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Gynecology and Obstetrics

Approach to the Gynecologic Patient
- General Gynecologic Evaluation
Symptoms of Gynecologic Disorders
Benign Gynecologic Lesions
Breast Disorders
Domestic Violence and Rape
- Medical Examination of the Rape Victim
- Domestic Violence
  - Effects
  - Management
Endometriosis
- Endometriosis
Family Planning
Female Reproductive Endocrinology
- Female Reproductive Endocrinology
Gynecologic Tumors
Infertility
Menopause
- Menopause
Menstrual Abnormalities
Pelvic Relaxation Syndromes

Prenatal Genetic Counseling and Evaluation
- Prenatal Genetic Counseling
  - Risk Factors
  - Reference
- Genetic Evaluation
Sexual Dysfunction in Women
Uterine Fibroids
- Uterine Fibroids
Vaginitis, Cervicitis, and Pelvic Inflammatory Disease (PID)
Approach to the Pregnant Woman and Prenatal Care
Symptoms During Pregnancy
Abnormalities and Complications of Labor and Delivery
Abnormalities of Pregnancy
Drugs in Pregnancy
- Drugs in Pregnancy
High-Risk Pregnancy
- Overview of High-Risk Pregnancy
  - Reference
  - Risk Assessment During Pregnancy
- Risk Factors for Complications During Pregnancy
Normal Labor and Delivery
- Management of Normal Labor
- Management of Normal Delivery
Postpartum Care and Associated Disorders
Pregnancy Complicated by Disease

Gynecologists are physicians who specialize in the medical and surgical care of the female reproductive system and associated disorders. Many gynecologists serve as primary care physicians for women. Many, but not all, gynecologists also practice obstetrics, the care provided throughout pregnancy and delivery.

Gynecology and ObstetricsSections (A-Z)

Abnormalities and Complications of Labor and Delivery

Abnormalities and complications of labor and delivery should be diagnosed and managed as early as possible.

Introduction to Abnormalities and Complications of Labor and Delivery
Operative Vaginal Delivery
Induction of Labor
Cesarean Delivery
Amniotic Fluid Embolism
Fetal Dystocia
Inverted Uterus
Multifetal Pregnancy
Placenta Accreta
Postpartum Hemorrhage
Postterm Pregnancy
Premature Rupture of Membranes (PROM)
Preterm Labor
Protracted Labor
Umbilical Cord Prolapse
Uterine Rupture

Abnormalities of Pregnancy

Abnormalities that develop during pregnancy may be directly related to the pregnancy or not (for nonobstetric disorders, see Pregnancy Complicated by Disease ). Obstetric abnormalities increase the risk of morbidity or mortality for the woman, fetus, or neonate, as do such factors as maternal characteristics, problems in previous pregnancies, and drug use (see High-Risk Pregnancy )

Introduction to Abnormalities of Pregnancy
Abruptio Placentae
Cervical Insufficiency
Intra–Amniotic Infection
Ectopic Pregnancy
Erythroblastosis Fetalis
Pemphigoid Gestationis
Hyperemesis Gravidarum
Polyhydramnios
Oligohydramnios
Placenta Previa
Preeclampsia and Eclampsia
Pruritic Urticarial Papules and Plaques of Pregnancy
Spontaneous Abortion
Septic Abortion
Stillbirth
Vasa Previa

Approach to the Gynecologic Patient

Most women, particularly those seeking general preventive care, require a complete history and physical examination as well as a gynecologic evaluation.

General Gynecologic Evaluation

Approach to the Pregnant Woman and Prenatal Care

For conception (fertilization), a live sperm must unite with an ovum in a fallopian tube with normally functioning epithelium. Conception occurs just after ovulation, about 14 days after a menstrual period. At ovulation, cervical mucus becomes less viscid, facilitating rapid movement of sperm to the ovum, usually near the fimbriated end of the tube. Sperm may remain alive in the vagina for about 3 days after intercourse.

Conception and Prenatal Development
Physiology of Pregnancy
Evaluation of the Obstetric Patient

Benign Gynecologic Lesions

Adnexal torsion is twisting of the ovary and sometimes the fallopian tube, interrupting the arterial supply and causing ischemia.

Adnexal Torsion
Bartholin Gland Cysts
Benign Ovarian Masses
Cervical Myomas
Cervical Polyps
Cervical Stenosis
Skene Duct Cyst
Uterine Adenomyosis
Vulvar Endometriomas
Vulvar Inclusion and Epidermal Cysts

Breast Disorders

Breast symptoms (eg, masses , nipple discharge , pain ) are common, accounting for > 15 million physician visits/yr. Although > 90% of symptoms have benign causes, breast cancer is always a concern. Because breast cancer is common and may mimic benign disorders, the approach to all breast symptoms and findings is to conclusively exclude or confirm cancer.

Evaluation of Breast Disorders
Breast Cancer
Breast Masses (Breast Lumps)
Mastalgia (Breast Pain)
Nipple Discharge
Phyllodes Tumor

Domestic Violence and Rape

Although legal and medical definitions vary, rape is typically defined as oral, anal, or vaginal penetration that involves threats or force against an unwilling person. Such penetration, whether wanted or not, is considered statutory rape if victims are younger than the age of consent. Sexual assault is rape or any other sexual contact that results from coercion, including seduction of a child through offers of affection or bribes; it also includes being touched, grabbed, kissed, or shown genitals. Rape and sexual assault, including childhood sexual assault, are common; the lifetime prevalence estimates for both ranges from 2 to 30% but tends to be about 15 to 20%. However, actual prevalence may be higher because rape and sexual assault tend to be underreported.

Medical Examination of the Rape Victim
Domestic Violence

Drugs in Pregnancy

Drugs are used in over half of all pregnancies, and prevalence of use is increasing. The most commonly used drugs include antiemetics, antacids, antihistamines, analgesics, antimicrobials, diuretics, hypnotics, tranquilizers, and social and illicit drugs. Despite this trend, firm evidence-based guidelines for drug use during pregnancy are still lacking.

Drugs in Pregnancy

Endometriosis

In endometriosis, functioning endometrial tissue is implanted in the pelvis outside the uterine cavity. Symptoms depend on location of the implants and may include dysmenorrhea, dyspareunia, infertility, dysuria, and pain during defecation. Severity of symptoms is not related to disease stage. Diagnosis is by direct visualization and sometimes biopsy, usually via laparoscopy. Treatments include anti-inflammatory drugs, drugs to suppress ovarian function and endometrial tissue growth, surgical ablation and excision of endometriotic implants, and, if disease is severe and no childbearing is planned, hysterectomy alone or hysterectomy plus bilateral salpingo-oophorectomy.

Endometriosis

Family Planning

A couple’s decision to begin, prevent, or interrupt a pregnancy may be influenced by many factors including maternal medical disorders, risks involved in the pregnancy, and socioeconomic factors.

Introduction to Family Planning
Overview of Contraception
Oral Contraceptives
Transdermal and Vaginal Ring Hormonal Contraceptives
Progestin Contraceptive Injections
Subdermal Contraceptive Implants
Barrier Contraceptives
Intrauterine Devices (IUDs)
Fertility Awareness‒Based Methods of Contraception
Emergency Contraception (EC)
Sterilization
Induced Abortion

Female Reproductive Endocrinology

Hormonal interaction between the hypothalamus, anterior pituitary gland, and ovaries regulates the female reproductive system.

Female Reproductive Endocrinology

Gynecologic Tumors

Gynecologic cancers often involve the uterus , ovaries , cervix , vulva , vagina , fallopian tubes , or the peritoneum. The most common gynecologic cancer in the US is endometrial cancer, followed by ovarian cancer. Cervical cancer is not very common in developed countries because Papanicolaou (Pap) test screening is widely available and effective. Gestational trophoblastic disease is a gynecologic tumor that may behave aggressively whether malignant or not.

Introduction to Gynecologic Tumors
Cervical Cancer
Endometrial Cancer
Fallopian Tube Cancer
Gestational Trophoblastic Disease
Ovarian Cancer
Uterine Sarcomas
Vaginal Cancer
Vulvar Cancer

High-Risk Pregnancy

In a high-risk (at-risk) pregnancy, the mother, fetus, or neonate is at increased risk of morbidity or mortality before or after delivery.

Overview of High-Risk Pregnancy
Risk Factors for Complications During Pregnancy

Infertility

Infertility is usually defined as inability of a couple to conceive after 1 yr of unprotected intercourse.

Overview of Infertility
Sperm Disorders
Abnormal Cervical Mucus
Decreased Ovarian Reserve (DOR)
Ovulatory Dysfunction
Tubal Dysfunction and Pelvic Lesions
Unexplained Infertility
Assisted Reproductive Techniques

Menopause

Menopause is physiologic or iatrogenic cessation of menses (amenorrhea) due to decreased ovarian function. Manifestations may include hot flushes and vulvovaginal atrophy. Diagnosis is clinical: absence of menses for 1 yr. Manifestations may be treated (eg, with lifestyle modification, complementary and alternative medicine, and/or hormone therapy).

Menopause

Menstrual Abnormalities

(For a description of the menstrual cycle, see Female Reproductive Endocrinology : Menstrual Cycle .)

Introduction to Menstrual Abnormalities
Amenorrhea
Dysfunctional Uterine Bleeding (DUB)
Dysmenorrhea
Pelvic Congestion Syndrome
Polycystic Ovary Syndrome (PCOS)
Primary Ovarian Insufficiency
Premenstrual Syndrome (PMS)

Normal Labor and Delivery

(See also Abnormalities and Complications of Labor and Delivery .)

Management of Normal Labor
Management of Normal Delivery

Pelvic Relaxation Syndromes

Pelvic relaxation syndromes result from laxities (similar to hernias) in the ligaments, fascia, and muscles supporting the pelvic organs (pelvic floor—see Figure: Pelvic relaxation syndromes. ). About 9% of women require surgical repair for a pelvic relaxation syndrome.

Overview of Pelvic Relaxation Syndromes
Cystoceles, Urethroceles, Enteroceles, and Rectoceles
Uterine and Vaginal Prolapse

Postpartum Care and Associated Disorders

Clinical manifestations during the puerperium (6-wk period after delivery) generally reflect reversal of the physiologic changes that occurred during pregnancy (see Table: Normal Postpartum Changes ). These changes are mild and temporary and should not be confused with pathologic conditions.

Postpartum Care
Mastitis
Puerperal Endometritis
Postpartum Pyelonephritis
Postpartum Depression

Pregnancy Complicated by Disease

Nonobstetric disorders often complicate pregnancy; management for pregnant patients sometimes differs from that for nonpregnant patients.

Introduction to Pregnancy Complicated by Disease
Anemia in Pregnancy
Asthma in Pregnancy
Autoimmune Disorders in Pregnancy
Cancer in Pregnancy
Diabetes Mellitus in Pregnancy
Fevers During Pregnancy
Fibroids in Pregnancy
Heart Disorders in Pregnancy
Hepatic Disorders in Pregnancy
Hypertension in Pregnancy
Infectious Disease in Pregnancy
Renal Insufficiency in Pregnancy
Seizure Disorders in Pregnancy
Disorders Requiring Surgery During Pregnancy
Thromboembolic Disorders in Pregnancy
Thyroid Disorders in Pregnancy
Urinary Tract Infection in Pregnancy

Prenatal Genetic Counseling and Evaluation

(See also General Principles of Medical Genetics .)

Prenatal Genetic Counseling
Genetic Evaluation

Sexual Dysfunction in Women

Men and women initiate or agree to sexual activity for many reasons, including sharing sexual excitement and physical pleasure and experiencing affection, love, romance, or intimacy. However, women are more likely to report emotional motivations such as

Overview of Female Sexual Function and Dysfunction
Sexual Desire/Interest Disorder
Sexual Arousal Disorders
Orgasmic Disorder
Vaginismus
Dyspareunia
Provoked Vestibulodynia (Vulvar Vestibulitis; PVD)
Persistent Genital Arousal Disorder

Symptoms During Pregnancy

Pelvic Pain During Early Pregnancy
Vaginal Bleeding During Early Pregnancy
Nausea and Vomiting During Early Pregnancy
Lower-Extremity Edema During Late Pregnancy
Vaginal Bleeding During Late Pregnancy

Symptoms of Gynecologic Disorders

(See also Benign Gynecologic Lesions and Gynecologic Tumors .)

Pelvic Mass
Pelvic Pain
Vaginal Bleeding
Vaginal Itching and Discharge

Uterine Fibroids

Uterine fibroids are benign uterine tumors of smooth muscle origin. Fibroids frequently cause abnormal uterine bleeding, pelvic pain and pressure, urinary and intestinal symptoms, and pregnancy complications. Diagnosis is by pelvic examination, ultrasonography, or other imaging. Treatment of symptomatic patients depends on the patient’s desire for fertility and her desire to keep her uterus. Treatment may include oral contraceptives, brief presurgical gonadotropin-releasing hormone therapy to shrink fibroids, progestin therapy, and more definitive surgical procedures (eg, hysterectomy, myomectomy).

Uterine Fibroids

Vaginitis, Cervicitis, and Pelvic Inflammatory Disease (PID)

The lower and upper female genital tracts are separated by the cervix. Inflammation of the lower tract may involve the vagina (vaginitis—see Overview of Vaginitis ), vulva (vulvitis), or both (vulvovaginitis).

Introduction to Vaginitis, Cervicitis, and Pelvic Inflammatory Disease
Overview of Vaginitis
Bacterial Vaginosis (BV)
Candidal Vaginitis
Inflammatory Vaginitis
Cervicitis
Pelvic Inflammatory Disease (PID)

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Also of Interest

Test your knowledge

Polycystic ovary syndrome (PCOS) is characterized by mild obesity, irregular menses or amenorrhea, and which of the following?

Adrenal insufficiency Androgen excess Ovarian cysts Type 1 diabetes

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