This document provides information about various gynecological tests and diagnostic procedures including basal body temperature, cervical mucus examination, plasma progesterone testing, pelvic ultrasonography, endometrial biopsy, hysterosalphingography, laparoscopy, and diagnostic tests for cervical cancer. It also discusses types of abortion including spontaneous, induced, and habitual abortion and covers etiology, symptoms, pathophysiology, assessment, diagnostics, pre-op, post-op, and follow-up considerations for abortion.

1. POWERPOINT PRESENTATION GROUP 4

2. The REPRODUCTIVE SYSTEM

3. Overview of the System

4. THE FEMALE REPRODUCTIVE SYSTEM

5. THE MALE REPRODUCTIVE SYSTEM

6. GYNECOLOGICAL TEST OR DIAGNOSTIC PROCEDURES

7. Basal Body Temperature BBT may be taken orally or rectally. However, the client must use the same method consistently. A special thermometer is used to measure BBT. It measures a smaller range of degrees of temperature and has a larger space between each number, thus increasing the ease of accurately identifying minimum changes in temperature.

8. Cervical mucus examination The maximum effect of estrogen occurs immediately near the time of ovulation. Cervical mucus responses include decreased viscosity, ferning and increased alkalinity. Abundant alkaline, clear, watery, elastic mucus facilitates sperm penetration and survival. Cervical mucus ferning Ferning is caused by the effects of estrogen on the concentration of sodium chloride and other electrolytes in the mucus; high estrogen levels produce more complete arborization. When the mucus is spread on a glass slide and allowed to dry, the pattern it forms resembles a fern leaf. Ferning is absent in anovulatory women.

9. Plasma progesterone Plasma level of progesterone increase significantly after ovulation following formation of the corpus luteum. Serum progesterone assays are drawn between the second day after ovulation and the onset of menses. Pelvic ultrasonography Uine Ultrasonography is a biomedical adaptation of marine sonar technology. Sound wave echos create a picture of the pelvic structures. Abdominal or vaginal ultrasonography may be used to visualized the reproductive structures. Ultrasonography can identify anatomic abnormalities and often used to determine follicular development and maturation in planning for therapeutic interventions, e.g. surgical removal of an ovum for use in in vitro fertilization.

10. Invasive Procedures Endometrial biopsy A curette is gently introduced through the cervical canal to the level of the uterine fundus, and one or two samples of tissue are removed for examination of the pathologist. Endometrial biopsy identifies estrogen/progesterone-induced endometrial changes and is helpful in ruling out a chronic inflammatory condition of the endometrium. Uterine and tubal factor assessment Tubal patency determination [rubin’s test] The patency of the fallopian tubes can be assessed by introducing co2 gas under pressure through the uterine cavity. With the client in lithotomy position, co2 is insufflated transcervically. Characteristic findings accompany passage of the gas through patent fallopian tubes. Although this test was used extensively in the past, it is being replaced by other tests that allow more definitive assessment.

11. Hysterosalphingography Instilling radiopaque dye through a small tube into the uterus permits roentgenographic visualization of the uterus and fallopian tubes. Hysterosalphingography has become the method of choice for evaluating the structure and patency of the uterus and fallopian tubes. Transvertical instillation of 1 to 2ml contrast medium is performed under fluoroscopy; the small amount of radiopaque dye may outline small abnormalities that would be obscured by a larger amount of medium. Larger amounts of medium are then instilled to distend the uterus and they flow upward through the fallopian tubes. Laparoscopy Insertion of an endoscope through a small abdominal incision permits direct visualization of pelvic structures. Laparoscopy is essential in the study of infertile woman when there is no obvious cause for failure to achieve pregnancy. Immediately before the laparoscopy, a cannula is placed at the cervix. A thin solution of methylene blue dye is introduced through the cannula .

12. A. Double puncture technique The double puncture technique allows the surgeon to use a probe to move the ovaries and tubes for optimum visualization, to explore the fimbriated ends of the fallopian tubes, and to view the undersurface of the broad ligaments if the ovaries. Unsuspected pelvic disease, adhesions and endometriosis have been discovered through use of this technique. Cervical factor assessment The sim-huhner (postcoital) test is used to identify the quality of the cervical mucus and its effect is on sperm survival and motility. The test is another component of the initial investigation and into possible infertility. Tomaximize the potential for concurrent achievement of pregnancy, the test usually is timed for 1 or 2 days before expected ovulation. At that time the influence of estrogen increases the cervical mucus hospitality to spermatozoa.

14. Hormone testing Hormone testing may be recommended, as certain hormones increase and decrease in production at various times in monthly cycle. Ultrasound Ultrasound can show the presence of follicles (the sacs containing developing eggs) and the thickness of the uterine tissues. Ultrasound can show abnormal conditions such as ovarian cysts or fibroids(benign tumors in the uterus). X-rays A hysterosalphingogram may be recommended. This test uses radio-opaque dye injected into the cervical opening to visualize the inside of the uterus and determine if the fallopian tubes are open.

16. Diagnostic test for cervical cancer The papanicolau smear (pap test) is used to screen for cervical intraepithelial neoplasia (cin) and cervical cancer. It can also be used to assess hormonal status and identify the presence of sexually transmitted diseases, such as human papilloma virus (hiv) infection. With the woman in lithotomy position, a speculum is inserted to visualize the cervix. A plastic or woodenll lsllllatua is used to scrape the cervical os and any suspicious-looking areas, and the material is transferred to a slide for histologic analysis. A cotton-tipped applicator or cytobrush is used to obtain a specimen from the endocervix; this specimen is then transferred to a second slide.

18. Cervical biopsy Cervical biopsy is performed to women whose pap smear findings indicate possible cervical cancer or cervical intraepithelial neoplasia. The biopsy is also used to screen women at high risk for vaginal and cervical cancers due to intrauterine des exposure. With the woman in lithotomy position, the cervix is cleaned with 3% acetic acid, and tissue samples are taken for biopsy.

19. ABORTION

23. 2. INDUCED ABORTION -this type of abortion uses drugs or instruments to stop the normal course of pregnancy 3. HABITUAL ABORTION - Successive (3) repeated abortions of unknown cause.

26. PATHOPHYSIOLOGY THREATENED - consists of any vaginal bleeding during early pregnancy without cervical dilatation or change in cervical consistency. Usually, no significant pain exists, although mild cramps may occur. More severe cramps may lead to an inevitable abortion INEVITABLE - Genetic anomalies (trisomies); hormonal abnormalities; and infectious, immunologic, and environmental factors usually result in first-trimester loss. Anatomic factors usually are associated with second-trimester loss INCOMPLETE - Genetic anomalies (eg, trisomies); hormonal abnormalities; and infectious, immunologic, and environmental factors usually result in first-trimester pregnancy loss. Anatomic factors usually are associated with second-trimester pregnancy loss.

27. COMPLETE - Typically, a history of vaginal bleeding, abdominal pain, and passage of tissue exists. After the tissue passes, the patient notes that the pain subsides and the vaginal bleeding significantly diminishes. The examination reveals some blood in the vaginal vault; a closed cervical os; and no tenderness of the cervix, uterus, adnexa, or abdomen. The ultrasound demonstrates an empty uterus. SEPTIC - Infection usually begins as endometritis and involves the endometrium and any retained products of conception. If not treated, the infection may spread further into the myometrium and parametrium. Parametritis may progress into peritonitis. The patient may develop bacteremia and sepsis at any stage of septic abortion. Pelvic inflammatory disease (PID) is the most common complication of septic abortion MISSED - Causes include anembryonic gestation (blighted ovum), fetal chromosomal abnormalities, maternal disease, embryonic anomalies, placental abnormalities, and uterine anomalies. Virtually all spontaneous abortions are preceded by missed abortion. A rare exception is expulsion of a normal pregnancy because of a uterine abnormality.

28. Assessment ASSESSING ABORTION Smaller than expected for length of pregnancy Closed No No No Slight MISSED Any of the above with tenderness Usually open; fever present Varies; fever present Varies; fever present Varies; fever present Varies; usually malodorous; fever present SEPTIC Smaller than expected for length of pregnancy Closed Possible Mild Mild Heavy COMPLETE Smaller than expected for length of pregnancy Open with tissue in cervix Possible Yes Severe Slight INCOMPLETE Agrees with length of pregnancy Open No No Moderate Moderate INEVITABLE Agrees with length of pregnancy Closed No No Mild Slight THREATENED SIZE OF UTERUS INTERNAL CERVICAL OS TISSUE IN VAGINA PASSAGE OF TISSUE UTERINE CRAMPING AMOUNT OF BLEEDING TYPE

44. MASTITIS

45. OVERVIEW OF THE DISEASE -Mastitis means that the breast is inflamed, and there is swelling, redness, tenderness and pain. There may be an infection, so it is wise to consult your health-care provider to determine whether or not an antibiotic is necessary. A breast infection can become a breast abscess that requires surgical draining, but this can almost always be prevented by treating mastitis promptly . - Mastitis is a condition that causes the breast tissue to become inflamed. It usually occurs in women who are breastfeeding, so it is often referred to as lactation mastitis. -Mastitis usually affects only one breast, causing it to become painful, red and swollen. Some women may also experience flu-like symptoms, which can include fever, chills or aches.

49. ASSESSMENT

57. CERVICAL CANCER

58. Anatomy and Physiology The cervix is one part of your reproductive system.It is the lower part of your womb, also called the uterus.The cervix connects your uterus and vagina.And your vagina leads to the outside of your body and the vulva, which is the skin area where you have pubic hair.These are the other parts of your reproductive system.They are all in the pubis. >Vagina >2 Ovaries >2 Fallopian tubes The cervix has two parts: 1.ECTOCERVIX-the outer part which is closest to the vagina 2.ENDOCERVIX-the inner part which is closest to the uterus.

60. TRANSFORMATION ZONE -where the ectocervix and endocervix meet where most cervical cancers start. Two types of cells which are on the surface of the cervix: 1.Squamous epithelial cells-line the outer part of the cervix. 2.Columnar epithelial cells-line the inner part of the cervix.

66. Pathophysiology: Potentially, all women with carcinoma in situ and 90% of women with nonmetastatic disease can be cured. Five to ten years may elapse between the preinvasive and invasive stages of cervical cancer. Most cervical cancers are of the squamous cell type. Squamous cell carcinoma usually begins at the squamocolumnar junction near the external end of thecervix. Some cervical adenocarcinomas occur but are more difficult to diagnose. Adenocarcinoma generally involves the endocervical glands. Cervical dysplasia, theearliest premalignant change noted incervical epithelium, is now further dividedinto several levels of cervical intraepithelial neoplasia (CIN):MILD DYSPLASIA is CIN1, MODERATE DYSPLASIA is CIN 2, SEVERE DYSPLASIA and carcinoma in situ are CIN

67. The spread of squamous cell cerervical cancer occurs first by direct extensionto the vaginal mucusa, the lower uterine segment,parametrium, pelvic wall, bladder, and bowel. Distant metastasis occurs mainly through lymphatic spread, with some spread occurring through the circulatory system to the liver, lungs, or bones. The 5 year survival rate for women with cervical cancer is 65% for nonlocalized disease.

77. SEXUALLY TRANSMITTED DISEASE

81. BREAST CANCER

85. PATHOPHYSIOLOGY