1. Amenorrhea -absence of menstruation
Anteversion- turning forward; inclining forward as a whole without bending
Carcinoma in situ -noninvasive cancer located in a small area of the epithelial layer
Cesarean section -removal of the fetus by abdominal incision into the uterus

2. Chromotubation -
Clitoris -an organ of sensitive, erectile tissue located anterior to the vaginal orifice and in front of the urethral meatus.
Conization - excision of a cone of tissue
Curette -an open spoon-shaped instrument used to scrape tissue from a surface

3. Cystocele -herniation of the bladder into the vaginal canal
Dilation -act of stretching or enlarging an organ or part of the body
Dilation and curettage (D&C) -
Dilation (widening of cervical canal) by insertion of probes of increasing sizes.
Curettage – scraping the inner lining of the uterus; to remove the lining of the uterus

4. Dysplasia -abnormal growth or development
Ectopic pregnancy -a pregnancy that occurs when the fetus lodges in a location other than the uterus
Endometriosis -presence of functioning endometrial tissue in places where it is not normally found
Enterocele -herniation of the cul-de-sac of Douglas which usually contains loops of small intestine

5. Episiotomy -incision into the perineum during normal labor to prevent lacerationsand to facilitate delivery with less trauma
Excision -surgical removal of a portion of a structure or organ; to cut out
Presentation -manner in which the fetus is positioned in relation to the cervix
Rectocele -herniation of the rectum into the vaginal canal

6. Retroversion -a turning backward, as of the uterus
Salpingooophorectomy -removal of the ovary and the fallopian tubes
Stress incontinence - inability of the body to control the evacuative function because of physical stress on body parts involved
Tubal ligation -sterilization; blocking of the fallopian tubes by burning or cutting them and tying them off.

7. Uterus -womb; organ that holds the embryo and fetus as it develops
Vaginal vault -the dome or upper part of the vagina
Vestibular glands - these glands release mucus into the vestibule and help to keep it moist and lubricated, facilitating intercourse
Vulva -external genitalia (reproduction organs) of female collectively

8. Purposes of obstetrics and gynecological surgery
To diagnose abnormal conditions
To treat abnormal conditions
To assist infertile couples to conceive

9. Type of Abortions
Missed abortion – Product of conception (fetus) is nonliving and is retained in the uterus for 2 mos. or longer.
Incomplete abortion -part of the product of conception has been retained in the uterus
Imminent abortion - patient is about to abort
Spontaneous abortion -abortion occurring without having been induced
Voluntary interrupted abortion - abortion performed because patient wants to terminate pregnancy

10. Obstetrical Complications
ectopic pregnancy - fertilized ovum becomes implanted outside the uterus
incompetent cervical os - [cervical os = cervical opening before placenta previa]
placenta previa - placenta is abnormally implanted in the lower uterine segment
and may completely cover the os cervix

11. Gynecological complications
Amenorrhea - absence of menstruation
Lesions - areas of pathologically altered tissue that may occur on or in
all reproductive structures and may be malignant or benign
sexually transmitted diseases - communicable diseases in both men and women

12. Diagnostic techniques used by Gynecologists
Colpotomy - (vaginotomy) a cutting operation in the vagina
Conization of the cervix - biopsy taken with a scalpel or cervitome to include the
squamo-columnar junction of the ectocervix and tapered to include the endocervical canal to the level of the internal os
hysterosalpingography - insertion of a water-soluble radiopaque dye into the
cervical canal to study the structure and function of the uterus and tubes in the evaluation of infertility

13. hysteroscopy - direct visualization of the interior of the uterus to diagnose
or treat disease via a fiberoptic scope
laparoscopy - endoscopic visualization of the peritoneal cavity through the
anterior abdominal wall after the establishment of a pneumoperitoneum
Schiller’s test - staining the vaginal vault and cervical squamous epithelium with
an iodine solution to pinpoint abnormal tissues which do not stain brown as normal tissues do

14. Abdominal Procedures
Anterior exenteration - removal of the reproductive organs, distal part of the
ureters, bladder, and vagina with resulting diversion of ureters to an ileal conduit for cancer of the cervix, vagina, or vulva with extension to the bladder
cesarean section - removal of the fetus by abdominal incision into the uterus
laparoscopy - endoscopic visualization of the peritoneal cavity through the
anterior abdominal wall primarily used as a diagnostic procedure, but which may also be used for other procedures such as aspiration of cysts, release of adhesions, tissue biopsies, and tubal ligations
Marshall-Marchetti-Krantz (MMK) - suspension of the bladder to the
symphysis pubis to correct stress incontinence

15. myomectomy - removal of fibromyomas from the uterine wall for pressure
symptoms in women desiring children (C-section)
oophorectomy - removal of an ovary
oophorocystectomy - removal of an ovarian cyst
posterior exenteration -
radical hysterectomy - en bloc dissection and removal of all pelvic lymph nodes
and wide removal of uterus, tubes, ovaries, supporting ligaments, and upper vagina

16. salpingectomy - removal of a fallopian tube
salpingo-oophorectomy - removal of a tube and all or part of the associated ovary
salpingostomy establishing an artificial opening in a fallopian tube in which the
fimbriated extremity has been closed by inflammation
subtotal hysterectomy - removal of body of uterus, leaving the cervix in place
total hysterectomy - removal of entire uterus, including the corpus and the cervix
tubal ligation - interruption of fallopian tube continuity designed to sterilize
the patient

17. Vaginal Procedures
D&C Dilation & Curettage - is the dilation of the os cervix and curetting of endocervical
and/or endometrial tissue to obtain tissue for microscopic examination, to halt uterine bleeding, to terminate pregnancy, or to remove tissue following an incomplete or missed abortion
Suction curettage - vacuum aspiration of intrauterine contents performed for
termination of pregnancy or for early incomplete spontaneous abortion
conization of the cervix - excision of cone of tissue from the cervix to remove a
cancerous lesion or tissue for biopsy

18. Marsupialization of Bartholin’s duct cyst or abscess -- removal or incision of the cyst
through the vaginal outlet and drainage of the area
Anterior and posterior repair -- reconstruction of the vaginal walls, the pelvic floor, and
the muscles and fascia of the rectum, urethra, bladder, and perineum to correct a cystocele and a rectocele and to reestablish the support of the anterior and posterior vaginal walls and thereby restore the bladder and rectum to their normal positions
Shirodkar or MacDonald cerclage operation - postconceptional placement of a collar-type
ligature at the level of the internal os to close it for incompetence of the cervix

19. Vaginal hysterectomy --
Vaginal hysterectomy -- removal of the uterus through an incision made in the vaginal
wall and the pelvic cavity
Simple vulvectomy - removal of the labia majora and labia minora, possibly the glans clitoris,
and occasionally the perianal area with a plastic closure for treatment of carcinoma in situ of the vulva
LeFort operation (Colpocleisis) - procedure which obliterates the vagina by denuding and
approximating the anterior and posterior walls to correct uterine prolapse; generally performed only on elderly patients

20. Hysteroscopy - direct visualization of the interior of the uterus to diagnose or treat
disease via a fiberoptic scope
Laparoscopic assisted vaginal hysterectomy removal of the uterus through an incision
in the vaginal wall and pelvic cavity, with the addition of a n endoscope for visualization.
Trachelorrhphy - removal of torn surfaces of the interior and posterior cervical
lips and reconstruction of the cervical canal when surfaces are free of infection and women are past child bearing age.
(med. Dict. = suture of a laceration of the uterine cervix)

21. Most common lasers – Argon CO2 ND:YAG
Applications of lasers for Gyneclogical surgery –
Eradication of Bartholin’s duct abscess

22. Types of Genital Fistulas
rethrovaginal fistula - fistual between urethra & vagina
Vesicovaginal fistula - fistual between cervix & vagina ????
Rectovaginal fistula - fistual between rectum & vagina

23. Special features of obstetrics and gynecologic operations
Patient is catheterized in OR (if not beofre) to prevent the bladder from becoming distended during the surgical procedure and to record urinary output.
Spinal or general anesthesia is primarily used.
Vaginal procedures are usually performed with the patient in lithotomy position.
Because of hazards of infection, separate sterile setups for vaginal & abdomen performed concurrently.
Medicated vaginal packing may be inserted following certain procedures.
In the abdominal approach, supine or Trendelenburg position is used.
Instrumentation for abdominal procedures includes basic laparatomy setup with the addition of long instruments for deep manipulations within the pelvis and/or laparoscopic instruments.

24. Basic OB/GYN medications and solutions
Lugol’s solution - strong iodine solution applied to vaginal tissue and the cervix
to identify abnormal tissue
methylene blue - dye used diluted in normal saline during chromotubation
to check for patency

25. Specialized abdominal hysterectomy instruments
O’Sullivan-O’Connor retractor
Heaney hysterectomy forceps or Heaney-Ballentine forceps
Heaney needleholder (curved at end)
Jorgenson scissors (long) (curved)

26. Specialized vaginal instruments
Auvard vaginal speculum, weighted
Graves self-retaining vaginal speculum (duck bill)
Uterine sound
Leep loop electrodes - used to take 1 cervical biopsy at the cervical
canal providing hemostasis at same time
Uterine forceps
Hysteroscope set

27. Uterine manipulator - inserted into the end of cervical canal to allow
for the manipulation of the uterus during laparoscopic procedure & some require suction during procedure
entrauterine cannula - uterine manipulators; methylene blue administered
into the tube
Benton forceps - used to clamp edges of the uterus after delivery
of infant during C-section

28. Procedure for D & C
With the patient in the lithotomy position, surgeon inserts a weighted speculum
into the vaginal outlet and grasps the cervix with a tenaculum.
Surgeon carefully introduces a graduated sound into the cervix to determine the depth and direction of the uterine cavity and therefore precent perforation during the procedure.
Surgeon uses curette of choice to obtain an endocervical tissue specimen.
Surgeon passes endocervical specimen to technologist. Two specimens are usually taken and must be kept separate and labeled as such.
Surgeon slowly dialates the cervix using Hegar or Hanks uterine dilators.

29. Surgeon places a Telfa strip over the speculum.
Surgeon gently curettes uterus, allowing the endometrial specimen to collect on the Telfa.
Surgeon passes endometrial specimen to technologist, and removes the speculum.
Surgeon or scrun person dresses perineum with a perineal pad.

30. Procedure for Repair of a Cystocele and Rectocele
Patient is placed in lithotomy position, prepped, and circulator performs a
straight catherization.
Surgeon inserts a weighted speculum into the vaginal outlet, grasps the cervix
with a tenaculum, and brings it forward.
Surgeon makes an incision in the anterior vaginal wall.
Incision edges are grasped with several clamps and retracted.
Surgeon deepens the incision with sharp and blunt dissection, and advances the
incision through the vaginal wall and into the fascia that lies behind it using additional clamps as needed.

31. When bladder neck is reached, surgeon places several absorbable sutures,
size 0, through the fascia, thus tightening the tissue to prevent the bulging.
Surgeon excises the vaginal mucosa, and approximates the vaginal walls with
absorbable sutures to complete the anterior repair.
To begin the posterior repair, surgeon places 2 Allis clamps on each side of the vaginal outlet on the posterior side.
Assistant offers traction with the clamps while surgeon makes a transverse incision in the mucosa.

32. Surgeon deepens the incision with curved Mayo or Metzenbaum scissors to the level of the rectum.
To correct the bulging of the rectum, surgeon brings the levator muscles together with interrupted absorbable sutures, size 2-0.
Surgeon excises the excess vaginal mucosa, and reconstructs the vaginal wall with interrupted absorbable sutures, size 2-0 swaged to a small needle.
Surgeon usually inserts a Foley or suprapublic catheter, and dresses the vagina with medicated packing.

33. Vaginal Hysterectomy
Patient is placed in the lithotomy position, prepped, and bladder is drained.
Surgeon grasps the cervix with a uterine tenaculum, and makes a circular incision
around the cervix using the knife or curved Mayo scissors.
Surgeon double-clamps, divides, and ligates the first set of ligaments with absorbable
suture ligatures of size 1 or 0 mounted or swaged to a heavy tapered needle.

34. Surgeon picks up the posterior peritoneum with toothed tissue forceps and incises it
with the knife or scissors.
Surgeon detaches the peritoneal attachment to the bladder with Mayo scissors.
Surgeon continues mobilization of the uterus using long tissue forceps and long
dissecting scissors.
When uterus is mobilized, surgeon delivers it to the technologist as a specimen.
Surgeon reperitonealizes the bladder, closes the peritoneum, inserts a Foley catheter,
and may dress the wound with a perineal pad.

35. Procedure for Abdominal Hysterectomy
Patient is placed in supine position, prepped, abdominally and vaginally and a Foley
catheter is inserted.
Surgeon incises abdomen using a lower midline incision or Pfannanstiel incision, and
deepens the incision through the subcutaneous tissue with the deep knife or electrosurgical pencil.
Surgeon nicks fascia with the knife, incises with curved Mayo scissors, grasps fascial
margin with two or more Kocher clamps, and separates fascia from underlying muscle using blunt dissection.
Surgeon divides the muscle layer manually.
Surgeon nicks peritoneum with the knife, lengthens with Metzenbaum scissors, and places in wound a self-retaining retractor such as O’Connor-O’Sullivan or Balfour.
Surgeon packs bowel away from the uterus with moist lap sponges.

36. Surgeon isolates the uterus by severing it from the uterine ligaments, ovaries, and fallopian tubes by double-clamping, dividing, and ligating with absorbable sutures.
Surgeon separates the uterus and the bladder using Mayo scissors and tissue forceps by dissecting the peritoneal covering away from the bladder.
Surgeon mobilizes uterus, places long Allis or Kocher clamps around the margin of the vaginal cuff, and then divides it from the vagina using long scissors or the long knife to completely free the uterus.

37. Surgeon passes uterus to technologist as a specimen and places all instruments that have come in contact with the cervix or vagina in the designated basin.
Surgeon closes vaginal vault usually with the same type of suture used on the uterine ligaments while a sponge count is taken.
Surgeon reperitonealizes the bladder flap with 2-0 or 3-0 absorbable swaged suture.
Surgeon closes the layers of the abdomen using sutures of choice.

38. Procedure for Laparoscopy
Patient is placed in a modified lithotomy position with lowered stirrups, is vaginally
and abdominally prepped, and the bladder is drained.
Technologist gloves surgeon.
Surgeon inserts uterine manipulator into the cervix.
Circulator removes surgeon’s gloves and technologist gowns and gloves the surgeon.
Surgeon makes a small nick in the abdominal wall close to the umbilicus.

39. Surgeon inserts an insufflation needle through the incision and attaches a 10-cc syringe filled with saline solution so the surgeon can aspirate to make sure that a blood vessel has not been punctured.
Surgeon attaches a length of flexible tubing to the needle while one end of the tubing is passed to the circulator, who connects it to the insufflator.
Circulator activates the insufflator and the abdomen is slowly filled with carbon dioxide which creates a pneumoperitoneum.
When sufficient gas has entered the abdomen, surgeon withdraws the needle

40. Technologist dips scope in hot water or antifogging solution wipes the lens with soap so the scope’s lenses do not fog.
Surgeon inserts the laparoscope into the sleeve and connects the light source cable.
Surgeon examines the abdominal contents for disease or injury, and then performs whatever additional procedure is decided upon, if needed.
Surgeon allows gas to escape through the sleeve, removes the sleeve, closes the incision(s) with subcuticular absorbable suture, and dresses with adhesive-bandages (Band-Aids).

41. Hysterectomies
allows for easier removal of the tubes and ovaries (& appendix)
At the same time
Provides better exposure
Is operation of choice for leiomuomata, adenomyosis, & uterine cancer
Is indicated for fibroid tumors that may be too large to remove vaginally
Is a cleaner procedure since it is not near the anal area
Allows for exploration of abdominal organs, esp. if cancer is suspected

42. Vaginal leaves no visible incision scar
Is indicated for prolapse of the uterus
Procedure requires least amount of time
Recovery period requires less time

43. Laparoscopic assisted vaginal hysterectomy
Lease minimal scars at puncture sites
Leaves no visible incision scar
Is indicated for prolapse of the uterus
Provides better exposure
Recovery period requires less time
Allows for exploration of abdominal organs, esp. if cancer is suspected

44. Procedure for a Cesarean Section
When the patient is placed in the supine position, her right hip may be elevated.
When spinal anesthesia is used, the patient will be prepped after being Anesthetized with general or spinal and then prepped.
Surgeon enters through lower midline incision or pfannenstiel.
Assistant retracts downward with bladder retractor.
Assistant pushes firmly on the upper abdomen while surgeon grasps newborns head and takes it upward.

45. Procedure for a Cesarean Section cont.
Cord samples
Four blood samples are taken
Surgeon manually takes the placenta and places on the field.
Surgeon closes uterus using preferred clams and suture while first count is taken.
Surgeon closes layers of abdomen with suture of choice.
Note: After the newborn is delivered, he/she is normally handed over to the
Pediatrician for neonatal care and assessment