Tasks of the Gynecologist&Obstetrician

Information about Tasks of the Gynecologist&Obstetrician

Published on December 9, 2009

Author: katalintamas

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Tasks and Patients of the Gynecologist and Obstetrician : Tasks and Patients of the Gynecologist and Obstetrician Dr. János Aranyosi University of Debrecen Medical School and Health Science Center Patients : Embryo Fetus Newborn Adolescent girl Young girls Women Pregnant women Breastfeeding women Peri- and postmenopausal women Patients Tasks : Improve perinatal morbidity and mortality Provide safe motherhood Improve safe female adulthood Provide safe family planning modalities Provide effective screening methods Provide minimally invasive op procedures Tasks Perinatal morbidity and mortality : Perinatal event: 28th gestational week - first neonatal week Perinatal morbidity and mortality Perinatal mortality : Malformations, Chromosomal abnormalities Preterm birth Placental insufficiency (early onset) Perinatal mortality MalformationsChromosomal abnormalities : Risk assessement History Biophysical screening – Ultrasound Biochemical screening – AFP, HCG Genetical Counseling MalformationsChromosomal abnormalities MalformationsChromosomal abnormalities : MalformationsChromosomal abnormalities MalformationsChromosomal abnormalities : MalformationsChromosomal abnormalities MalformationsChromosomal abnormalities : MalformationsChromosomal abnormalities Slide 10: NTDs = neural tube defects; AFP = alpha-fetoprotein; hCG = human chorionic gonadotropin; uE3 = unconjugated estriol. Information from Cunningham FG, MacDonald PC, Gant NF, Leveno KJ, Gilstrap LC. Williams Obstetrics. 20th ed. Stamford, Conn.: Appleton & Lange, 1997. MalformationsChromosomal abnormalities Preterm birth : Prevalence : 10% Multifactorial disease Definition of birth: - completed 24 weeks - fetus > 500 gramms - vital signs Preterm birth Preterm birth : Premature rupture of membranes Preterm uterine contractions Preterm birth Preterm birth : Early recognition/perception of uterine activity Education of imminent signs and symptoms Early beginning of protective therapy Improving clinical prognosis Prolongation of gestation: - Antibiotics - Tokolytics IN UTERO transportaion IRDS and ICH profilaxis by Corticosteroids Preterm birth Preterm birth : CERVICO-VAGINAL INFECTIONS Chlamydia Streptococcus Staphylococcus Cervical exam Antibiotics Tokolytics Preterm birth Fetal mortality 2002: 5/1000 : Demográfiai évkönyv KSH 2003. Fetal mortality 2002: 5/1000 Perinatal hypoxia : Screening „at risk” population Early medical and obstetrical management ANTENATAL CARE Perinatal hypoxia Antenatal Care : 10 countries 28 obsterical departments 70.000 deliveries/year First type of fetal assessement - NST: 43 % - S/F: 17 % - US: 17 % - MM: 14 % - BFP: 3 % - Doppler: 3 % Juhász A.G., Aranyosi J., Zatik J., Major T. Orv. Hetil. 2002, 143. Antenatal Care Antenatal Care - Ultrasound : Structural Functional Antenatal Care - Ultrasound Ultrasound examination : Fetal growth Biophysical profile-heart rate-fetal movements-Amniotic fluid volume-placental structure Plecento-Fetal -arterial-cardiac-venous Ultrasound examination Prevention of perinatal hypoxia : Prevention of preterm birth Recognition of Placental Insufficiency Recognition of early fetal compensation Prevention of perinatal hypoxia UTERINE Artery Doppler 20th. week : A. UTERINA abnormal flow pattern 20 + week PI Hypertension preeclampsia retardation perinatal morbidity OR: 5.4 - 6.4 Trudinger BJ. 1985, Arduini D. 1987, Steel SA. 1990, Mires GJ. 1998, Kurdi W. 1998, Benedetto C. 1998, Chien 2000. UTERINE Artery Doppler 20th. week UMBILICAL Artery Doppler : UMBILICAL Artery Doppler A. UMBILICALIS Abnormal flow 28-32. weeksl retardation - morbidity- mortality NEGATIVE:- mortality- Antenatal tests OR: 0.56 -0,67Westergaard HB. 2001, Haddad B. 1999, Illyés M. 1988, Gofinet F. 1997. Todros T. 1996 ARTERIAL REDISTRIBUTION : ARTERIAL REDISTRIBUTION Peeters LL. 1979., Jensen A. 1999., Aranyosi J. 2001. MONITORING LABOR : MONITORING LABOR Monitoring labor: protocols : Pp:292-389. Monitoring labor: protocols Monitoring Labor: Practice : 1960- Monitoring Labor: Practice Course and progression of labor : Course and progression of labor Friedman Emanuel 1978 – PARTOGRAM- Cervical dilatation- Engagement and descent Healthy NEWBORN (boy) : Healthy NEWBORN (boy) ObstetricalAnaesthesia : ObstetricalAnaesthesia Maternal perinatal mortality : Haemorrhage- placenta previa- placental abruption- postpartum haemorrhage Perinatal infection – sepsis puerperalis Maternal perinatal mortality Family planning : Oral contraceptive method Intra uterine contraceptive system Medical indications-contraindications Risk assessement for thrombotic diseases Thrombophylia screening Safe abortion (PG, Laminaria, Antibiotics) Irreversible male and female sterilisation Family planning Intra uterineLNG contraceptivesystem : Intra uterineLNG contraceptivesystem Gynecology : Infertility Endometriosis Benign diseases Malignant diseases Vulva, Cervix,Corpus, Ovaries Gynecology Infertility : Infertility Infertility diagnostic protocol : Infertility diagnostic protocol Infertility: Diagnosis : Infertility: Diagnosis Slide 38: 2 cells 2. day: 8 cells 7. day: implantation 10. day Huge „chocolate cyst” of the ovary : Huge „chocolate cyst” of the ovary Endometriosis 2-10% : Heavy menstrual period Killer cramps Dyspareunia Chronic pelvic pain Infertility Endometriosis 2-10% Gynecologic diseases : Gynecologic diseases Cervical cancer screening : Kolposcopy Cytology (Papanicolau, Bethesda) HPV (Human Papilloma Virus) Cervical cancer screening Cervical cancer: progression : Cervical cancer: progression Fibroids : Fibroids Fibroid removal:1. Hysteroscopy2. Laparotomy: enulcleation : Fibroid removal:1. Hysteroscopy2. Laparotomy: enulcleation Endometrial: polyps : Endometrial: polyps Endometrial cancer : Endometrial cancer Endometrial cancer screening : Age: 50+ Irregular bleeding Medical diseases Hypertension, Diabetes, Obesity Ultrasound assessment of endometrium Endometrial aspiration - hystology Endometrial cancer screening Endometrial cancer screening : Endometrial cancer screening Ovarian Cancer : Ovarian Cancer Ovarian Cancer Screening : Age: 40+ Familiar history Superovulation therapy priorly POS: Palpable Ovary Syndrome Ultrasound structure and neovascularisation Tumor markers: Ca-125 Ovarian Cancer Screening Obstetrics-Gynecology : More PREVENTIVE Less RADICAL Minimally accesive – invasive Obstetrics-Gynecology Obstetrics-Gynecology : MORE ENTERTAINING Obstetrics-Gynecology Obstetrics-Gynecology : Safe intra-uterine life Safe motherhood Safe family planning Safe adulthood Safe and satisfactory elderly ages Obstetrics-Gynecology Obstetrics-Gynecology : Lifetime educationfor the medical personnel Obstetrics-Gynecology

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