Cervical insufficiency (incompetent cervix)

Painless early pregnancy dilation

Etiology

• Trauma from rapid forceful cervical dilation associated with 2nd trimester abortion
• Cervical laceration from rapid delivery
• Injury from deep cervical cone
• Congenital weakness from DES exposure

Diagnosis:

• History of 2 or more unexplained second trimester pregnancy losses.
• Benefit of cerclage is unclear  

Management: 

• Elective cerclage at 13-16 weeks gestation
• Emergency or Urgent cerclage
• Cerclage removal at 36-37 weeks

Fetoscopy

When to perform : 18-20 weeks

• its for Biopsy of fetal tissue and IU surgery
• Loss rate : 2-5 % 

Management of Cervical Neoplasia in Pregnancy

Cervical Neoplasia in Pregnancy

Dx: Colpo & Biopsy, Do not perform ECC because of increase vascularity

Management of Cervical Neoplasia in Pregnant .

CIN intraepithelial :

• Pap & Colpo every 3 months
• PP 2 months: revaluate & Rx

MICRO invasion  :

• Cone biopsy: r/o frank invasion Follow conservatively, then Vaginal Delivery
• PP 2 month: treat residual lesions

FRANK invasion :

• less than 24 wk: ignore pregnancy, Rx CA
• greater than 24 wk: wait to 32 wk, then CS & treat CA per staging 

RAH :

Radical abdominal hysterectomy (RAH)

• Radical abdominal hysterectomy specimen with fetus in situ performed at 18 weeks of gestation for stage IB cervical cancer.

Trimethylamineuria (Fish Odor Syndrome)

Trimethylamineuria (Fish Odor Syndrome)

• autosomal recessive

• A rare clinical entity with an offensive persistent odor that no amount of bathing or washing or perfuming will correct.

Vaginal Discharge

Differential Diagnosis :  Normal : Lactobacillus 70 % and non-Lactobacillus 30 %

• Bacterial Vaginosis  ----- 50 %
• Candida                    ----- 30 %
• Trich                         ----- 15 % 

Visual inspection : Inflammatory response Vaginal discharge e.g thin-thick gray-white-green,frothy

Vaginal pH : Normal: < 4.5 Use Nitrazine paper

Micro-exam : Wet Prep Saline and KOH

Urinary incontinence types and its treatment

Ask your patient about the symptoms ? 

Bladder diary: Name / Date

Fluids

• type and amount of fluids

Urination 

• Strong urge to urinate (Y,N)
• Amount urinated in toilet (S,M,L)

Accidents

• Amount of leakage (S,M,L)
• Activity preceding leakage

Here are the examples of Urinary incontinence

Submaximal Exercise Testing

Cardiovascular Angiography