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Adnexa

Appendages or accessory structures of an organ.

Bony pelvis

The 4 bones of the pelvis that make up the lower part of the trunk of the body; serves to support the upper body and protect the pelvic organs.

Breech

Intrauterine position of a fetus in which that buttocks or feet present first.

Cesarean section (C-section)

A surgical procedure in which the abdomen and uterus are incised to deliver a baby.

Corpus luteum

Short-term endocrine gland. A small mass of yellow-colored tissue that develops on the ovary and that grows within the ruptured ovarian follicle after ovulation; responsible for secreting progesterone to maintain the high level of vascular supply to the uterine endometrium for the purposes of implantation and pregnancy. If conception takes place it will continue to grow and secrete progesterone.

Dystocia

Difficult birth due to various reasons, such as cephalopelvic distortion, fetus size, or condition or position of fetus.

Dysmenorrhea

Painful menstruation.

Episiotomy

The surgical incision of perineum to enlarge the vaginal opening and prevent tearing of the perineum and muscles during delivery.

Exenteration

Refers to total removal of; usually used in reference to the surgical procedure of total pelvic exenteration, which involves the removal of the vagina, uterus, and cervix, fallopian tubes, ovaries, bladder, and rectum for surgical treatment of cancer.

Fimbria

Finger-like structures that form on an edge of the fallopian tubes.

Fistula

Abnormal communication between to normally seperate internal structures, or an abnormal communication between an internal structure and the body surface.

Gravida

Refers to the pregnant female; in reference to number of pregnanncies.

LEEP

Loop Electrosurgical Excision; Surgical procedure that uses the electrosurgical unit coupled to a loop electrode on the cautery pencil; used to excise a cone of tissue to remove an area of neoplasia.

Ligament

A band of fibrous tissue composed of collagen that connects bone to bone.

Marsupialization

Incision of a closed cavity with the suturing of the opened edges to the wall of the wound to form an open wound that will heal by second intention.

Myoma

A benign fibroid tumor of the uterus.

Occiput anterior

The most common relationship between the presenting fetal part and the maternal body pelvis.

Parity

The classification used to indicate the number of live and stillborn births that a female has delivered at more than 20 weeks of gestation (viability).

Perineum

The diamond shaped wedge of fibromuscular tissue between the posterior portion of the vagina or scrotum and the opening to the anus. Forms the base of the perineal floor and posterior wall of the vagina. The levator ani muslces form a sling to keep the pelvic contents intacts during coughing, straining, or bearing down in labor.

Pfannenstiel

Surgical transverse incision made in the lower abdomen, uaully employed when performing a C-section.

Vestibule

Smooth area surrounded by minora; includes urethra, vagina, and Bartholin's glands

What is the fornix?

The annular recess created by the cervical-vaginal junction.

What are the 3 layers of the uterine wall?

Peritoneum, myometrium, and endometrium

Where are the Bartholin's glands located and that is their function?

They are located within the vestibule and they secrete a lubricating mucoid substance.

List the structures contained within the broad ligament.

Uterine fallopian tube, the round and ovarian ligaments, various blood vessles, nerves, and lymphatics.

What are the 2 other names for the fallopian tubes?

Uterine tubes and oviducts.

Name the 2 hormones from the anterior pituitary that stimulate the ovarian cycle.

Luteinizing hormone (LH) and follicle stimulating hormone (FSH).

Name the 2 hormones that are produced by the ovary.

Estrogen and progesterone.

What is the main muscle of the pelvic floor? Name it's 3 components.

Levator ani muscle; it's 3 components are, 1) iliococcygeal 2) pubococcygeal and 3) puborectalis.

Labia Majora

Rounded prominent longitudinal flaps, the large outer lips. Contains sebaceous and sweat galnds, covered in a triangle of hair - after menopause the labia majora atrophies.

Vulva

The external female genitalia.

Mons pubis

Rounded elevated portion of fatty tissue prominence over symphysis pubis, covered with hair.

Clitoris

Erectile structure of the female anatomy, it's the female equivalent to the penis.

Labia minora

Connective tissue within the labia majora, they are the 2 smaller lips that contain sebaceous glands. The anterior portion forms the prepuce of the clitoris, the medial sides form the frenulum

Anus

Rectal oriface.

Hymen

Thin fold of membrane just inside the vaginal oriface.

T or F; The uterus is pear shaped with a fundus, body, and cervix.

True

What are the ligaments connected to the pelvic wall?

Cardinal, round, and infundibulopelvic.

The graafian follicle

Releases the oocyte,

The corpus luteum releases ____?___ to maintain the endometrial lining.

False; progesterone.

T or F; The pituitary gland releases LH and FSH to stimulate development of an oocyte or ovum.

True

Blood flow is supplied to the uterus via branches of the ?

Internal iliac artery

The ___?___ of the fallopian tube is important in the prevention of endometriosis.

Cornu

Are Braxton-Hicks contractions an indication that delivery of the fetus is imminent?

No, they are normal contractions not associated with progressive cervical dialation=false labor.

Effacement

Cervix softens and thins.

Dilation

Opening of the cervix.

Presentation

Fetal part overlying pelvic inlet.

Para

Number of times giving birth.

Crowning

Largest diameter of head encircled by vulvular ring.

Station

Descent of presenting part of fetus in relation to ischial spines.

CPD

Cephalopelvic disproportion; Fetus' head is too large for maternal birth canal. Usually ends up being delivered via C-Section.

First stage of vaginal delivery

Onset of true labor and is considered complete when the cervix is fully dialated.

Second stage of vaginal delivery.

Complete dialation of the cervix and terminates with the birth of the infant.

Third stage of vaginal delivery.

Initiated with the birth of the infant and ends when the placenta is delivered.

Fourth stage of vaginal delivery.

Begins at the point and is completed when the mother's condition has stabilized.

What surgical intervention is commonly done during a normal vaginal delivery?

Episiotomy.

Cord blood is collected routinely with every delivery. Why?

To check cord gases. Also, it's collected for it is rich with stem cells which can be preserved and used for later use if needed.

What does "fetal distress" mean?

Sustained low heart rate.

List the possibe sites for ectopic pregnancy.

Fallopian tubes, peritoneal cavity, ovary, or uterine cervix.

Leiomyoma

Benign leisons of the uterus.

Bartholin's glands

Secrete vaginal lubricant, lies deep in the bulbocavernosus.

Hymen

Thin, vascular membrane of connective tissue that surround the vaginal oriface. Wide variations of thickness and elasticity. The presence or absense of a hyminal ring does not indiacte sexual activity.

The reproductive organs lie in the_______ _________protected by the bony pelvis.

pelvic cavity.

The ________ _______ of the uterus and the ________ constitute the birth canal.

dialated cervix, vagina.

D&C

Dialation and Curettage. Done within 10 minutes, done on women that have polyps, blood clots, and can't stop bleeding. Usually goes on for about a month or more.

D&E

Dialation and Evacuation. Done up to 12 weeks, possibly 16 weeks (1st trimester).

Cone Biopsy

Done w/or without laser, looks for cancerous cells on the cervix.

Hysterectomy

Can be done vaginally, abdomenally, or LAVH (Laproscopic Assisted Vaginal Hysterectomy) which is becoming more common.

Tubal ligation

Usually done after giving birth (PPTL: Post Partam Tubal Ligation), but can be done laparoscopically or transvaginally. Fallopian tubes are cut and tried off to prevent further pregnancies, a permanent procedure. cautery, clips, silastic bands, babcock, Essure.

Why is a foley catheter used?

To prevent bladder distension and possible injury.

What happens if the ureter is accidentally cut?

The patient will most likely die.

DVT

Deep vien thrombosis; which can lead to pulmonary thrombosis, a heart attack, or stroke.

What is used to prevent DVT?

Heparin injection, antiembolitic stockings, sequential compression devices, and early ambulation.

Why are lasers used over ESU?

Lasers can make fine cuts that don't have the effect of a deep thermal burn like the ESU.

Hypertrophied

overgrowth of tissue.

Why would the patient be put into Trendelenburg postion for an abdominal apporach?

It shifts the organs upward so the surgeon can get a better view.

What are adhesions?

bands of scar tissue.

Adhesions may cause?

Infertility, intestinal obstruction, and chronic pain.

What are some diagnostics that are used when looking at the vagina?

Pelvic exam, Pap smear (Papanicolaou), cytological aspirations for cancer of the endometrium, fallopian tubes, ovaries or cervix, and the Schiller Test.

What is the Schiller test?

It's the staining of the vaginal vault and cervix with Lugol's solution to determine areas of abnormal tissue for biopsy. Normal tissue satins brown/abnormal stains white or does not take up the iodine.

Uterine Cancer consists of:

Cervical cancer (cervix) and Endometrial cancer (w/i the uterine lining).

Endometrial cancer is more common than_______ and occurs more in _______________ women.

Cervical cancer, postmenopausal.

Cervical cancer effects....

Those with early sexual intercourse, multiple partners, non barrier contraceptives, poor sexual hygiene, chronic cervical infections of hx of STD's.

Why is a sound used before any procedure is done?

A sound is placed to determine uterine depth so the uterus dosen't get perferated.

What are some complications that can arise with a D&C and a D&E?

Perforation of the uterus, laceration of the cervix, tear in the internal OS, damage to other pelvic organs, excessive bleeding (monitered for 6 hours), post-op infection.

Excisional biopsy on the cervix is the removal of the...

entire lesion, may require sutures and hemostasis for the cervix is highly vascular (have raytecs handy).

Insisional biopsy on the cervix can be done by a_______ _______ or a _______.

Punch biopsy, LEEP (Loop-Electrocautery Excisional Procedure).

Colposcope

Is an instument that shines a light on the cervix and magnifies the view for the doctor.

_______ ________ is applied to the cervix and vagina with a cotton ball or swab. The solution turns abdnormal tissue ______ for identification of areas that may need further evaluation.

3% acetic acid, white.

Colposcopy-directed biopsy

Is a procedure in which the cervix is examined with a colposcope for abnormalities and a tissue sample is taken.

Cervical biopsy

Done on patients that have been diagnosed by PAP smear for severe cervical dysplasia or intraepithelial cancer of the cervix.

Cold cone biopsy

Is a surgical procedure requiring general anethesia and is done from the presense of precancerous changes in the cervix. A large area of tissue around the cervix is excised for examination in Pathology.

Cervical punch biopsy

The cervix may be stained with iodine solution (Lugols) in order to see abnormalities better. A small tissue samples are taken from the cervix and examined for disease or other problems. Usually done in a drs office.

Tubal Perfusion

To test tubal patency using methylene blue and saline. Using a laparoscope, dye entering the uterus from the fallopian tubes indicate patency.

Hysterosalpingography

Infertility radiologic study of the uterus and tubes after repeated negative Ruben testing.

Pelvic laparoscopy

a sx procedure that examines and treats pelvis organs through a small sx viewing instrument (laproscope) inserted into the abdomen at the naval.

When will a pelvic laparoscopy be recommended?

Pelvic pain due to Endometriosis (uterine tissue found outside of the uterus), abdominal infections, suspected twisting/torsion of an ovary, ovarian cyst, scar tissue, perforation of the uterus following a D&C or by and IUD, evaluation of infertility, sterilization, evaluation and removal of an abnormal pelvic mass, removal of uterine fibroids (myomectomy), removal of the uterus (hysterectomy), sx tx of tubal pregnancy, and evaluation of a women who may have appendicitis or salpingitis.

Complications and considerations with pelvic laparoscopy.

Care must be taken not to perforate blood vessels, the uterus or bladder, Perforation leads to infection, this is a sterile procedure, and surgeon expertise, patient selection, and adequate anesthesia and safe equipment are essential.

Hysteroscopy

Introduction of scope to allow inspection of interior of uterus & tube openings. Is used to diagnose and treat many uterine disorders, including extremely heavy periods and abnormal bleeding.

Diagnostic hysteroscopy

Is performed to examine the uterus for signs of normalcy or abnormality (myomas).

Abnormal bleeding may be caused by a _______ _______, it may also be caused by benign growths, such as ______ ______ or ______.

hormonal inbalance, fibroid tumors, polyps.

In some cases, abnormal bleeding may be a sign of __________ ________, particularly in women over 45 (postmenopausal bleeding).

endometrial cancer.

Why is postmenopausal bleeding a concern?

It is usually a key sign that someone has endometrial cancer. You are considered postmenopausal when you have experienced no bleeding for 1 year. If you start bleeding after that time frame, you need to see your dr.

Air or gas are not used to expand the uterus for danger of air or gas embolism. What is used instead?

Glycine (liquid glucose), saline, or hyskon can be used.

Diagnostic laparoscopy

Is used to view a women's reproductive organs-uterus, ovaries, tubes, and bearby organs.

Colporrhaphy

For prolapsed vaginal wall r/t urethrocystocele (herniation of bladder into vaginal canal)

Enterocele (Cul-de-sac Hernia)

Bowel herniates in the vaginal Cul-de-sac (pouch of Douglas)

Vesicovaginal

Bladder/vagina fistulas. May also include urethra(urethrovaginal) and/or ureters (ureterovaginal)

Rectovaginal

rectum/vagina fistulas

Cystocele

Prolapse or protrusion of the bladder into the vagina. Caused by a defect in the pubocervical fascia - fibrous tissue that seperates the bladder and vagina.

Urethrocele

Prolapse of the urethra into the vagina.

Rectocele

Prolapse or protrusion of the rectum into the vagina caused by a defect in the rectovaginal fascia - fibrous tissue that seperates the cecum and vagina.

Enterocele

Prolapse of the small bowel into the vagina.

Prolapse

Occurs when an organ falls or sinks out of its normal anatomical place.

Uterine prolapse

Occurs when the uterus protrudes downward into the vagina.

Factors that are linked to pelvic organ prolapse include:

Age, repeated childbirth, hormone deficiency, ongoing physical activity, and prior hysterectomy.

Symptoms of prolapse

Stress incontinence, a vaginal bulge, painful sexual intercourse, back pain, difficult urination or bowel movements.

Colporrhaphy may be performed on the ______ and/or _________ walls of the vagina.

Anterior (front), posterior (back)

What does an anterior colporraphy treat?

Cystocele or urethrocele.

What does a posterior colporrhaphy treat?

Rectocele

What is a cystogram used for?

A cystogram may be used to determine the extent of a cystocele; the bladder is filled by urinary catheter with a contrast medium and then X-rayed.

Menorrhagia

Excessive uterine bleeding.

Metrorrhagia

Intermenstrual bleeding, bleeding between regular menses which may be associated w/either benign or malignant conditions that requires further investigation.

Why is a caesarean birth done?

Eclampsia, active genital herpes in the mother, uterine dystocia (difficult labor), breech birth, and fetal distress.

Maternal indications for a cesarean...

Diseases such as eclampsia or preeclampsia, cardiac disease, diabetes mellitus, cervical cancer, herpes. Previous C births (classic type), previous uterine surgery (full thickness myomas), a previous uterine rupture, obstruction to birth canal, fibroids, ovarian tumors, dystocia, or maternal demise.

Fetal indications for a cesarean...

Fetal distress, prolapsed umbilical cord, breech, transverse presentation, multiple births (depends on number and presentation), and fetal demise.

Placenta previa

placenta that is implanted in the lower uterine segment

Placenta abruption

the placenta breaks away from the wall of the uterus too early, before the baby is supposed to be born.)

The incidence of an ecoptic pregnancy is higher among women with...

previous tubal disease, tubal surgery, previous ectopic pregnancy, assisted reproduction, and IUD users.

Cornual ectopic

These ectopics grow in the portion of the tube that passes through the uterine cornua. These tend to rupture early and violently, with massive abdominal hemorrhage. Many of the fatalities due to ectopic pregnancy are from cornual pregnancies.

First degree perineal laceration

Involves the vaginal mucose or perineal skin.

Second degree perineal laceration

Extends into the vaginal submucosa or perineum with or without the perineal body musculature being involved.

Third degree perineal laceration

Involves the anal sphincter.

Fourth degree perineal laceration

Involves the rectal mucosa.

Cervical Cerclage (Shirodkar's procedure)

Is the placement of a large diameter Dacrom or Mersilene taope around the cervix at the level of the internal OS to prevent spontaneous abortion. The procedure is usually performed in late second trimester or early third trimester of pregnancy to correct an incompetent cervix.

Tuboplasty

Microscopic resection and anastomosis of the fallopian tube to restore tubal patency. It is the operative choice when infertility is secondary to tubal obstruction.

Why would a Simple Vulvectomy be performed?

It's performed on women with multifocal in situ neoplasia of the vulva.

Myomectomy

The surgical removal of uterine fibroids from the muscular myometrial wall.

When doing a hysterectomy, why would the ovaries be left behind?

So the patient won't go into early menopause. Ovaries are usually left behind for their hormonal value.

Oophorectomy

Removal of the ovaries.

Salpingectomy

Removal of part or all of the fallopian tube.

The pelvic girdle consists of the_________.

iliac crest, ischia, pubic bones, and sacrum.

Bartholin's glands are located within the _________.

vestibule.

The pH of vaginal fluids is________.

Acidic.

The uterine lining is called the_________.

Endometrium.

The ligament that supports the bulk of the ovary is called the _________ ligament.

suspensory.

The uterine tubes are contained within the _______ ligament.

broad.

The uterine appendages are the _________.

ovaries and fallopian tubes.

Which is a synonym for the fallopian tubes?

Uterine tubes.

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