Organizace v

1
Organization of the teaching - gynecology and
obstetrics
Lecture for 5th year general medicine course and
dentist medicine course
2
(No Transcript)
3
Contents

• lecture's
• practice (obstetrics hall, small gynecology
  procedures, department of risk pregnancy,
  department of gynecology surgery, ultrasound
  laboratory, phantom exercise)
• seminar's
• practice before SE
• night duty (14-22 22-6)

Synopsis of the choice lecture www.gyne.cz
4
State examination

• two credits (winter and summer term)
• 14th days practice at the department of GO
• test from GO
• practice part (CTG, HSG, phantom, obstetrical
  examination, gynecological examination)
• assay (deadline 4/2005)

5
Basic literature
6
Possible literature
7
Possible literature
8
Virtual guide of the Department of GO
9
Obstetrics part of the clinic
10
Entry for students
11
Outpatient and gynecology department
12
Lecture hall
13
Lecture hall
14
Practice cabinet
15
Library with the PC
16
Ultrasound laboratory
17
Department of gynecology surgery
18
Department of intensive care
19
Endoscopic operating hall
20
Delivery hall
21
Woman life cycles

• newborn period
• childhood
• puberty
• adolescence
• fertile age
• climacterium
• senium (old age)

22
Cycles of woman organism

• Ovarian cycle
• maturation of the foliculus
• ovulation
• corpus luteum
• corpus albicans

23
Cycles of woman organism

• Uterine cycle
• proliferative phase (picture 1.)
• secretory phase (picture 2.)
• uterine cervix changes (cervical becomes thin
  through ovulation because of estrogen peak, than
  thick because of progesterone)
• menstruation 28/5

24
Picture 1.
25
Picture 2.
26
Cycles of woman organism

• Vaginal cycle
• in proliferative phase oesinophile cells exist
  (influence of estrogens)
• in secretory phase intermedial cells leucocytes
  exist (influence of progestin's)
• acidity of vaginal secret

27
Cycles of woman organism

• Fallopian tube and breast cycle
• increased motility of tube in first phase
• enlargement of the breast, edema, breast pain,
  increasing sensitivity at the end of the cycle

28
Physiology of female reproduction system

• Menstruation periodic discharge of the blood,
  tissue, fluid and endometrial debris from the
  uterus, the mean blood loss is 30 ml
• Menarche girl's first menstrual period
  average 12,5 years
• Menopause last women menstrual period average
  50 years

29
Physiology of female reproduction system II.

• Menstrual cycle LMP, 28/5, light, mild, heavy
• The ovarian follicle liquor folliculi, oocyte,
  granulosa cells, theca externa, theca interna,
  size before ovulation (14th day of the cycle)
  from 15 to 20 mm
• Follicular proliferative phase (ovulation)
• Luteal secretory phase (corpus luteum)

30
Sexual and reproductive health

• Puberty
• from first signs of sexual development till
  menarche
• P1 prepuberty 9-10 yrs
• P2 early puberty 10-11 yrs (start of hormone
  secretion)
• P3 thelarche 10-11 yrs, pubarche 11-12 yrs
• P4 breast fully developed
• P5 menarche yrs 12,6

31
Sexual and reproductive health

• Adolescence
• from menarche till stabilization of ovulatory
  cycles
• duration 2,5 years
• after that fertile period

32
Perinatology
Independent scientific discipline
33
Screening test in pregnancy

• screening interview
• weight
• Rh factor, HB
• urine protein and sugar
• BP
• cytology
• AFP, hCG, E3
• Rh antibody

34
Abnormal pregnancy

• pathological pregnancy
• risk gravidity
• pregnancy with increased probability of perinatal
  morbidity and mortality

35
Risk factors

• lack of antenatal care
• Social unmarried woman, smoking, drugs,
  alcohol, low education, low social class, poor
  diet, age
• Biological obesity, small height, breech
  presentation, twins, disease of mother (DM, Rh
  incompatibility, cardiopathy, nephritis,
  hypertension, hepatitis)

36
Risk factors leading to prematurity

• previous termination of pregnancy
• twins
• preeclampsia
• hepatitis
• zoonosis
• uterine malformation
• social risk's

37
Antenatal visit
The first visit ideally at 8-10 weeks gestation,
monthly until 28 weeks, fortnightly until 36
weeks, weekly until delivery
38
History

• DM
• tuberculosis
• hypertension
• past obstetrics history
• allergies
• LMP
• first movements

39
Examination, investigation

• palpation, colposcopy, cytology, breast
• urine (sugar, protein, bacilluria)
• blood (Hb, red cell, ABO and rhesus group)
• screening test for syphilis (RRR)
• test for Australian antigen
• rubella antibodies
• anti HIV antibodies

40
Special visit 16th week

• AFP, hCG and E3
• Ultrasound examination
• to establish gestational age accurately
• to exclude major abnormalities of the fetus
• to diagnose multiple pregnancy
• localization of the placenta

41
Psychoprofylaxis

• mother craft
• relaxation classes
• books available
• Social welfare
• iron (300 µg a day)
• iodine 100 mg a day
• folic acid 500µg a day
• vitamin supplementation

42
Psychoprofylaxis II.

• smoking - premature delivery, small babies
• alcohol is cell poison, alcohol syndrome of
  fetus (short nose, low bridge, small eyes, mental
  retardation)
• intercourse no restriction in normal G
• exercise walking, swimming
• cloth brassieres are not required, shoes flat
  heels, comfortable dress
• bathing not hot water, better shower

43
Vital statistics
44
Birth rates

• Crude birth rate
• is the number of live birth per 1000 total
  population (includes men, children and women)
• General fertility rate
• is the number of live births per 1000 women
  between 15 and 44

45
Obstetrical statistics

• Stillbirth (SB)
• child delivered after 24th week of pregnancy that
  did not show any sign of life birth weight is
  greater than 500 grams or less than 500 grams but
  not alive 24 hours
• Stillbirth rate (SBR)
• is defined as the number of stillbirth per 1000
  total birth (still and live)

46
Obstetrical statistics II.

• Early neonatal death (END)
• is defined as the number of infants dying in the
  7 days after delivery per 1000 live birth
• Perinatal mortality rate (PMR)
• number of stillbirth early neonatal death per
  1000 total birth
• Rectified perinatal mortality
• number of dead babies above 1000 g

47
PMR
PMR

END
SBR
48
Priority of PMR

END 2000g
SBR 2000g
SA
END 2000g
49
Causes of perinatal death

• Ante partum
• unknown in 25
• congenital abnormality 30
• hypoxia (torsion of umbilicus, placental
  abruption, eclampsia, vasa praevia etc.)
• Neonatal death
• 80 due to preterm labour, babies born before
  26th week have chance to survive 40

50
Perinatal morbidity

• disorders of child development in perinatal
  period
• malformation - (genetic, infectious, toxic)
  sensoric (deafness) motoric (children's brain
  paralysis) mental (slight brain dysfunction)
• cause - prematurity, prolonged labour, mechanical
  damage, chronic hypoxia, late solution of acute
  hypoxia, mother's disease DM, preeclampsia

51
Maternal mortality

• means death connected to gravidity, labour till
  60 day's after the labour
• the number is 0,04 per 1000 total birth
• A. Specific risk preeclampsia (I.), haemorrhage
  (II.), shock, uterine rupture (III.), puerperal
  infection (IV.), thrombosis (V.), connection with
  abortion (VI.)
• B. Unspecific risk internal medicine (I.),
  surgical disease (II.)
• C. Death without relation to G

52
Maternal mortality
Number of death women per 100 000 total birth in
Czech Republic
MM complete
MM rectified
53
MM in Czech Republic 1997 (0,08)

• Decrease of maternal mortality due to
• control of infection
• blood transfusion
• advances in anesthesia and resuscitation
• improvement in the health and nutrition
• prevention of disease in gravidity

Detailed analysis of any maternal mortality
(Annual Report on Maternal Deaths).
54
MM - notes

• Hypertensive disease of pregnancy deaths from
  eclampsia and preeclampsia can be avoided i n 75
  (early admission to hospital, nutrition, control
  of BP)
• Pulmonary embolism prevention in puerperium,
  right checking of puls rate, heparinisation
  (LMWH), early mobilization, therapy of
  thrombophlebitis, decrease of cesarean section
  rate, no estrogen's in lactation inhibition

55
MM - notes

• Amniotic fluid embolism sudden collapse, strong
  contraction's, dyspnoe, cyanosis, blood stained
  sputum treatment oxygen, steroid's, correction
  of coagulopathy
• Hemorrhage placental abruption, placenta
  praevia, coagulopathy, postpartum atonia, uterine
  rupture, risk of home birth
• Cesarean section death's from associated and
  undercurrent condition's (cardiac disease)