yesturday. Temperature 37, 4 C. Urinetest: Leukocytes negative, Nitrate negative) Should we take HCG? Birger Breum, MD, OB/GYN. 14/10 -2010
Gynecology and Obstetrics A clinical case 22 year old female, goes to the ER due to abdominal pain. Case 3 Pain started suddenly, 20 hours ago, varies, pain gets worse when moving around, started diffusely, now worst in lower right abdominal quadrant. Trying to get pregnant, but started to bleed around 3 weeks late (usually has irregular menstruation), the bleeding was yesturday. Temperature 37, 4 C. Urinetest: HCG positive, Leukocytes negative, Nitrate negative) Birger Breum, MD, OB/GYN. 14/10 -2010
Gynecology and Obstetrics A clinical case 22 year old female, goes to the ER due to abdominal pain. Case 3 Pain started suddenly, 20 hours ago, varies, pain gets worse when moving around, started diffusely, now worst in lower right abdominal quadrant. Trying to get pregnant, but started to bleed around 3 weeks late (usually has irregular menstruation), this was yesturday. Temperature 37, 4 C. Urinetest: HCG positive, Leukocytes negative, Nitrate negative) Abortion? Extra uterine pregnancy? VIDEO 3 Birger Breum, MD, OB/GYN. 14/10 -2010
Gynecology and Obstetrics A clinical case 22 year old female, goes to the ER due to abdominal pain. Case 4 Pain started suddenly, 20 hours ago, varies, pain gets worse when moving, started diffusely, now worst in lower right abdominal quadrant. Trying to get pregnant, but started to bleed around 3 weeks late (usually has irregular menstruation), this was yesturday. Temperature 37, 4 C. Urinetest: HCG positive, Leukocytes negative, Nitrate negative) But ultrasound yesturday: Normal pregnancy! Birger Breum, MD, OB/GYN. 14/10 -2010
Gynecology and Obstetrics Early pregnancy diagnostics problems a. Symptyms of spontanious abortion are: Bleeding and pain, but one or both might not be present (asymptomatic) b. c. Symptyms of extrauterine pregnancy are: Bleeding and pain, but one or both might not be present (asymptomatic) d. e. Around 20% of normal pregnancies bleed one or more times. f. g. Around 20% of normal pregnancies have pain or more times. h. SOLUTION: i. Ultrasound and S-HCG j. Birger Breum, MD, OB/GYN. 14/10 -2010
Gynecology and Obstetrics Birger Breum, MD, OB/GYN. 14/10 -2010
Gynecology and Obstetrics Some later pregnancy conditions/problems a. Nausia b. Hypertension, before or because of pregnancy c. Preeklampsia (hypertension, protein in urine. . . ) d. Diabetes, before or because of pregnancy e. Obesity f. Astma g. Infections do usually not harm foetus. Exceptions (rubella, toxoplasmosis, Group B streptococs. . ) h. Bleeding i. Intra uterine growth retartion j. Abortion/foetal death k. Medicine-changes needed. (Myxoedema, depression) Birger Breum, MD, OB/GYN. 14/10 -2010
Gynecology and Obstetrics Normal delivery Children that are born between the 36 th and 39 th week (38 and 41 weeks after the Last Menstrual Period) are considered as being normal term deliveries. Statistically, only 2/3 of all children are born within the 3 weeks around the calculated date of birth and around 80 % within a month around the predicted date of birth. Birger Breum, MD, OB/GYN. 14/10 -2010
Gynecology and Obstetrics Normal delivery Delivery proceeds in three periods: a. Dilatation period • Expulsion or press period (subdivided into 4 phases) • After-birth period Birger Breum, MD, OB/GYN. 14/10 -2010
Gynecology and Obstetrics Normal delivery During delivery the infantile head has to conform to the various pelvic sections. In the expulsion period the first 3 phases describe the development of the head while phase 4 that of the shoulders, whereby the head rotates 90° back again. Birger Breum, MD, OB/GYN. 14/10 -2010
Gynecology and Obstetrics Normal delivery Birger Breum, MD, OB/GYN. 14/10 -2010
Gynecology and Obstetrics Normal delivery Press Period Problems (Expulsion problems)? Consider the 3 Ps Power (or Push or Pattern of contractions) Pelvis (not large enough? ) Passenger (Babysize, baby orientation) Usually a com. Pnation (combination) of the three Birger Breum, MD, OB/GYN. 14/10 -2010
Gynecology and Obstetrics Pathological delivery Helping the baby along: Enforsing contractions: oxytocin-drip Direction and force: vacuum extraction/Forceps Manual manipulation Alternative route. Operation: C-section Birger Breum, MD, OB/GYN. 14/10 -2010
Gynecology and Obstetrics Pathological delivery Post partum bleeding Fysiological (normal bleeding) 300 -500 ml Pathological >500 ml Imediate action (operating theater) >1000 ml Birger Breum, MD, OB/GYN. 14/10 -2010
Gynecology and Obstetrics Pathological delivery Bleeding >500 ml is patological. Consider: Tonus: Atonia Tissue: in uterus (placenta/clots) Traume: Tears Thrombin: Koagulation - maybe secondary to bleeding Bleeding > 1000 ml: Intrauterine palpation, tears in collum, vagina and perineum – Operating theater Match-test, Hgb, plateles, factor 2 -5 -7, APTT - perhaps. DIC-screening Birger Breum, MD, OB/GYN. 14/10 -2010
Gynecology and Obstetrics Pathological delivery Treatment Call help: obstetrician, midwife in charge, healtcareworker Empty bladder Uterus massage and compression. Observations (Respiration, BP, pulse, i. v. fluids, estimated bloodloss, diuresis and medicin). Trendelenburgs IV acces 2 large - Bloodmatch Na. Cl 2 liter, Plasma expanders 500 - 1000 ml. Oxygen Medicin Intrauterine palpation. Birger Breum, MD, OB/GYN. 14/10 -2010
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