Introduction to Obstetrics & Gynecology

Overview

Objectives

• Match the terms r/t OB-GYN w/correct definitions• Review female anatomy

• List purposes of OB-GYN surgery• Discuss types of abortions• Match common GYN complications with correct

definitions• Match diagnostic techniques w/correct definitions• Match abdominal procedures w/correct descriptions

• Define and discuss vaginal procedures• Explain applications of lasers in GYN surgery

Objectives

• Match the types of genital fistulas w/correct illustrations• Select true statements r/t special features of OB/GYN

surgery• Match basic OB-GYN medications and solutions w/their

uses

• Identify specialized instruments for OB/GYN surgery

• Discuss the steps of a D & C

OB-GYN Terms

• Carcinoma in Situ• Cervical

• Chromotubation• Conization• Cystocele• Dilatation• Dysplasia

• Endometriosis• Enterocele• Episiotomy

• Fibroma• GIFT• Insufflation

• Marsupilization

• Myoma• Pneumoperitoneum• Presentation• Rectocele• Stress Incontinence

• Vaginal Vault

Female Reproductive System

Anatomy: Bony Pelvis/Girdle

Anatomy: External Genitalia

• Vagina

• Uterus– Cervix

• Fallopian tubes/ovaries

• External genitalia

Anatomy: Female Pelvis

Support of Female Pelvis

Uterus, Fallopian Tubes, Ovaries

• Hollow, thick-walled

• Situated between bladder and rectum

• Lined with endometrium

• Ligaments suspend the uterus

Female Reproductive System Concept Map

Why OB-GYN Surgery?

• Dx abnormal symptoms• Tx abnormal conditions

• Relieve pain• Electively prevent pregnancy• Assist infertile couples to conceive

• Prevent Spontaneous abortion w/structural defects• Abdominally deliver an infant when vaginal

delivery is contraindicated or not possible

Types of Abortions

• Missed

• Incomplete

• Imminent

• Spontaneous

• Voluntary Interrupted

Common OB Complications

• Dystocia• Placenta Previa• Abruptio Placenta

• CPD

• Abnormal presentations– Breech, Transverse, Footling, Vertex

• Incompetent cervical os• Infertility• Ectopic pregnancy

Common GYN Complications

• Menstrual abnormalities– Amenorrhea, dysmenorrhea, menorrhagia, metrorrhagia

• Lesions

• Weakened musculature

• STDs

Diagnostics

• Colposcopy• Colpotomy

• Conization of Cervix• Culdocentesis• Culdoscopy

• Hysterpsalpingography

• Hysteroscopy• PAP smear Punch Biopsy

• Rubin’s test• Schiller’s test• Uterine curettage

Abdominal Procedures

• Abdominal Hysterectomy• Cesarean Section

• Laparoscopy• MMK Suspension• Microscopic Reconstructive

Surgery of Fallopian Tubes• Myomectomy

• Oophorectomy• Oophorocystectomy• Pelvic Exenteration• Salpingectomy/Salpingostomy• Tubal ligation

Fibroid tumors

Vaginal Procedures• Anterior & Posterior repair• Conization of cervix• Dilatation & Curettage• Hysteroscopy• LAVH• Colpocleisis• Marsupilization of Bartholin’ s duct cyst• Repair of fistula• Shirodkar or MacDonald cerclage• Simple vulvectomy• Suction curettage• Trachelorrhaphy• Vaginal Hysterectomy

Lasers in GYN

• Most commonly used: Argon, CO2, Nd: YAG• Applications

– Ablation

– Eradication

– Endometrial ablation– Transecting uterine ligaments & controlling bleeding

Genital Fistulas

• Vesicovaginal

• Ureterovaginal

• Urethrovaginal

• Rectovaginal

Special Features• Typically pt is catheterized• General or spinal• Important: antiembolic devices, ambulation• Drains• Lithotomy/Vaginal• Vaginal: Long instruments• Vaginal procedures: sponges/medicated packing• Use of catheters: ID of ureters• Order of procedures: vag/abd• Separate set-ups• Special equipment

Medications & Solutions

• Oxytocics

• Lugol’s solution

• Acetic Acid 3 %

• Anti-infective creams

• Methylene blue

• Solutions for hysteroscopic exams

• Solutions for laser & cautery

Specialized Instruments

• Abdominal Hysterectomy

• Vaginal

• Laparoscopic

• Obstetrical

• Adaptations for vag hyst

• Adaptations for LAVH

ABD Hysterectomy

D & C Procedure Summary

• Lithotomy position• Insert Weighted speculum

• Grasp cervix w/ Tenaculum• Dilation using Graduated sound into cervix: depth & direction• Curette of choice for Endocervical curettings specimen• Endometrial curettings• Dilation using Hegar or Hanks uterine dilators

• Curettings: Telfa strip for specimen• Dressing: perineal pad

Labor & Delivery Stages

• Stage one: onset of labor

• Stage two: complete dilatation of cervix

• Stage three: birth of the infant

• Stage four: after placenta is delivered

Objectives

• Match the terms r/t OB-GYN w/correct definitions• List purposes of OB-GYN surgery

• Discuss types of abortions• Match common GYN complications with correct

definitions• Match diagnostic techniques w/correct definitions• Match abdominal procedures w/correct descriptions• Define and discuss vaginal procedures

• Explain applications of lasers in GYN surgery• Match the types of genital fistulas w/correct illustrations