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 MAVCC Unit 5 p. 123-124 OBJ 1

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

Anatomy: Bony Pelvis/Girdle STST p. 478-479 The pelvic girdle consists of the iliac crest, ischia, pubic bones, and sacrum; it’s attached to the vertebral column at the sacrum.

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. 1026. 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 0.5-1 cm in diameter that secrete a lubricating mucoid substance.

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.

Support of Female Pelvis Fig 15-4: p. 479 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.

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.

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

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

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

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

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

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

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

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.

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

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

Genital Fistulas Vesicovaginal Ureterovaginal Urethrovaginal Rectovaginal MAVCC Unit 5 OBJ 10

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

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)

Specialized Instruments Abdominal Hysterectomy Vaginal Laparoscopic Obstetrical Adaptations for vag hyst Adaptations for LAVH Refer to STST pages 489-493 for pictures See also for pictures: Chart in Scrub room; Brent Beckett instrumentation book, Alexander’s , Tighe

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

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

STST p. 536

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