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Gynecology and Obstetrics

Gynecology and Obstetrics. What are the organs of the female reproductive system? What do they look like - size and shape How are they connected?. Anatomy and physiology. Birger Bre um, MD, OB/GYN. 14/10-2010. Gynecology and Obstetrics. Anatomy and physiology.

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Gynecology and Obstetrics

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  1. Gynecology and Obstetrics What are the organs of the female reproductive system? What do they look like - size and shape How are they connected? Anatomy and physiology Birger Breum, MD, OB/GYN. 14/10-2010

  2. Gynecology and Obstetrics Anatomy and physiology Birger Breum, MD, OB/GYN. 14/10-2010

  3. Gynecology and Obstetrics Anatomy and physiology Birger Breum, MD, OB/GYN. 14/10-2010

  4. Gynecology and Obstetrics What is the purpose of the uterus? What is the purpose of the ovaries? How does the egg (secondary oocyte) get to the uterus? Where does the egg meet the sperm cells? What happens after fertilisation? Anatomy and physiology Birger Breum, MD, OB/GYN. 14/10-2010

  5. Gynecology and Obstetrics Anatomy and physiology Birger Breum, MD, OB/GYN. 14/10-2010

  6. Gynecology and Obstetrics Birger Breum, MD, OB/GYN. 14/10-2010

  7. Gynecology and Obstetrics Guess (hopefully qualified) what we see in this video. Female Sterilization What other forms of birth control do you know? Male condom, female condom, diaphragm,  spermacides (gel, foam...). birth controll pill, nuvaring, IUD, injectable contraception (solid og fluid)...... Birth Control Birger Breum, MD, OB/GYN. 14/10-2010

  8. Gynecology and Obstetrics Pathology - what can go wrong? Cancer Infection Cysts Torsion Fibroma Polyps..... Pregnancy related Bleeding Pain Nausia Abortion (&missed abortion) Ectopic pregnancy Birger Breum, MD, OB/GYN. 14/10-2010

  9. Gynecology and Obstetrics 22 year old female, goes to the ER due to abdominal pain. What do we want to know? Description of pain. Where in the cycle? Is she pregnant? Is she (or has she been) sexually active?Temperature? Urinetest for (HCG, Leukocytes, Nitrate) A clinical case Birger Breum, MD, OB/GYN. 14/10-2010

  10. Gynecology and Obstetrics 22 year old female, goes to the ER due to abdominal pain. Case 1 Pain started suddenly, 20 hours ago, varies, pain gets worse when moving around, started diffusely, now worst in lower right abdominal quadrant. Period 2 weeks ago. She has not been sexually active for the last three months. Temperature 38,4 C. Urinetest: HCG negative, 2+ Leukocytes, Nitrate negative) Appendicitis, Cystitis or PID? A clinical case Birger Breum, MD, OB/GYN. 14/10-2010

  11. Gynecology and Obstetrics 22 year old female, goes to the ER due to abdominal pain. Case 2 Pain started slowly, a few days ago, varies, pain gets worse when moving around, low in the middle og the abdomen. Period 2 weeks ago. She has not been sexually active for the last three months. Temperature 38,4 C. Urinetest: HCG negative, 2+ Leukocytes, Nitrate positive) Cystitis! A clinical case Birger Breum, MD, OB/GYN. 14/10-2010

  12. Gynecology and Obstetrics 22 year old female, goes to the ER due to abdominal pain. Case 3 Pain started suddenly, 20 hours ago, varies, pain gets worse when moving around, started diffusely, now worst in lower right abdominal quadrant. Trying to get pregnant, but started to bleed around 3 weeks late (usually has irregular menstruation), the bleeding was yesturday.  Temperature 37,4 C. Urinetest: Leukocytes negative, Nitrate negative) Should we take HCG? A clinical case Birger Breum, MD, OB/GYN. 14/10-2010

  13. Gynecology and Obstetrics 22 year old female, goes to the ER due to abdominal pain. Case 3 Pain started suddenly, 20 hours ago, varies, pain gets worse when moving around, started diffusely, now worst in lower right abdominal quadrant. Trying to get pregnant, but started to bleed around 3 weeks late (usually has irregular menstruation), the bleeding was yesturday.  Temperature 37,4 C. Urinetest: HCG positive, Leukocytes negative, Nitrate negative) A clinical case Birger Breum, MD, OB/GYN. 14/10-2010

  14. Gynecology and Obstetrics 22 year old female, goes to the ER due to abdominal pain. Case 3 Pain started suddenly, 20 hours ago, varies, pain gets worse when moving around, started diffusely, now worst in lower right abdominal quadrant. Trying to get pregnant, but started to bleed around 3 weeks late (usually has irregular menstruation), this was yesturday.  Temperature 37,4 C. Urinetest: HCG positive, Leukocytes negative, Nitrate negative) Abortion? Extra uterine pregnancy? VIDEO 3 A clinical case Birger Breum, MD, OB/GYN. 14/10-2010

  15. Gynecology and Obstetrics 22 year old female, goes to the ER due to abdominal pain. Case 4 Pain started suddenly, 20 hours ago, varies, pain gets worse when moving, started diffusely, now worst in lower right abdominal quadrant. Trying to get pregnant, but started to bleed around 3 weeks late (usually has irregular menstruation), this was yesturday.  Temperature 37,4 C. Urinetest: HCG positive, Leukocytes negative, Nitrate negative) But ultrasound yesturday: Normal pregnancy! A clinical case Birger Breum, MD, OB/GYN. 14/10-2010

  16. Gynecology and Obstetrics • Symptyms of spontanious abortion are: Bleeding and pain, but one or both might not be present (asymptomatic) • Symptyms of extrauterine pregnancy are: Bleeding and pain, but one or both might not be present (asymptomatic) • Around 20% of normal pregnanciesbleed one or more times. • Around 20% of normal pregnancieshave pain or more times.  • SOLUTION: • Ultrasound and S-HCG Early pregnancy diagnostics problems Birger Breum, MD, OB/GYN. 14/10-2010

  17. Gynecology and Obstetrics Birger Breum, MD, OB/GYN. 14/10-2010

  18. Gynecology and Obstetrics • Nausia • Hypertension, before or because of pregnancy • Preeklampsia (hypertension, protein in urine...) • Diabetes, before or because of pregnancy • Obesity • Astma • Infections do usually not harm foetus. Exceptions (rubella, toxoplasmosis, Group B streptococs....) • Bleeding • Intra uterine growth retartion • Abortion/foetal death • Medicine-changes needed.(Myxoedema, depression) Some later pregnancy conditions/problems Birger Breum, MD, OB/GYN. 14/10-2010

  19. Gynecology and Obstetrics Children that are born between the 36th and 39th week (38 and 41 weeks after the Last Menstrual Period) are considered as being normal term deliveries. Statistically, only 2/3 of all children are born within the 3 weeks around the calculated date of birth and around 80 % within a month around the predicted date of birth. Normal delivery Birger Breum, MD, OB/GYN. 14/10-2010

  20. Gynecology and Obstetrics • Delivery proceeds in three periods: • Dilatation period • Expulsion or press period (subdivided into 4 phases) • After-birth period Normal delivery Birger Breum, MD, OB/GYN. 14/10-2010

  21. Gynecology and Obstetrics During delivery the infantile head has to conform to the various pelvic sections.  In the expulsion period the first 3 phases describe the development of the head while phase 4 that of the shoulders, whereby the head rotates 90° back again. Normal delivery Birger Breum, MD, OB/GYN. 14/10-2010

  22. Gynecology and Obstetrics Normal delivery Birger Breum, MD, OB/GYN. 14/10-2010

  23. Gynecology and Obstetrics Press Period Problems (Expulsion problems)? Consider the 3 Ps Power (or Push or Pattern of contractions) Pelvis (not large enough?) Passenger (Babysize, baby orientation) Usually a comPnation (combination) of the three Normal delivery Birger Breum, MD, OB/GYN. 14/10-2010

  24. Gynecology and Obstetrics Helping the baby along: Enforsing contractions:  oxytocin-drip Direction and force: vacuum extraction/Forceps Manual manipulation Alternative route. Operation: C-section Pathological delivery Birger Breum, MD, OB/GYN. 14/10-2010

  25. Gynecology and Obstetrics Post partum bleeding Fysiological (normal bleeding) 300-500 ml Pathological >500 ml Imediate action (operating theater) >1000 ml Pathological delivery Birger Breum, MD, OB/GYN. 14/10-2010

  26. Bleeding >500 ml is patological. Consider: Tonus: Atonia Tissue: in uterus (placenta/clots) Traume: Tears Thrombin: Koagulation - maybe secondary to bleeding Bleeding > 1000 ml: Intrauterine palpation, tears in collum, vagina and perineum – Operating theater Match-test, Hgb, plateles, factor 2-5-7, APTT - perhaps. DIC-screening Gynecology and Obstetrics Pathological delivery Birger Breum, MD, OB/GYN. 14/10-2010

  27. Treatment Call help: obstetrician, midwife in charge, healtcareworker Empty bladder Uterus massage and compression. Observations (Respiration, BP, pulse, i.v. fluids, estimated bloodloss, diuresis and medicin). Trendelenburgs IV acces 2 large - Bloodmatch NaCl 2 liter, Plasma expanders 500 - 1000 ml. Oxygen  Medicin Intrauterine palpation. Gynecology and Obstetrics Pathological delivery Birger Breum, MD, OB/GYN. 14/10-2010

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