Thursday, April 30, 2015

Cervical insufficiency (incompetent cervix)

Painless early pregnancy dilation

Etiology

  • Trauma from rapid forceful cervical dilation associated with 2nd trimester abortion
  • Cervical laceration from rapid delivery
  • Injury from deep cervical cone
  • Congenital weakness from DES exposure

Diagnosis:


  • History of 2 or more unexplained second trimester pregnancy losses.
  • Benefit of cerclage is unclear  


Management: 


  • Elective cerclage at 13-16 weeks gestation
  • Emergency or Urgent cerclage
  • Cerclage removal at 36-37 weeks

Thursday, April 23, 2015

Fetoscopy

When to perform : 18-20 weeks
  • its for Biopsy of fetal tissue and IU surgery
  • Loss rate : 2-5 % 




Friday, April 10, 2015

Management of Cervical Neoplasia in Pregnancy

Cervical Neoplasia in Pregnancy

Dx: Colpo & Biopsy, Do not perform ECC because of increase vascularity

Management of Cervical Neoplasia in Pregnant .

CIN intraepithelial :

  • Pap & Colpo every 3 months
  • PP 2 months: revaluate & Rx


MICRO invasion  :

  • Cone biopsy: r/o frank invasion Follow conservatively, then Vaginal Delivery
  • PP 2 month: treat residual lesions


FRANK invasion :
  • less than 24 wk: ignore pregnancy, Rx CA
  • greater than 24 wk: wait to 32 wk, then CS & treat CA per staging 

RAH :

Radical abdominal hysterectomy (RAH)


  • Radical abdominal hysterectomy specimen with fetus in situ performed at 18 weeks of gestation for stage IB cervical cancer.

Thursday, April 9, 2015

Trimethylamineuria (Fish Odor Syndrome)

Trimethylamineuria (Fish Odor Syndrome)
  • autosomal recessive



  • A rare clinical entity with an offensive persistent odor that no amount of bathing or washing or perfuming will correct.

Vaginal Discharge

Differential Diagnosis :  Normal : Lactobacillus 70 % and non-Lactobacillus 30 %





  • Bacterial Vaginosis  ----- 50 %
  • Candida                    ----- 30 %
  • Trich                         ----- 15 % 


Visual inspection : Inflammatory response Vaginal discharge e.g thin-thick gray-white-green,frothy

Vaginal pH : Normal: < 4.5 Use Nitrazine paper

Micro-exam : Wet Prep Saline and KOH

Wednesday, April 8, 2015

Urinary incontinence types and its treatment

Ask your patient about the symptoms ? 

Bladder diary: Name / Date

Fluids
  • type and amount of fluids

Urination 
  • Strong urge to urinate (Y,N)
  • Amount urinated in toilet (S,M,L)

Accidents
  • Amount of leakage (S,M,L)
  • Activity preceding leakage

Here are the examples of Urinary incontinence

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