1. Introduction to Obstetrics & Gynecology
Overview

2. 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

3. 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

4. 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
MAVCC Unit 5 p OBJ 1

5. Female Reproductive System
MAVCC Female Reproductive System correlate to terms and definitions upcoming

6. Anatomy: Bony Pelvis/Girdle
STST p
The pelvic girdle consists of the iliac crest, ischia, pubic bones, and sacrum; it’s attached to the vertebral column at the sacrum.

7. Anatomy: External Genitalia
Vagina
Uterus
Cervix
Fallopian tubes/ovaries
External genitalia
A & P Overview (Know the words in RED in STST)
Conditions arising from dysfunction of the pelvic musculature which relate to GYN surgery include prolapse of internal organs, such as of the bladder or rectum, into the vaginal vault. Surgically, these organs are approached using various techniques by incision into the spaces that surround and divide them. These anatomical planes are called the prevesical, vesicovaginal, vesicocervical, and rectovaginal spaces.
The perineum is the area between the vaginal opening and the anus. It is generally 2-3 cm in length and is supported by the peliv and urogenital diaphagms, which consist of the levator ani, coccygeal, and deep transverse perineal muscles. (See Appendix A Plate 2, p
The vestibule is the cavity between the labia minora, and it contains the urethra meatus, inferior to the clitoris, as well as the orifaces of the vestibular glands (or Bartholin’s glands). So—the Bartholin’s glands are located within the vestibule. What are they? Paired structures about cm in diameter that secrete a lubricating mucoid substance.

8. Anatomy: Female Pelvis
STST p. 479
The structures of the pelvic outlet relate to the function of childbearing. The pelvis can be divided into 2 cavities: the superior and the inferior cavity. The superior is the “false pelvis” and the inferior is the “true pelvis” which has a pelvic inlet and pelvic outlet thru which the fetus passes during childbirth. This shallower and wider outlet aids in the process of fetal delivery.

9. Support of Female Pelvis
Fig 15-4: p The pelvic ligaments lend support to the pelvic organs and help maintain the relative positions of the organs in the lesser pelvis. The pelvic ligaments, which include the cardinal, round, and infundibulopelopelvic ligaments, are loose configurations of areolar tissue, blood vessels, and muscle tissues that act as “moorings” for the uterus and vagina. Connective tissue helps to keep the structural integrity of the organs in stasis. Connective tissue change with age, nutritional status, amt of exercise, and hormonal fluctuations.

10. Uterus, Fallopian Tubes, Ovaries
Hollow, thick-walled
Situated between bladder and rectum
Lined with endometrium
Ligaments suspend the uterus
STST p. 482
Vagina: p. 481/482: The vaginal mucosa becomes thicker at puberty and is enriched with glycogen that supports a normal flora that renders vaginal fluid acidic—so pH is acidic.
Another name for the fallopian tubes and ovaries (together) are the adnexa, or the uterine appendages.
Another name for fallopian tubes are uterine tubes.
The uterus is lined with endometrium that varies in its consistency an sheds in accordance with phases of the menstrual cycle.
Ligaments extending to the pelvic walls suspend the uterus: broad, cardinal, pubic, sacral. The broad ligament contains the uterine folds, contains the uterine (fallopian) tube, the round and ovarian ligaments, and various blood vessels, nerves, and
lymphatics.
The ovaries are supported at either end by ligaments. A fold of peritoneum arising near the overlying fimbria forms the suspensory ligament. The ovarian ligament, lying in the broad ligament, supports the bulk of the ovary. Blood arrives to the organs via the ovarian arteries branching from the aorta and follows ovarian veins back to the inferior vena cava.

11. Female Reproductive System Concept Map
STST p. 485 Important A & P summary

12. 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
MAVCC Unit 5 p. 125 OBJ 2

13. Types of Abortions Missed Incomplete Imminent Spontaneous
Voluntary Interrupted
MAVCC Unit 5 OBJ 3

14. Common OB Complications
Dystocia
Placenta Previa
Abruptio Placenta
CPD
Abnormal presentations
Breech, Transverse, Footling, Vertex
Incompetent cervical os
Infertility
Ectopic pregnancy
MAVCC OBJ 4 p. 126

15. Common GYN Complications
Menstrual abnormalities
Amenorrhea, dysmenorrhea, menorrhagia, metrorrhagia
Lesions
Weakened musculature
STDs
MAVCC Unit 5 OBJ 5 p. 127

16. Diagnostics Colposcopy Colpotomy Conization of Cervix Culdocentesis
Culdoscopy
Hysterpsalpingography
Hysteroscopy
PAP smear Punch Biopsy
Rubin’s test
Schiller’s test
Uterine curettage
MAVCC p. 127 OBJ 6

17. Abdominal Procedures Abdominal Hysterectomy Cesarean Section
Laparoscopy
MMK Suspension
Microscopic Reconstructive
Surgery of Fallopian Tubes
Myomectomy
Oophorectomy
Oophorocystectomy
Pelvic Exenteration
Salpingectomy/Salpingostomy
Tubal ligation
MAVCC Unit 5 p. 129 OBJ 7

18. Fibroid tumors
This—out of Lemone and Burke Ch 48: Types of Uterine fibroid tumors –also called leiomyomata). Leiomyomata are benign tumors that originate from smooth muscle of the uterus. The are the most common form of pelvic tumor, believed to occur n 1 of every 4 or 5 women older than 35 yrs of age. Fibroid tumors usually develop in the uterine corpus, and may be intramural, subserous, or submucous. Intramural fibroid tumors lie within the uterine wall. Subserous fibroid tumors lie beneath the serous lining of the uterus and project into the peritoneum. Submucous fibroid tumors lie beneath the endometrial lining of the uterus. Fibroids are seen more often and grow more rapidly in African Americans. Myomectomy—removal of the tumor without removing the entire uterus, is the surgical procedure of choice for women who which to retain productive capability.

19. 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
MAVCC Unit 5 OBJ 8 p. 131

20. Lasers in GYN Most commonly used: Argon, CO2, Nd: YAG Applications
Ablation
Eradication
Endometrial ablation
Transecting uterine ligaments & controlling bleeding
MAVCC Unit 5 OBJ 9 p. 132

21. Genital Fistulas Vesicovaginal Ureterovaginal Urethrovaginal
Rectovaginal
MAVCC Unit 5 OBJ 10

22. 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
MAVCC Unit 5 OBJ 11 p. 133

23. Medications & Solutions
Oxytocics
Lugol’s solution
Acetic Acid 3 %
Anti-infective creams
Methylene blue
Solutions for hysteroscopic exams
Solutions for laser & cautery
MAVCC Unit 5 OBJ 12 p. 135
Hysteroscopy: Hyskon, Dextrose 5%, Glycine (latter 3 can be used with laser and cautery)

24. Specialized Instruments
Abdominal Hysterectomy
Vaginal
Laparoscopic
Obstetrical
Adaptations for vag hyst
Adaptations for LAVH
Refer to STST pages for pictures
See also for pictures: Chart in Scrub room; Brent Beckett instrumentation book, Alexander’s , Tighe

25. ABD Hysterectomy MAVCC OBJ # 13 p. 136 O Connor O Sullivan
Heaney hysterectomy forceps
Heany needle holder
Jorgenson scissors

26. 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
MAVCC Unit 5 OBJ 14

27. STST p. 536

28. 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

29. 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