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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.
Cesarean section (C-section)
A surgical procedure in which the abdomen and uterus are incised to deliver a baby.
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.
Difficult birth due to various reasons, such as cephalopelvic distortion, fetus size, or condition or position of fetus.
The surgical incision of perineum to enlarge the vaginal opening and prevent tearing of the perineum and muscles during delivery.
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.
Abnormal communication between to normally seperate internal structures, or an abnormal communication between an internal structure and the body surface.
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.
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.
The most common relationship between the presenting fetal part and the maternal body pelvis.
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).
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.
Surgical transverse incision made in the lower abdomen, uaully employed when performing a C-section.
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.
Name the 2 hormones from the anterior pituitary that stimulate the ovarian cycle.
Luteinizing hormone (LH) and follicle stimulating hormone (FSH).
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.
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.
Rounded elevated portion of fatty tissue prominence over symphysis pubis, covered with hair.
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
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.
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.
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.
List the possibe sites for ectopic pregnancy.
Fallopian tubes, peritoneal cavity, ovary, or uterine cervix.
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 ________ _______ of the uterus and the ________ constitute the birth canal.
dialated cervix, vagina.
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.
Can be done vaginally, abdomenally, or LAVH (Laproscopic Assisted Vaginal Hysterectomy) which is becoming more common.
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.
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.
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 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).
_______ ________ 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.
Is a procedure in which the cervix is examined with a colposcope for abnormalities and a tissue sample is taken.
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.
To test tubal patency using methylene blue and saline. Using a laparoscope, dye entering the uterus from the fallopian tubes indicate patency.
Infertility radiologic study of the uterus and tubes after repeated negative Ruben testing.
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.
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.
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).
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.
Is used to view a women's reproductive organs-uterus, ovaries, tubes, and bearby organs.
For prolapsed vaginal wall r/t urethrocystocele (herniation of bladder into vaginal canal)
Bladder/vagina fistulas. May also include urethra(urethrovaginal) and/or ureters (ureterovaginal)
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.
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.
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 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.
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.
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.
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.
Second degree perineal laceration
Extends into the vaginal submucosa or perineum with or without the perineal body musculature being involved.
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.
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.
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.
The 3 layers of the uterine wall are the __________.
visceral peritoneum, myometrium, and endometrium.
The 2 hormones from the anterior pituitary that stimulates the ovarian cycle are_______ and ______.
LH and FSH.
A foley catheter is used routinely during a pelvic procedure to ___________.
decompress the bladder to prevent injury.
The trendelenburg position is used to prevent injury and enhance visualizationby displacing the abdominal contents ___________.
Total abdominal hysterectomy involves the removal of which structure(s)?
just the uterus. A radical abdominal hysterectomy involves the uterus, ovaries, and fallopian tubes.
The fornix is the _______.
annular recess created by the cervical-vaginal junction. AKA the cul-de-sac.
All of the following are parts of the uterus EXCEPT the fundus, corpus, fimbrae, and cervix.
Vaginal hysterectomy is used to describe the removal of the ____________.
uterus through a vaginal incision.
The name of the female erectile tissue located directly above the urethral oriface is known as the_______.
Which name is give to the ligament that suspends the uterus anteriorally and supports as a pivot?
Arterial blood supply to the uterus is derived from the uterine branch of which artery?
Which hormone is repsonsible for maintaining the growth of the uterine lining in preperation for implantation and development of ferilized ovum?
What is the name given to a fistula that forms between the bladder and vagina?
Blood, fluid, or pus in the cul-de-sac is aspirated by needle via the posterior vaginal formix for suspected intraperitoneal bleeding, ectopic pregnancy, or tubo-ovarian abscess.
Indications that may lead to infertility?
Immature or abnormal reproductive system, anomalies or organs, endocrine dysfunction, emotional problems, adhesions, STD's, PID, and repeat abortions.
Secondary sexual characteristics, initiates growth of lining of the uterus, regulates the menstrual cycle
Process of fertilization
1.) Release of LH & FSH stimulates begining of ovarian cycle
2.) FSH influences primary follicle development
3.) LH influences ripening of follicle to graafian follical, which then erupts, releasing oocyte into fimbria and fallopian tubes.
4.) Within the ruptured follicle the corpus luteum now grows in the ovary, where it will remain until 6 months gestation.
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