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Showing posts with label OBGYN Test and Procedure. Show all posts
Showing posts with label OBGYN Test and Procedure. Show all posts
Thursday, September 25, 2008
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Magnetic Resonance Imaging

Also known as



MRI (magnetic resonance imaging) is an imaging technique used to get cross-sectional images of the body using strong magnetic field and radio waves (radio frequency pulses) instead of X-rays.

In MRI scanning, patients are placed inside a very large and strong magnet, so that all the protons in the atoms of the patient's body can be aligned to a magnetic field. Then, radio waves (called radio frequency pulses) are directed at the protons (i.e., the nuclei of hydrogen atoms) to excite the protons. Once the radio waves are stopped, excited atoms emit radio signals received by an antenna (i.e., a surface coil in the MRI machine), which are then measured and processed to form an image using a computer.

In the human body, protons are most abundant in the hydrogen atoms of water. Thus, MRI images represent the water content in the area of the exam. The more water present, the more radio signals emitted, and the whiter the image.

MRI can provide a clear and detailed picture of soft tissue structures near and around bones and joints, such as tendons, ligaments, muscles, joint capsules and mass.

Types of MRI

# Head MRI Brain MRI
# Sellar MRI
# Head and Neck MRI
# Orbit MRI
# Temporal MRI

Spine MRI
# Cervical spine MRI
# Thoracic spine MRI
# Lumbosacral spine MRI

Body MRI
# Abdominal MRI
# Male pelvis MRI
# Female pelvis MRI
# Thorax MRI

Cardiovascular MRI (including heart, aorta and blood vessels)

Musculoskeletal MRI
# Ankle MRI
# Hip MRI
# Knee MRI
# Shoulder MRI
# Wrist MRI

Advantages of this procedure

* To provide cross-sectional images in any anatomical plane (upper to lower, right to left, front to back, oblique).
* To provide clear, detailed images of various soft tissues, such as internal organs, tumors, and blood vessels.
* No radiation.
* Compared to the iodine-based contrast medium in X-ray or CAT scan, MRI dye is relatively safe.
* Provides angiographic images without being invasive.
* MRI can evaluate organ function, as well as structure.

How this procedure is performed

You will be asked to lie on the scan table. After proper positioning, the exam table will slide into the center of the magnet.


During actual scanning, you will hear loud tapping noises, but you are required to remain still until it's done (to get clear pictures).

In the event that a contrast medium is needed to make organs and blood vessels stand out, it will be injected into your vein during the exam.

The exam usually takes from 15 minutes to an hour and a half.

Preparation for this procedure

* Wear comfortable, loose-fitting clothing.
* Disrobe in the examining area and put on a hospital gown. Remove any metal objects, such as watches, car keys, wallets, beepers, cellular phones, zippers, snaps, hairpins, jewelry, accessories, eyeglasses, hearing aids and any removable dental work, because they can be affected by the huge magnet and degrade quality imaging. The information on credit cards can be erased by this strong magnetic field.
* Let your radiologist or technologist know when you have a metal object in your body, such as a cardiac pacemaker, prosthetic heart valve, prosthetic hip or knee joint, implanted infusion pump, intrauterine device (IUD), cochlear implant, aneurysm clip or vascular clips, hearing aid, metal monitoring device, surgical staples, metal plates, pins, screws, bullets, shrapnel or any metal fragments. This is because the strong magnetic fields can cause these ferromagnetic metal objects to move, dislodge, cause burns, or electrical currents.
* Tattoos may degrade image quality.
* For contrast-enhanced MRI, you will be asked if you have any drug allergies.
* Earplugs can be used to protect your ear from loud repetitive noises during scanning.

Results of this procedure

A radiologist (a physician specialist trained to interpret MRI images or other radiology exams, such as CAT scans, X-rays, mammographies, etc.) reviews the body MRI and reports the results to your personal doctor. Your physician's office will inform you of the results when they are complete, and will use the results as a reference in evaluating and treating your condition.

Risks of this procedure

* The strong magnetic field can cause metal implants to dislodge, burn, and cause additional injuries. If you have any metal implants in your body, such as a pacemaker, prosthetic valves, or clips, you should let your radiologist or technologist know its brand name and model. If it is not confirmed to be compatible with the magnet, you should not take the MRI. If you have had bullet injuries or possible metal fragments in your body, X-rays can be taken, instead.
* Women in the first 12 weeks of pregnancy should avoid MRI and the contrast medium. There are no known harmful effects to pregnant women and unborn babies. However, because it is a recently developed technology, the long-term effects of MRI are not known.
* Allergic reactions to the contrast medium are possible, but very rare.
* If you have any history of claustrophobia, you should inform your radiologist or technologist. Sedatives can be given before scanning.

Limitations of this procedure

* Limited ability in imaging bone -- conventional X-ray or CAT scan is better in demonstrating bone details.
* MRI is less sensitive in demonstrating acute hemorrhage when compared to CAT scans.
* Hard to depict calcifications.
* MRI does not always distinguish between tumor tissue and edema fluid.
* Less sensitive in detecting small abnormalities compared to CAT scan (poor spatial resolution).
* Inability to scan critically ill patients requiring life-support systems and monitoring devices that employ ferromagnetic materials.
* May be dangerous in scanning patients with metal implants and other metal objects.
* May provoke claustrophobia.
* Longer exam time compared to CAT scans.
* Safety in scanning pregnant women is not known.

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Vasectomy and Reverse Vasectomy


There are many types of contraceptives available for both men and women. However, many are only temporary measures that require preparation each time before intercourse.

A more permanent solution to preventing unwanted pregnancies is the vasectomy (surgical removal of the ductus deferens or ligature of right and left ductus deferens) for men and the salpingectomy (removal of the uterine tube) for women.

The principle behind a vasectomy is to block the passage of sperm from the testicles, where it is produced, through the vas deferens and the urethra, by tying up or removing the vas deferens. Nowadays ligature, or crossover vasectomy, is preferred, as surgical reconstruction may restore the use of the canals in men who change their minds and decide to father more offspring (see Reverse Vasectomy below).

Occasionally, after surgery, there may be pain in the area, bleeding, inflammation of the epididymis, leakage of sperm, and even a return to fertility. Thus, as a precautionary measure, other contraceptive measures should be used until the semen is verified to be without sperm.

There are concerns that a vasectomy might reduce sexual energy or the amount of semen produced; however, these concerns are unfounded. The male erection is mainly influenced by the corpus cavernosum, and the vas deferens has no role in an erection. The male hormone, which is produced in the testicles, is continuously secreted and absorbed by the body, leaving sexual function unaffected. The seminal fluid is mostly a secretion of the prostate gland and the seminal vesicle, and is composed of only 1% sperm, so a reduction in the amount of semen should be of very little concern.

Reverse Vasectomy

A reverse vasectomy is a surgical procedure to reconnect or unblock the vas deferens to restore reproductive capability for patients who have had a vasectomy or are sterile for other reasons. Reversing a vasectomy will not necessarily bring back reproductive capability. Therefore, it is very important to carefully consider the consequences before deciding on a vasectomy.

Due to the increase in divorce and remarriage rates, the number of men wishing to reverse a vasectomy is on the rise. Since the surgical procedure is microscopic in nature, and uses threads thinner than human hair, a reverse vasectomy is a very delicate operation and is only successful 90% of the time for men who have had a vasectomy within the last 10 years. However, the pregnancy rate for these people may be much lower -- 60-70% -- depending on such factors as the fertility of the spouse and the receptivity of the sperm in the women's reproductive tract.

When recovering from a reverse vasectomy, extreme exercise should be avoided, and for the first 2-3 days it is advisable to fix or secure the testicles to keep them from being disturbed. A bath should not be taken until after 5 days, and the man should abstain from sexual relations for 1 month, at which point the semen is tested for the absence of sperm. The success rate of the reverse operation is highest during the first 5-7 years after a vasectomy and drops off after 7 years, so an early decision can be the difference between success and failure.

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Fallopian tubes are pipe-like structures about 12 cm long that extend both ways from the uterus toward the ovaries and flare out into the shape of a trumpet. The internal diameter of the fallopian tubes is as thin as a stand of hair near the uterus, but much wider near the ovaries. During ovulation, the wider end“blooms?like a trumpet flower, receiving the egg from the ovaries. After intercourse, the sperm migrate past the uterus and into the fallopian tube to meet and fertilize the ovum. The fallopian tube then transports the fertilized egg to the uterus.

When to use this procedure

If the fallopian tubes become constricted, allowing passage of the sperm but not the egg, an ectopic pregnancy in the fallopian tube may occur. When a woman undergoes surgical sterilization, the fallopian tubes are tied with a ring or completely blocked to prevent the ovum from leaving the ovaries. Nowadays, an increasing number of patients want to reverse this procedure, and they are turning to tuboplasty to get the results they desire. With modern microscopic technology, tuboplasty has come a long way from the days when a magnifying glass and the naked eye were the only tools surgeons had to rely on. The procedure offers an improved success rate and a same-day hospital discharge. However, not all tuboplasty surgeries can recover or reverse reproductive capability, so careful consideration is advised before choosing sterilization in the first place.

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Prenatal Ultrasound


More than any other diagnostic tool, the introduction of ultrasound has been most effective and revolutionary in the field of obstetrics and gynecology. Ever since its first use in 1958, it has become widely accepted as an essential diagnostic tool in medicine. With over 43 years of clinical use, it has proven to be very safe in its use of low-frequency sound waves. Some indications for ultrasound use in obstetrics are as follows.

Indications for ultrasound

# Evaluation of fetal growth
# Unknown vaginal bleeding
# Examination of fetal position
# Suspected multiple fetuses
# Amniotic sac examinations (assist in needle insertion)
# Abnormal difference in the size of the fetus and the uterus
# Pelvic tumors
# Pregnancy outside the uterus (ectopic pregnancy)
# Suspected fetal death
# Suspected deformity in the uterus
# Verification of uterine apparatus
# Examination of fetal health
# Verification of fetal location during labor pains
# Abnormal results of fetal tests for deformity
# Prior history of fetal deformity

Prenatal ultrasound

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Also known as

Episiotomy repair






# Infection of the wound
# Separation of the wound

Postsurgical Care


# Inspect the wound to see that is healing and if the wound is closed.
# To avoid discomfort while sitting, squeeze the buttocks together before sitting.

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Pelvic Ultrasound

Also Known As

Pelvic ultrasound (US) scanning, pelvic US imaging, pelvic ultrasonography or sonography.



Ultrasound waves sent to the part of the body being examined are reflected, refracted, or absorbed at the interfaces inside the body. Echoes that return in this way, carry information about the size, distance, and uniformity of internal organs. This is displayed on a monitor to create an ultrasound image.

Pelvic sonography is a useful way of examining pelvic organs, such as the uterus, ovaries, fallopian tubes (uterine tubes), bladder in females; and the prostate gland, seminal vesicles, and bladder in males. During pregnancy, it is used to monitor the health and development of the fetus/embryo (unborn baby in mother's womb).

During a pelvic sonography, a hand-held device called a "transducer", is placed on the skin surface of the area being examined and is moved around. This transducer generates ultrasound and sends it through the body. It also detects the returning echoes and transmits them as electrical signals. Because one transducer continuously generates many ultrasound waves while detecting echoes, a real time image can be produced on a viewing monitor. These images can be recorded on videotape or can be frozen and recorded on to film.

Ultrasound is similar to audible sound in that it can pass through water and human organs easily, but it can't pass through air or bone. So, gel is applied to the skin to bridge the gap between the transducer and the internal organs to more effectively send the ultrasound waves.

When taking a pelvic ultrasound, drink a lot of water to fill the bladder. Normally the uterus and ovaries are behind the intestine and hard to see, but a distended bladder pushes the intestine up and the uterus back, spreading them out evenly and making the uterus and ovaries easy to see.

Advantages of this procedure

* Safe, painless, easy, fast, and widely available.
* No radiation.
* In case of an emergency, bedside sonography can be done without special patient preparations.

Types of Pelvic Ultrasound

There are three types of pelvic ultrasound procedures:

1.Transabdominal (abdominal) ultrasound
While the patient is lying down, a transducer is placed on the lower stomach allowing the uterus, ovaries, and pelvic organs to be seen through a full bladder. The bladder must be full with urine, and resolution is low, but a wide picture of the entire pelvis can be seen.

2.Transvaginal (endovaginal, vaginal) ultrasound
A protective cover and lubricating gel is placed on the end of a thin, long transducer, which is inserted into the vagina to obtain US images. As the transducer by-passes the intestine and is more closely positioned to the pelvic organs, like the uterus and ovaries, better images can be obtained. There is no need to fill the bladder for this exam.

3.Transrectal (rectal) ultrasound
A protective cover and lubricating gel is placed on the end of a thin, long transducer, which is inserted into the rectum through the anus to examine the prostate gland. Because the prostate gland is right in front of the rectum, good images can be obtained through the transducer.

Doppler ultrasound can be done during each type of pelvic ultrasound procedure, which provides additional information about blood flow, helps diagnose blockages in pelvic blood vessels, and is used for examining ovarian tumors. Transvaginal ultrasound with color doppler can be used for individuals at high risk of developing ovarian cancer. Color doppler, duplex doppler and power doppler are three different techniques of doppler ultrasound.

Conditions that benefit from this procedure

* Monitoring fetal development.
* Pelvic pain.
* Pelvic mass.
* Abnormal bleeding.
* Abnormal discharge.
* Menstrual problems.
* To guide invasive procedures such as a needle biopsy and withdrawal of fluid.
* To examine blood flow and reveal blockages, including atherosclerotic plaque and blood clots, in the arteries and veins of the pelvis.

Common conditions revealed by this procedure

* Fibroids (myoma) of the uterus
* Cysts of the ovaries, uterus
* Ectopic pregnancy
* Infection
* Pelvic inflammatory diseases
* Abscess -- tubo-ovarian abscess, pelvic abscess
* Tumors, cancers of the ovaries, uterus
* Congenital anomaly
* Injury
* Stones in the bladder, urethra, lower ureters
* Lost IUD (intrauterine contraceptive device)
* Congenital anomalies, intrauterine growth retardation, death of the fetus/embryo
* Complications of pregnancy -- spontaneous abortion, missed abortion, threatened abortion, incomplete abortion
* Placental abnormality
* Hydatidiform mole
* Hyperplasia, cancer of prostate gland (in males)
* Tumor, inflammation of bladder

How this procedure is performed

You will need to remove your upper garments and put on a hospital gown. You will then be positioned on an examination table on your back with your hands above your head, and a lubricating gel will be applied to your pelvic area. An apparatus, known as a transducer, will be placed on your pelvic area and moved around to get real-time images.

If needed, a transvaginal ultrasound or transrectal ultrasound examination may be added. If so, you will be asked to urinate completely and remove all your lower garments. While lying down, a transducer will be inserted into your vagina or rectum.

After the examination, the gel will be cleaned off and you can change back into your clothes. The entire examinations usually take 10-30 minutes.

Preparation for this procedure

* Drink six glasses of water one to two hours prior to your exam, and avoid urinating. A full bladder helps with visualization of the uterus, ovaries, and bladder wall.
* Wear comfortable, loose-fitting clothing.
* Remove your upper garments before examination and put on a hospital gown.
* For transvaginal ultrasound or transrectal ultrasound examinations, you need to remove lower garments and urinate before your exam and.
* In an emergency, bedside exams can be done without special preparations.
* Tell the sonographer, sonologist, or physician sonologist conducting the examination about pain, bleeding, discharge, fever, or any other symptoms you have. Telling the examiner about past ultrasounds and surgeries is also helpful, and is sometimes crucial information.

Result of this procedure

The image recorded on film or videotape is interpreted and analyzed by a radiologist (a physician specialist experienced in ultrasound and other radiology exams). The official report is sent to the practitioner who requested the examination, who will inform you of the results and will use them as a reference in your evaluation and treatment.

Risk of this procedure

There is no known risk to humans from diagnostic ultrasound. Unlike X-ray examinations, ultrasound does not use radiation.

Limitations of this procedure

* Ultrasound does not penetrate air or bone. So if an abnormality is behind bowel gas, ribs, or calcified rib cartilage, it may not be discovered via this procedure.
* There is a limitation to ultrasound's ability to reach deep into the body. Because ultrasound is absorbed and reflected inside the body, only some of the waves reach deep places farthest from the transducer. For example, given two tumors of equal size, the tumor closest to the transducer will be discovered more readily than the more distant one. Consequently, examinations are not as productive for obese, tall patients as they are for thin or petite ones.
* Ultrasonography is an operator-dependent, subjective test. The more experienced the operator and the more closely the patient follows the operator's instructions (e.g. 'hold your breath', 'do not eat', 'repress the urge to urinate'), the better the results. Further, the more the operator knows about the patient's past medical history, current medical history, and the results of other radiological and laboratory tests, the better the examination. For best results, before taking ultrasonography, ask if the practice where the scan is being performed is accredited either by the American Institute of Ultrasound in Medicine or the American College of Radiology.
* Not all abnormalities can be discovered with a pelvic ultrasonography. For example, a PAP smear is a more sensitive test than ultrasound in detecting cervical cancer. And when diagnosed with cervical cancer, CT scans and MRI are more accurate than ultrasound in making plans for treatment.

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Pap Smear


# In the 1940s Dr. George Papanicolaou proposed that a trained observer could detect cancer of the cervix by scraping cells from the cervix and then evaluating them under a microscope. This test came to be known as the Pap smear, and, now serves as the modern basis for screening women for cervical cancer.
# Women should be screened with Pap smears, starting at either the year that they become sexually active or age 18, whichever comes first. Initially, the smears should be done every year, but sometimes screening can be done every 3 years if the first three or four specimens are normal and you are with the same sexual partner who is also monogamous. However, if you change sexual partners or notice any changes in your vaginal discharge and/or have spotting or bleeding after intercourse or between periods, see your gynecologist immediately.
# The Pap smear is the only screening test for cancer, and it is responsible for a decrease in cervical cancer cases and deaths.
# A Pap smear is a screening tool, not a diagnostic test; further evaluation is required when abnormal changes are reported. Occasionally, cervical cancer is present and the Pap smear is normal, which is why a gynecologist orders further tests if there is something abnormal on the cervix.
# Pap smears do not detect cancer of the uterus, fallopian tubes, or ovaries.


Of abnormal pap smear:
# Human papilloma virus (HPV) is the most important cause, because HPV is found in over 99% of women with cervical cancer. Tobacco use increases the cancer-causing potential of HPV. HPV is the major cause of genital warts, but people may have HPV on their genital organs and surrounding skin without any visible changes. Unfortunately, HPV is epidemic since condoms are not very effective in preventing HPV.
# Other cervical infections: Herpes simplex, Trichomonas, Candida, etc.
# Chemicals from contraceptive gels and/or foams, douches, etc.
# Acquired immunodeficiency syndrome (AIDS) and other lowered immune states allow HPV and other infections to grow and cause more damage.


Pap smear:
# Requires a trained cytologist (person who looks at cells) and/or pathologist who will assign a 'class' to each Pap smear slide.
# Class I means that the sample is normal.
# Class II means that there are atypical (abnormal) cells present.
# Class III means dysplasia (a premalignant condition) is present.
# Class IV means there is carcinoma in situ present (cancer cells have not invaded).
# Class V means that there is evidence that invasive cancer is present.


# A colposcope is used to magnify the features of the cervix, allowing for a more detailed and thorough examination of the surface of the cervix than with the unaided eye. A colposcope is a large, electric microscope with a bright light and is positioned approximately 30 cm from the vagina. When a person uses the colposcope to determine the cause of an abnormal Pap smear or just to get a better look, the procedure is called colposcopy. Colposcopy is relatively simple and painless, and is performed in your physician's office. The time needed for colposcopy varies, depending on the cervix, but on average takes 15 minutes.
# Biopsy of the cervix: Definitive diagnose requires removal of a small sample of tissue from the cervix.


# Medication for cervical and/or vaginal infection
# Stop using tobacco
# Removal of specific lesion on the cervix
# Cryosurgery freezes the surface of the cervix; the intent is that it will destroy abnormal cells and they will not be present when the cervix heals.
# Laser therapy uses heat to destroy the surface of the cervix.
# Conization: This procedure removes the surface of the cervix in the shape of an inward pointing cone.

Abnormal Pap Smear

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Also Known As

Mammogram, mammography exam






Advantages of this procedure

* Fast and safe.
* The most sensitive test used to detect breast cancer early.
* Low dose of radiation.

Conditions that benefit from this procedure

* Breast lump
* Thickening of the breast
* Breast pain
* Nipple discharge
* Skin change on the breast
* Women over age 50

Common conditions revealed by this procedure

Screening mammography


Diagnostic mammography

2. Used to evaluate abnormalities detected on a screening mammogram.

Common diseases revealed by this procedure

Benign conditions

1. Cyst
2. Fibroadenoma
3. Fibrocystic breast condition
4. Abscesses
5. Fat necrosis
6. Galactoceles

Breast cancer

1. Ductal carcinoma
2. Invasive ductal carcinoma
3. Medullary carcinoma

How this procedure is performed





Preparation for this procedure


Results of this procedure




Risks of this procedure

* Radiation exposure from a screening mammography is believed to be safe.

What to do if the result are abnormal




If you have breast implants




Getting high-quality mammograms





Risk factors for breast cancer

As you get older, your risk of breast cancer increases.

Personal history of breast cancer

Family history of breast cancer

Genetic alterations

Certain breast changes

Dense breast tissue

Radiation therapy

Reproductive and menstrual history

When to start this procedure


Age 50-69




Age 35-40

Previous breast cancer


Further procedures


Breast sonography

MRI (magnetic resonance imaging)

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Dilation, Suction or Curettage

Also known as


Dilation and suction and/or curettage are often referred to as a D&C because the name was used before suction was invented. D&C refers to dilation of the cervix (widening the cervix) and curetting or scraping out the endometrium (the lining of the uterus). Suction devices have revolutionized this procedure and the uterus can now be emptied more rapidly and through a smaller opening in the cervix. The material obtained from suction and/or curettage is sent to the laboratory where it is placed on slides, stained, and then examined by a pathologist.


1. Abnormal or heavy bleeding from the uterus. D&C may temporarily or permanently cure the problem and will at least diagnose the cause of the bleeding.
2. Incomplete abortion (miscarriage) or to make sure abortion is complete.
3. Early termination of pregnancy
a. Genetic analysis of cells collected during amniocentesis reveals a severely abnormal fetus.
b. Pregnancy is inadvisable for medical reasons, e.g., cancer, heart disease.
c. The mother ingested medication(s), alcohol or drugs (teratogens) which could result in the birth of a severely deformed fetus.
d. The mother had an infection early in pregnancy, e.g., rubella, which is known to cause congenital defects.
e. The pregnancy is unwanted.


# The patient's cervix is usually numbed or anesthetized with a needle containing a local anesthetic, e.g., lidocaine. Additional medication to put the patient to sleep, eliminate any pain, or decrease anxiety may be given intravenously. If the uterus is large or it is difficult to enter the cervix, e.g., a postmenopausal woman who has not had children vaginally, the physician may recommend that the patient be hospitalized and be given an epidural or general anesthetic.
# Dilation can be carried out in many ways. If the patient is having a miscarriage, the cervix may already be dilated, so the contents of the uterus just have to be suctioned and/or curetted out. If the cervix is not dilated, a series of dilators, starting with a very small one and increasing in size, are introduced through the external os and internal os of the cervix.
# Alternatively, one can use laminaria to dilate the cervix. Laminaria are thin pieces of specially prepared and sanitized seaweed, Laminaria japonicum, which grow in the Sea of Japan. One or more laminaria are inserted into the cervix and left in place for a period of time. They absorb moisture from the surrounding tissue and slowly expand, dilating the cervix over several hours. They are usually inserted the day before a suction and/or curettage procedure. They may cause cramping and require a pain reliever such as acetaminophen (Tylenol); aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided because they inhibit the formation of clots and may increase bleeding.
# Once the cervix is dilated, the interior of the uterus can be probed to determine its size or look for uterine growths, e.g., a polyp or fibroid. If a polyp is suspected, a pair of grasping forceps is inserted into the uterus and closed; the polyp is pulled out of the uterus if it is not too strongly attached.
# In a classic D&C, a uterine curette is inserted into the uterine cavity and the wall of the cavity is scraped. More recently, the cavity is often suctioned first. The material suctioned and scraped away from the wall can then be sent for pathological examination.

Procedures specific to Abortion:

# Vacuum Aspiration: From 6 to 13 weeks, vacuum aspiration is used to empty the uterus. This traditional first trimester abortion involves three main steps: (1) an injection to numb the cervix, (2) insertion of a soft flexible tube through the cervix into the uterus, and (3) suction created by an aspirating machine to remove the uterine contents. It takes less than 5 minutes to complete.
# IPAS Syringe - Early Abortion with Manual Vacuum Aspiration (MVA): As soon as the pregnancy can be detected by ultrasound (typically 3-4 weeks), an abortion can be performed using a manual aspiration device called the IPAS Syringe. Similar to the suction aspiration procedure, the IPAS system consists of thin flexible tubing, but instead of using a machine to create suction a hand-held syringe is used. The procedure usually takes less than 5 minutes to complete. Aftercare is the same as with suction aspiration method.
1. 1. D & E (Dilate and Evacuate):
# From 13 to 24 weeks, the Dilation and Evacuation (D&E) procedure may be administered. Usually, appointments are made for 2-3 consecutive days. On the first day, an ultrasound (sonogram) is performed to determine the size of the fetus. Then, the abortion procedure begins, and the cervix is numbed with injections and dilators are inserted into the cervix. Overnight, these dilators gently expand, opening the entrance to the uterus. The next day, the cervix is again numbed, the dilators are removed, and the doctor uses special instruments inserted into the uterus to remove the fetus. The final step is suction, using the aspirating machine. In more advanced pregnancies, additional dilators are inserted on the second day and the fetus is removed on the third day. Removal of the pregnancy actually takes about 10-15 minutes.


# Perforation of the uterus with an instrument may occur because the uterus is very soft from pregnancy, distorted by disease, or the uterus is tipped back toward the spine (retroverted) making entrance into the uterus more difficult. The uterus probably heals on its own more often than we realize because the injury goes unrecognized. If an injury is recognized, your physician may recommend a laparoscopy and/or laparotomy (opening the abdomen) to exam and repair the hole.
# Infection: D&C is often done to prevent the development of infection, particularly after an incomplete abortion. However, it the cervix was infected by chlamydia, gonorrhea or other harmful organisms, they may be pushed up into the uterus during the procedure and cause an infection of the uterine lining (endometritis), less commonly the infection spreads into the fallopian tubes (salpingitis), or further. It is important that you report any foul smelling discharge from your vagina, fever, chills, or continuous pelvic pain so the infection can be treated before it causes permanent damage.
# Reaction to anesthetic or other problems associated with anesthesia: Patients rarely have adverse reactions to a local anesthetic, however, if you have had any problems at the dentist or with burn sprays containing anesthetics (Benzocaine), make sure you tell your physician. Serious complications from general anesthesia occur in approximately 1-2 people/10,000, which is why your physician may recommend a local or epidural over a general anesthetic.
# Infertility: Infertility rarely occurs today as a complication of D&C because of the use of suction and effective antibiotics to treat infection.

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Laser Laparoscopic Surgery


Video laparoscopic surgery and laser laparoscopic surgery are the latest gynecological surgical techniques. Until these procedures were made available, most gynecological surgeries required that the abdomen be opened (laparotomy). However, recent advancements in medical tools and the efforts of surgeons have eliminated many abdominal surgeries.

Surgical applications

Diagnostic laparoscopy is the process of determining the condition and cause of the disorder, whereas surgical laparoscopy is the process of operating on the disorder, through the use of lasers and video. Some of its surgical applications are:

* ectopic pregnancy (pregnancy in the fallopian tube), ovarian cyst, uterine myoma, endometriosis, and other gynecologic problems;
* papilloma of the fallopian tubes;
* infertility due to adhesions around the fallopian tubes and the pelvic region;
* hysterectomy;
* plastic surgery for the fallopian tubes (tuboplasty).

Advantages over laparotomy

* surgical time is short;
* bleeding is minimal;
* very little scaring;
* requires short or no hospitalization;
* fast recovery.

Surgical procedure

Anesthesia, general anesthesia, or subdural anesthesia is applied. Three to four incisions, approximately 0.5-1 cm long, are made in the lower abdomen. Then, operation-specific tools, electronic controls, and the laser are used to operate on the affected area with the guidance of an external viewing monitor, which is connected to the laparoscope.


Though complications are rare, potential risks of laparoscopic surgery may include:

* pelvic infection;
* bleeding from the stitches;
* discharge and infection of the incision;
* internal bleeding;
* damage to internal organs or vessels;
* adhesion formation;
* pain;
* fever;
* complications caused by anesthesia.

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Also Known as
'Tubogram' or 'Hysterosalpingography'

An hysterosalpingogram (HSG) is an X-ray test performed to evaluate the inside of the uterus and fallopian tubes by injecting radiologic dye into the uterine cervix through the vagina.

Normally, injected dye will fill the uterus, pass through the fallopian tubes and spill out into the peritoneal cavity. Fallopian tube abnormalities and infertility due to adhesion in the uterine cavity (e.g. tubal blockages, fibroid tumors, polyps, scar tissue, or an abnormal shape to the cavity) can be diagnosed with an HSG.

Usually an HSG is taken 2-5 days after menstruation has ended, and before ovulation, to ensure the patient is not pregnant during the procedure. Limited research suggests that fertility increases after X-rays are taken with an oil contrast, the hypothesis being that after administration, adhesions fall off, function of the uterine cavity improves, mucous is removed, and the ability of the smooth muscle improves. This suggests that the HSG may have treatment applications; but most HSGs are performed only for diagnostic purposes because its therapeutic effect is still controversial.

Indications of HSG

1. Infertility
2. To detect a blocked fallopian tube.
3. To detect uterine abnormalities, such as uterine anomalies, endometrial polyps, fibroids, intrauterine adhesions, genital tuberculosis.
4. To evaluate the results of tubal surgeries, such as a tubal ligation or reversal operation.

How to prepare for HSG

* An HSG is usually scheduled within 2-5 days after the period ends (day 7-10 of the menstrual cycle) and before ovulation (day 14 of the cycle) to avoid exposing the uterus to radiation and X-ray dye, if the woman is pregnant. Tell your doctor if you might be pregnant.
* If you have had a pelvic inflammatory disease or sexually transmitted disease (gonorrhea, chlamydia, etc.), you are at a higher risk of developing complications after the HSG. Tell your doctor if you suspect pelvic infection, as you may need to take antibiotics before the test.
* Tell your doctor before the test if you:
- are allergic to X-ray dye (iodine), any medications
or foods.
- are asthmatic.
- are taking any medications.
- have any bleeding disorders.

How it is done
You will be asked to disrobe below the waist and lie on an exam table under a fluoroscopy (real-time X-ray machine with a video monitor). The gynecologist or radiologist will insert a speculum in the vagina, place a tube into the opening of the cervix, then gently inject a small amount of X-ray dye into the uterus while watching the fluoroscopy monitor. Contrast material will fill the uterus and fallopian tubes and finally spill out into the pelvic cavity around the uterus and tubes. Several X-ray pictures will be taken during the procedure.

This procedure may cause mild to moderate cramping, similar to menstrual cramping. Tell your doctor if you experience cramping for more than several hours after an HSG.

Risks and complications of an HSG

* Infection is the most common complication of an HSG, but it is rare and found in less than 1% of all cases. It usually occurs in patients with a history of pelvic infection. If you have fever or abdominal pain within a day or two after the HSG, contact your doctor immediately.
* Allergic reaction to iodine dye may cause skin rash, itching, shortness of breath, or swelling in the throat or in other parts of the body.
* Fainting.
* The patient may experience a small amount of vaginal bleeding a few days after an HSG.
* The amount of radiation from HSG is too small to do any harm. However, if you suspect that you are pregnant, you should not take the test.
* Damage to the uterus or fallopian tubes.

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# Hysterectomy is the second most frequent major surgery performed on women in the United States, with about half a million procedures performed each year. For instance, in 1995, approximately 590,000 women in this country underwent the procedure. One in three women will have a hysterectomy by age 60. Annual costs associated with this surgery exceed $5 billion, and there are wide variations in rates of hysterectomy in different parts of the country.
# The procedure is performed for a variety of diseases, and, particularly, for cancer of the uterus or ovary. Most women who undergo hysterectomy are between the ages of 35 and 54, with the highest age-specific rate for women 35 to 44 years of age.


# Fibroids account for approximately one third of hysterectomies.
# Endometriosis accounts for 18% of surgeries.
# Cancer of the uterus, the ovaries, or the cervix
# Uterine prolapse
# Very heavy or irregular bleeding
# Stress incontinence (involuntary loss of urine)
# Chronic pelvic pain, severe pelvic infection
# Emergency heavy bleeding from the uterus after delivery or during surgery


Hysterectomy is the surgical removal of the uterus. It ends menstruation and the ability to become pregnant. Depending on the patient's specific condition, the surgery may also involve removal of other organs and tissue in addition to the uterus. Here are the different procedures:
# Total hysterectomy: removal of the uterus, including the cervix
# Subtotal hysterectomy: removal of the uterus, leaving the cervix, ovaries, and fallopian tubes in place
# Total hysterectomy with bilateral salpingo-oophorectomy: removal of the uterus, cervix, ovaries, and fallopian tubes
# Laparoscopic hysterectomy: Hysterectomy is carried out using a laparoscope instead of a large incision.
# Vaginal hysterectomy: The uterus is removed through the vagina.


# Effects of anesthesia
# Damage to nearby organs: bowel or rectum, bladder or ureter
# Hemorrhage (bleeding) that may require a blood transfusion
# Wound infection, urinary tract infection, bowel obstruction
# Incontinence or urinary retention requiring the continued use of a catheter
# Vaginal pain, fistula (abnormal passage) between the vagina and bladder or rectum

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High-frequency Coagulation Method


Many women suffer from vaginal bleeding and leukorrhea due to cervical erosion and vaginitis. Vaginitis can be treated by proper feminine hygiene and medications, but cervical erosion cannot be completely treated, even with long-term treatments (3 months to 1 year). If cervical erosion is not properly treated, vaginitis may recur. An even more threatening consequence of improper or inadequate treatment is the higher likelihood of uterine cancer, which experts believe is connected with the disappearance and reappearance of vaginitis and, ultimately, with cervical erosion. Thus, early treatment of cervical erosion is highly recommended as a preventive measure against uterine cancer and in reducing leukorrhea and vaginal bleeding.


Cervical erosion is not easily treated and none of the available treatment measures are 100% effective, thus, some doctors contend it is not necessary to treat it. However, considering the possible consequences of untreated cervical erosion, the best strategy, and the current consensus, is that the best available treatment measure should be taken. Methods include electrical cauterization, cryocoagulation method, cold coagulator coagulation method, laser surgery, conization, and high-frequency coagulation method. Electrical cauterization, cryocoagulation method, and the cold coagulator coagulation method have the drawback of not being permanent treatments; laser surgery has the disadvantage of being delicate and difficult to perform, as well as inducing a lot of bleeding. Therefore, high-frequency coagulation method is recommended.

What is high-frequency coagulation method?

# In the high-frequency coagulation method, the instruments automatically and accurately focus the needed energy to the eroded area and to a depth of 5 mm, which is needed to adequately treat cervical erosion.
# The high-frequency coagulation method has a single surgical success rate of about 95%, surpassing that of any other method by a large margin. This is because the technique uses an automated machine that is much more accurate than other methods, which rely on human interpretation.
# Surgery just takes 3-5 minutes, and usually only treatment is needed.
# The amount of pain during surgery is equivalent to that of menstruation and labor and, thus, anesthetics are usually not needed.
# There are no reported cases of sterility, arthresthesia of the cervix, pyometra, or perforation due to extreme coagulation, as a result of this surgery.

Wednesday, September 24, 2008
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Computed Tomography

Also known as


What is CT scan?






* Provides detailed two-dimensional images with great clarity.
* Simple, painless and noninvasive.
* Can provide three-dimensional images.

Types of CT scans

Head CT Scans

* Brain
* Facial
* Paranasal sinus
* Orbit
* Sellar (to view pituitary gland)
* Temporal bone

Body CT Scans

* Chest
* Abdominal
* Pelvis

Spine CT Scans

* Cervical spine
* Thoracic spine
* Lumbosacral spine

Extremity CT Scans

How is the procedure performed?





The exam usually takes from 10-30 minutes.

Preparing for a CT scan





Obtaining results


Risks of CT scan


Adverse reactions to contrast agent given intravenously, include:

Allergic reactions

Anaphylactic reaction

Kidney failure
Particularly among patients taking Glucophage (Metformin) for diabetes.





Computed Tomography

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Cesarean Section


# This surgical method of delivery requires that an incision be made in the mother's stomach and uterus so the baby can be removed through the incisions. Supposedly, Roman emperor Julius Caesar was born in this manner, thus, the procedure's name.
# Cesarean sections are a good way to manage emergency situations that put either the mother or baby, or both, at risk. This method of delivery is not recommended "on demand" as a way to avoid the labor associated with a vaginal delivery. A natural childbirth should be encouraged. If a cesarean section is inevitable, it is usually for the following reasons.


# Maternal causes
# Pelvis is smaller than the baby's head.
# Severe toxemia of pregnancy (gestosis)
# An STD has infected the uterine neck or vagina, putting the baby at risk of infection if delivered naturally.
# Water breaks early, and the umbilical cord is exposed.
# Placenta previa: The placenta is blocking the uterine opening.
# A multiple pregnancy, which can result in possible premature birth and delays in delivery.
# Induced labor has failed
# The mother has diabetes, heart disease, high blood pressure, myoma of the uterus, or ovarian cyst, making natural birth difficult.
# Fetal causes
# Fetus is upside down or lying sideways.
# Abnormal pulse before or during delivery and deteriorating condition that may cause a stillbirth
# Fetus is too big to fit through the pelvis.


# If you need to have a cesarean birth, you will receive an epidural, spinal, or general anesthesia.
# If you have epidural or spinal anesthesia, you can be awake during your surgery and you can see your baby right after he/she is born.
# A presurgical fast is required for at least 8 hours, as well as a basic preoperative evaluation, such as a blood test that includes blood typing, urine test, liver function test, and an electrocardiogram.
# The surgical region is shaved and disinfected, and a catheter is inserted to discharge urine. An IV is started to facilitate the administration of drugs.
# General anesthesia, epidural anesthesia, or spinal anesthesia is then administered.
# The uterine incision is then made down to the amniotic sac (fetal membranes or bag of water).
# Once the incisions are made, the baby is removed-the fetal head or buttocks are delivered through the uterine incision, followed by the rest of the body-in 5-10 minutes
# The umbilical cord is cut, the placenta is completely removed before the incision is closed (the layers of the abdominal wall are sutured, and then the skin closed with either suture or staples), and the mother is taken to the recovery room after the incision has been closed.
# Total surgical time, from anesthesia to stitches, is 40 minutes to an hour.


Medical advances have greatly reduced the dangers associated with cesarean sections. Still, compared to a natural childbirth, there are risks, sometimes life-threatening for the mother, associated with this procedure.

Newborn Dyspnea

# A baby born comfortably in the absence of labor pains, or few labor pains, has less ability to adjust to the uncomfortable and irritating outside world, and has a higher risk for developing dyspnea, i.e., difficulty breathing.
# During a normal vaginal birth, the baby's chest is pressed by the birth canal, pushing amniotic fluids and other secretions out of its lungs, but this action becomes weak in surgery. If the baby is parturient and healthy, problems rarely occur; if the baby is weak, it will have trouble spitting and develop dyspnea.

Hysterorrhexis, Metrorrhexis

# The incision on the uterus may heal well, but there will be a scar on the uterine muscle and the uterus may not recover to its original state. Most scarred areas are weak and occasionally become paper thin, which can rupture during the next pregnancy or labor.
# The danger for rupture increases when the uterus has been cut vertically because of placenta previa and cross birth (transverse presentation). Mothers who have received vertically cut cesarean sections should remember this and remind their physician, in the event of subsequent births.

Pregnancy at the region of the incision

# Chances are high that the next pregnancy will occur where the uterine incision was made, thereby increasing the possibility of placenta previa.
# If an embryonic sack grows on the outside of the incision region, there is a danger of hysterorrhexis (metrorrhexis) early in the pregnancy. Appropriate measures should be taken to avoid an extrauterine pregnancy (ectopic pregnancy).

Limited Number of Operations

# Women often receive abdominal incisions (celiotomy, laparotomy) because of uterine and ovarian abnormalities or extrauterine pregnancies. A cesarean section adds to the overall number of surgeries. Most women who undergo a cesarean section receive another with each additional pregnancy, continuously burdening the body. Therefore, it is recommended that a natural birth be attempted with the first pregnancy.

cesarean section

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Breast Cancer Detection


American Cancer Society Recommendations for Early Breast Cancer Detection: Doctors recommend you begin practicing breast self-examination (BSE) as soon as your breasts start developing. This will help you become familiar with your normal breast structure and to learn to notice any unusual changes. If you have no breast cancer symptoms, your doctor should examine your breasts every 3 years if you are between 20 and 40 years of age and every year for those over the age of 40. Women should have a baseline screening mammogram by age 40, and a follow-up mammogram every 1-2 years from age 40-49 and every year for women age 50 and over. Women with a personal or family history of breast cancer should consult their physician about more frequent exams or mammograms.
If a change occurs, such as development of a lump or swelling, skin irritation or dimpling, nipple pain or retraction (turning inward), redness or scaliness on the nipple or breast skin, or a discharge other than breast milk, you should see your health care provider as soon as possible for evaluation.
Experienced health care professionals can examine the breast and determine whether the changes you have noticed are most likely benign or whether there is a possibility they may be due to breast cancer. They can determine when additional tests are appropriate to rule out a cancer and when follow-up exams are the best strategy. If there is any suspicion of cancer, a biopsy will be recommended.


The best time for a BSE is about a week after your menstrual period starts, because your breasts are not tender or swollen at that time.
# Lie down, put a pillow under your right shoulder, and your right hand behind your head. Gently massage and feel your breast for lumps or other changes.
# Use the finger pads of the three middle fingers on your left hand to feel for lumps in the right breast. Press firmly enough to know how your breast feels. A firm ridge in the lower curve of each breast is normal. If you are not sure how hard to press, talk with your doctor or nurse.
# Repeat with towel under left shoulder with left hand behind head.
# Look for changes to the shape or texture of your nipples. Gently squeeze each nipple and look for discharge or blood.
# Raise your right arm and examine every part of your left breast. Move in increasingly smaller circles, from the outside in, using the pads of your index and middle fingers.
# Gently press and feel for lumps or thickenings of the breast area and outside your breast, such as under your arm.
# Repeat with your left arm and right breast.

Healthbeat - Breast Cancer Detection

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Amniotic Fluid Examination

Also known as:-


Indications for amniocentesis

1. The mother is 35 or older at the time of delivery. The probability of fetal malformation increases with age. Up to 35, the increase in probability is slow; but after 35, probability of fetal malformation increases rapidly.
2. The mother has delivered a baby with chromosome abnormalities.
3. One of the parents is a balanced translocation carrier or has abnormalities with chromosome structure.
4. A close relative has Down Syndrome or other chromosome abnormality.
5. There is a danger of Mendelian or polymeric genetic diseases such as cleft lip, cystic fibrosis, and Tay-Sachs disease.
6. In the past, children or parents have had a neural-tube defect, or the mother's blood serum (fetoprotein or triple screen) test results were abnormal.
7. The fetus appears abnormal on ultrasound.
8. Mother has given birth to a baby with multiple major malformations, but has not received a cytogenetic examination.
9. There is danger of a severe sex-linked genetic disease, and the sex of the baby needs to be determined.
10. A significant answer has been given to a genetic screening question.
11. The mother is worried about fetal deformation and requests an examination.

Examining the amniotic fluid

Generally, it is ideal to perform or undergo an amniocentesis between the 15th and 18th week of the pregnancy, when the success rate for cultivating fetal cells is high. However, since it takes 3 weeks to cultivate cells, abnormalities may not be discovered until the 5th month of the pregnancy. Recently, early amniocentesis examinations have been performed between the 11th and 14th weeks of gestation. An early amniocentesis carries a 2.5 times higher risk of miscarriage than an amniocentesis conducted during weeks 15 through 18.

How the fluid is examined

After the mother's abdomen is draped and prepped, a 3- to 6-inch needle is used to penetrate the abdomen and uterus to collect amniotic fluid from the amniotic sac. Approximately 20-30 ml is needed for cultivation, and additional fluid may be collected for DNA analysis.

Complications with the examination

The three main dangers associated with amniocentesis are: injury to the mother and fetus, infection, and miscarriage or premature labor.

(For mothers with Rh-negative blood who are bleeding, special precautions and procedures will be necessary to avoid iso-immunization in the mother).

The chance of losing a baby from an amniocentesis performed during weeks 15 to 18 is approximately 1 in 200 to 1 in 300 procedures, similar to the chance of losing a baby during this time if an amniocentesis was not performed. Therefore, an amniocentesis performed during weeks 15 to 18 is considered relatively safe.


Most pregnant women can safely undergo an amniocentesis. Special circumstances that prevent the use of an amniocentesis are: if symptoms of infection are present; if the woman refuses to undergo the procedure; if danger of a premature birth exists.


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