Investigational Methods in Gynecology Michal Mra Dept of

Investigational Methods in Gynecology Michal Mára Dept. of Obstetrics & Gynecology, 1 st Medical Faculty of Charles University Prague

Investigational Methods in Gynecology • basic • inflammatory diseases / pelvic pain • gyn-endocrinology • infertility & ART • urogynecology • gyn-oncology

Basic methods • external physical examination (vitals !, acute abdomen !, external genitalia) • spec. • vag. (bimanual) • rectal • lab • USG

Ultrasonography • findings, not diagnosis • abdominal • transvaginal • transperineal, rectal • Doppler ! • other imaging methods -gynecologists) (non

Interdisciplinary approach • sub-specialists inside OB&GYN • IC specialists • surgeons • urologists • others • nurses, midwifes

Investigational Methods in Gynecology • basic • inflammatory diseases / pelvic pain • gyn-endocrinology • infertility & ART • urogynecology • gyn-oncology

Vaginal discharge • colpitis (vulvo-vaginitis), cervicitis • not always pathology • mycosis (C. albicans) • BV • native microscope, cultures • special exams (PCR)

(Sub)Acute pelvic pain • PID • wide ddx ! (gyn x non-gyn) • history & clinical picture • USG, cultures • lab. : inflammatory markers ! • laparoscopy

Chronic pelvic pain • Endometriosis (or normal finding) • wide ddx !!! (gyn x non-gyn) • history & clinical picture • USG, cultures, lab tests (Ca 125) • invasiveness ! • ATB ! • laparoscopy

Investigational Methods in Gynecology • basic • inflammatory diseases / pelvic pain • gyn-endocrinology • infertility & ART • urogynecology • gyn-oncology

Endocrinology • children (puberty) • tests before COC or HRT • PCOs • CAH • premature ovarian failure • climacteric medicine • RIA

Investigational Methods in Gynecology • basic • inflammatory diseases / pelvic pain • gyn-endocrinology • infertility & ART • urogynecology • gyn-oncology

Infertility • primary x secondary • infertility x repeated abortions (terminology) • social problem (10 -20%)

Infertility & ART • tuboperitoneal (HSG, laparoscopy) • anovulation (BT, USG, progesterone) • male factor (sperm analysis) • basal hormones assay (FSH, LH, E 2, PRL, TSH, androgens from 2 nd till 4 th day of cycle) • • genetics, reprod. immunology (PCT), …

Investigational Methods in Gynecology • basic • inflammatory diseases / pelvic pain • gyn-endocrinology • infertility & ART • urogynecology • gyn-oncology

Urogynecology • urinary incontinence (stress + urgent) • R/O infection • history • functional tests (pad-weight) • urodynamics • USG

Investigational Methods in Gynecology • basic • inflammatory diseases / pelvic pain • gyn-endocrinology • infertility & ART • urogynecology • gyn-oncology

Oncology • depends on location • screening !? ? • tumor markers • imaging methods + further • pre-bioptic tests / LEEP cervix • US, D&C, hysteroscopy endometrium • US / Ca 125, surgery ovary

Pre-bioptic tests (cervix) • colposcopy • cytology • PAP smear (I-V) • Bethesda system

Gyn-endoscopy • Diagnosis & Tx (minimally invasive surgery) • Hysteroscopy, Laparoscopy • Colposcopy, culdoscopy • Fetoscopy, faloscopy, fertiloscopy (TVHL)