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Gynecological diseases complicating pregnancy
Bsc nursing (blaw 213)
Kerala University of Health Sciences
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douches bacterial growth. tract infections. Drugs Treatment commonly Antibiotics include: septra, others) for (bactrim, Nitrofurantoin Fosfomycin (macrodantin, macrobid) (monurol) Cephalexin (keflex) treatment recommendations, Ceftriaxone such as: UTIs. doctor may If woman have frequent for 6 months but sometimes longer. antibiotics. of antibiotic initially after sexual intercourse if infections are related to sexual activity, A single estrogen dose therapy if woman is postmenopausal. Vaginal (Already discussed above in Medical Diseases Complicating Pregnancy) GYNECOLOGICAL DISORDERS COMPLICATING PREGNANCY The common gynecological disorders that may complicate the pregnancy are: Retroversion. retroflexion Fistula Uterine displacement and prolapse (Procidentia) Already discussed above. Uterine malformations Uterine polyps Fibroids Cysts Tumors of the reproductive and malignant. Cysts Cysts are abnormal, closed structures within a tissue that contain a liquid, gaseous, or semisolid substance. Cysts can occur anywhere in the body and can vary in size. Ovarian Cyst An ovarian cyst is a sac within the ovary (Fig. 22). Types of Ovarian Cysts and Functional ovarian these cysts: Cysts that develop as part of the menstrual cycle and are Pathological are the most common type of cysts: Cysts that occur due to abnormal ovarian cyst. cell these are 426 douches bacterial growth. tract infections. Drugs Treatment commonly Antibiotics include: septra, others) for (bactrim, Nitrofurantoin Fosfomycin (macrodantin, macrobid) (monurol) Cephalexin (keflex) treatment recommendations, Ceftriaxone such as: UTIs. doctor may If woman have frequent for 6 months but sometimes longer. antibiotics. of antibiotic initially after sexual intercourse if infections are related to sexual activity, A single estrogen dose therapy if woman is postmenopausal. Vaginal (Already discussed above in Medical Diseases Complicating Pregnancy) GYNECOLOGICAL DISORDERS COMPLICATING PREGNANCY The common gynecological disorders that may complicate the pregnancy are: Retroversion. retroflexion Fistula Uterine displacement and prolapse (Procidentia) Already discussed above. Uterine malformations Uterine polyps Fibroids Cysts Tumors of the reproductive and malignant. Cysts Cysts are abnormal, closed structures within a tissue that contain a liquid, gaseous, or semisolid substance. Cysts can occur anywhere in the body and can vary in size. Ovarian Cyst An ovarian cyst is a sac within the ovary (Fig. 22). Types of Ovarian Cysts and Functional ovarian these cysts: Cysts that develop as part of the menstrual cycle and are Pathological are the most common type of cysts: Cysts that occur due to abnormal ovarian cyst. cell these are 426 and Risk Factors Management History of previous ovarian cysts Irregular menstrual cycles Infertility Polycystic ovarian syndrome Endometriosis Obesity Uterus Normal ovary Ovary with cyst Vagina Fig. 22: Ovarian cysts Early menarche (11 years or younger) Hyperthyroidism Tamoxifen therapy for breast cancer Symptoms Often ovarian cysts do not cause any symptoms. However, symptoms can appear as the cyst grows. Symptoms may include: Abdominal bloating or swelling Painful bowel movements Pelvic pain before or during the menstrual cycle Painful intercourse Pain in the lower back or thighs Breast tenderness Nausea and vomiting Severe symptoms of an ovarian cyst that require immediate medical attention include: Severe or sharp pelvic pain Fever Faintness or dizziness Rapid breathing. Diagnosis Pelvic and transvaginal ultrasound: Ovarian cysts are often detected during a pelvic mixture examination. of the Pelvic ultrasound is helpful to determine whether it comprises fluid, solid tissue, or a 427 and Risk Factors Management History of previous ovarian cysts Irregular menstrual cycles Infertility Polycystic ovarian syndrome Endometriosis Obesity Uterus Normal ovary Ovary with cyst Vagina Fig. 22: Ovarian cysts Early menarche (11 years or younger) Hyperthyroidism Tamoxifen therapy for breast cancer Symptoms Often ovarian cysts do not cause any symptoms. However, symptoms can appear as the cyst grows. Symptoms may include: Abdominal bloating or swelling Painful bowel movements Pelvic pain before or during the menstrual cycle Painful intercourse Pain in the lower back or thighs Breast tenderness Nausea and vomiting Severe symptoms of an ovarian cyst that require immediate medical attention include: Severe or sharp pelvic pain Fever Faintness or dizziness Rapid breathing. Diagnosis Pelvic and transvaginal ultrasound: Ovarian cysts are often detected during a pelvic mixture examination. of the Pelvic ultrasound is helpful to determine whether it comprises fluid, solid tissue, or a 427 Unit 8 and Management is perhaps cyst caused a backup of infection fluid. Fluid or injury, may accumulate irritation or when the opening of the gland (duct) bacteria an infection that cause can gonorrhea lead to the growth of a cyst. Bacteria an extra that growth can of infect skin. a cyst include or chlamydia. more likely to have a gland cyst when she is: sexually active. woman. had one pregnancy. Has Small cysts may not cause any symptoms. When symptoms occur, they usually include the painless, small lump near the opening of the vagina. Redness near opening of the vagina. Swelling near the opening of the vagina. Discomfort during sexual intercourse, walking, or sitting. cyst becomes infected, additional symptoms can develop. These include pus draining from the cyst, fever. and chills. When a cyst is infected, referred to as an abscess. Diagnosis To diagnose a cyst, doctor may: Collect medical history. Perform pelvic examination. Take a sample of secretions from vagina or cervix to test for a sexually transmitted infection. Recommend a test of the mass (biopsy) to check for cancerous cells if the woman is postmenopausal or over 40 years of age. Prevention Sexually active people should use a barrier method of contraception, such as a condom. Sitting in a warm bath may help the cyst to burst, thus preventing the formation of an abscess. Treatment If the cyst is small and presents no symptoms, the doctor may recommend no patient especially will be asked to report any growth in the size of the cyst. Any lump in the vaginal area should be reported, if the patient has started the menopause. Medical Treatment A doctor may perform a minor procedure where: A catheter is inserted into the cyst. The catheter is inflated to fix it in place. For weeks, fluid is drained the catheter, and a normal opening is formed. Other Treatments Marsupialization: This involves cutting the cyst open and draining the fluid out. The edges of the skin are stitched open for the secretions to come through. Carbon dioxide laser: This can create an opening to help drain the cyst. 429 Unit 8 and Management is perhaps cyst caused a backup of infection fluid. Fluid or injury, may accumulate irritation or when the opening of the gland (duct) bacteria an infection that cause can gonorrhea lead to the growth of a cyst. Bacteria an extra that growth can of infect skin. a cyst include or chlamydia. more likely to have a gland cyst when she is: sexually active. woman. had one pregnancy. Has Small cysts may not cause any symptoms. When symptoms occur, they usually include the painless, small lump near the opening of the vagina. Redness near opening of the vagina. Swelling near the opening of the vagina. Discomfort during sexual intercourse, walking, or sitting. cyst becomes infected, additional symptoms can develop. These include pus draining from the cyst, fever. and chills. When a cyst is infected, referred to as an abscess. Diagnosis To diagnose a cyst, doctor may: Collect medical history. Perform pelvic examination. Take a sample of secretions from vagina or cervix to test for a sexually transmitted infection. Recommend a test of the mass (biopsy) to check for cancerous cells if the woman is postmenopausal or over 40 years of age. Prevention Sexually active people should use a barrier method of contraception, such as a condom. Sitting in a warm bath may help the cyst to burst, thus preventing the formation of an abscess. Treatment If the cyst is small and presents no symptoms, the doctor may recommend no patient especially will be asked to report any growth in the size of the cyst. Any lump in the vaginal area should be reported, if the patient has started the menopause. Medical Treatment A doctor may perform a minor procedure where: A catheter is inserted into the cyst. The catheter is inflated to fix it in place. For weeks, fluid is drained the catheter, and a normal opening is formed. Other Treatments Marsupialization: This involves cutting the cyst open and draining the fluid out. The edges of the skin are stitched open for the secretions to come through. Carbon dioxide laser: This can create an opening to help drain the cyst. 429 Textbook of Obstetric and Gynecological Nursing for KUHS draining Needle aspiration: the cyst, the cavity is filled with a minuteometimes to In this procedure, a needle is alcohol inserted liquid into the solution cyst to for drain a few the cyst. Gland chances excision: If the cysts are recurring and does not respond well to any of infection. to remove the gland. BENIGN AND MALIGNANT TUMORS OF THE REPRODUCTIVE TRACT Tumors of the Ovary Ovarian cancer is the fifth most common cancer in woman all over the world. It cause of cancer death in woman. Three cell types make up the normal ovary: The multipotential surface (coelomic) covering the totipotential germ cells, and the multipotent sex cells. Each of these types epithelium to a variety of tumors. Neoplasms of the surface epithelial origin account for almost of ovarian cancers. Surface epithelial: Stromal: Germ cell tumors: Metastatic tumors: Pathogenesis: Several risk factors for epithelial ovarian cancers have been recognized. Two of the most important are nulliparity and family history. Prolonged use of oral contraceptives reduces the risk somewhat. BRCA2 gene. A majority of hereditary ovarian cancers seem to be caused mutations in the BRCA1 and Surface Epithelial Tumors All types can be benign, borderline, or malignant. Serous Tumors Serous tumors are the most common malignant ovarian tumors and accounts for of all ovarian cancers. Grossly, may be small, but most are large, spherical to ovoid, cystic structures. 40 Benign lesions are usually encountered between the age of 30 and between years, and malignant serous tumors are more commonly seen 45 and 65 years of age (Figs 24A and B). A B Serous Cystadenoma Figs 24 A and B: Serous tumors It is characterized : Fine papillae. Single layer of columnar ciliated epithelium is present. Mucinous Tumors These are serous similar tumors that to consists of the of endocervical cells (Fig. 25). Fig. 25: Mucinous tumors Textbook of Obstetric and Gynecological Nursing for KUHS draining Needle aspiration: the cyst, the cavity is filled with a minuteometimes to In this procedure, a needle is alcohol inserted liquid into the solution cyst to for drain a few the cyst. Gland chances excision: If the cysts are recurring and does not respond well to any of infection. to remove the gland. BENIGN AND MALIGNANT TUMORS OF THE REPRODUCTIVE TRACT Tumors of the Ovary Ovarian cancer is the fifth most common cancer in woman all over the world. It cause of cancer death in woman. Three cell types make up the normal ovary: The multipotential surface (coelomic) covering the totipotential germ cells, and the multipotent sex cells. Each of these types epithelium to a variety of tumors. Neoplasms of the surface epithelial origin account for almost of ovarian cancers. Surface epithelial: Stromal: Germ cell tumors: Metastatic tumors: Pathogenesis: Several risk factors for epithelial ovarian cancers have been recognized. Two of the most important are nulliparity and family history. Prolonged use of oral contraceptives reduces the risk somewhat. BRCA2 gene. A majority of hereditary ovarian cancers seem to be caused mutations in the BRCA1 and Surface Epithelial Tumors All types can be benign, borderline, or malignant. Serous Tumors Serous tumors are the most common malignant ovarian tumors and accounts for of all ovarian cancers. Grossly, may be small, but most are large, spherical to ovoid, cystic structures. 40 Benign lesions are usually encountered between the age of 30 and between years, and malignant serous tumors are more commonly seen 45 and 65 years of age (Figs 24A and B). A B Serous Cystadenoma Figs 24 A and B: Serous tumors It is characterized : Fine papillae. Single layer of columnar ciliated epithelium is present. Mucinous Tumors These are serous similar tumors that to consists of the of endocervical cells (Fig. 25). Fig. 25: Mucinous tumors KUHS Textbook of Obstetric and Gynecological Nursing for Tumor uncommon, most are benign, solid, containing usually unilateral nest of They are consisting of an abundant stroma urinary tract. Occasionally, the nests are cystic and are lined tumors, epithelium resembling that of the columnar cells (Fig. 29). They may arise from the surface epithelium or from urogenital They are generally smoothly encapsulated. epithelium trapped within the germinal ridge. Fig. 29: Teratomas These are neoplasms of origin and constitute of ovarian tumors. However, more than of these are benign mature cystic teratomas. The immature malignant is rare. variant Benign (Mature) Cystic Teratomas They are marked differentiation totipotent germ mature tissues representing all of cells into germ cell layers. Usually there are cysts lined recognizable epidermis replete. On transection, often filled with sebaceous secretion and they are matted hair, when removed, reveal epidermal lining. Sometimes teeth protrude from nodular projection. Occasionally, foci of bone and cartilage, nests of bronchial or gastrointestinal epithelium, and other recognizable lines of development are also present (Fig. 30). Sometimes, they produce infertility for unknown reasons. Fig. 30: Benign cystic teratomas Immature Malignant Teratomas They They are found early in life, the mean age is 18 punctuated predominantly solid or on transection, and bulky, are and differ from benign teratomas as they are years. often secretion, Uncommonly, one of the cystic foci areas of necrosis (Fig. 31). teratoma. hair, and other feature similar may to those contain in the sebaceous mature Fig. 31: Immature KUHS Textbook of Obstetric and Gynecological Nursing for Tumor uncommon, most are benign, solid, containing usually unilateral nest of They are consisting of an abundant stroma urinary tract. Occasionally, the nests are cystic and are lined tumors, epithelium resembling that of the columnar cells (Fig. 29). They may arise from the surface epithelium or from urogenital They are generally smoothly encapsulated. epithelium trapped within the germinal ridge. Fig. 29: Teratomas These are neoplasms of origin and constitute of ovarian tumors. However, more than of these are benign mature cystic teratomas. The immature malignant is rare. variant Benign (Mature) Cystic Teratomas They are marked differentiation totipotent germ mature tissues representing all of cells into germ cell layers. Usually there are cysts lined recognizable epidermis replete. On transection, often filled with sebaceous secretion and they are matted hair, when removed, reveal epidermal lining. Sometimes teeth protrude from nodular projection. Occasionally, foci of bone and cartilage, nests of bronchial or gastrointestinal epithelium, and other recognizable lines of development are also present (Fig. 30). Sometimes, they produce infertility for unknown reasons. Fig. 30: Benign cystic teratomas Immature Malignant Teratomas They They are found early in life, the mean age is 18 punctuated predominantly solid or on transection, and bulky, are and differ from benign teratomas as they are years. often secretion, Uncommonly, one of the cystic foci areas of necrosis (Fig. 31). teratoma. hair, and other feature similar may to those contain in the sebaceous mature Fig. 31: Immature Unit 8 D and Management distinguishing feature is immature areas of differentiation toward cartilage, bone, structures. composed entirely of mature thyroid tissue that may hyperfunction and produce solid, unilateral brown ovarian masses. carcinoid may be combined in the same ovary. One of these elements may become malignant. Uterine Endometrial Tumors Endometrial Polyps and usually hemispheric. These Histologically, they are composed of endometrium resembling the basalis, frequently with small muscular arteries. often they have cystic dilated glands, but some have normal endometrial architecture. More They may occur at any age, but more commonly, they develop at the time of menopause. Clinical significance Production of abnormal uterine bleeding Risk of giving rise to a cancer (rare). Endometrial Carcinoma It is the most frequent cancer occurring in the female genital 65 tract. Appears most frequently between in which the ages endometrial of 55 and carcinomas years. arise: in perimenopausal woman of with the There are excess two clinical and in older settings woman with endometrial atrophy (endometroid and serous carcinoma estrogen endometrium, respectively). for endometroid carcinoma: obesity, diabetes, hypertension and that infertility prolonged risk factors to increased estrogen stimulation, and it is well risk recognized of this cancer. These risk factors point and tumors increase the endometrial estrogen replacement therapy bleeding are the first clinical indication of all fixed to carcinoma. surrounding Marked With progression, leucorrhea uterus and irregular may be palpably enlarged, and in time, it becomes structures extension of the cancer beyond the uterus. Myometrial Tumors Leiomyoma The most common benign tumor in females and are found in in of woman during reproductive life. More frequent blacks than in whites (Fig. 32). They are often referred to as fibroids because they are firm. Estrogens and oral contraceptives stimulate their conversely, they shrink postmenopausally. They may be entirely asymptomatic, discovered on routine pelvic is Fig. 32: Leiomyoma examination. The most frequent manifestation, when present, 433 Unit 8 D and Management distinguishing feature is immature areas of differentiation toward cartilage, bone, structures. composed entirely of mature thyroid tissue that may hyperfunction and produce solid, unilateral brown ovarian masses. carcinoid may be combined in the same ovary. One of these elements may become malignant. Uterine Endometrial Tumors Endometrial Polyps and usually hemispheric. These Histologically, they are composed of endometrium resembling the basalis, frequently with small muscular arteries. often they have cystic dilated glands, but some have normal endometrial architecture. More They may occur at any age, but more commonly, they develop at the time of menopause. Clinical significance Production of abnormal uterine bleeding Risk of giving rise to a cancer (rare). Endometrial Carcinoma It is the most frequent cancer occurring in the female genital 65 tract. Appears most frequently between in which the ages endometrial of 55 and carcinomas years. arise: in perimenopausal woman of with the There are excess two clinical and in older settings woman with endometrial atrophy (endometroid and serous carcinoma estrogen endometrium, respectively). for endometroid carcinoma: obesity, diabetes, hypertension and that infertility prolonged risk factors to increased estrogen stimulation, and it is well risk recognized of this cancer. These risk factors point and tumors increase the endometrial estrogen replacement therapy bleeding are the first clinical indication of all fixed to carcinoma. surrounding Marked With progression, leucorrhea uterus and irregular may be palpably enlarged, and in time, it becomes structures extension of the cancer beyond the uterus. Myometrial Tumors Leiomyoma The most common benign tumor in females and are found in in of woman during reproductive life. More frequent blacks than in whites (Fig. 32). They are often referred to as fibroids because they are firm. Estrogens and oral contraceptives stimulate their conversely, they shrink postmenopausally. They may be entirely asymptomatic, discovered on routine pelvic is Fig. 32: Leiomyoma examination. The most frequent manifestation, when present, 433 Unit 8 I and Management detect cervical intraepithelial neoplasia (CIN) before the development of an However, about 30 only a fraction of cases of CIN progress to invasive carcinoma. development CIN and invasive carcinoma are: CIN is of years, whereas that of invasive carcinoma is about 45 years. first intercourse multiple previous sexual partners Persistent human papilloma virus (HPV) the Cervix cervical carcinoma is squamous cell carcinoma adenocarcinoma and carcinoma and small cell neuroendocrine carcinoma with aggressive intraepithelial changes, the time interval may be considerably shorter, in woman CIN precursors may persist for life. The only reliable way to monitor the course the disease is with careful and repeated biopsies. Symptoms include vaginal bleeding, leucorrhea, painful coitus, and dysuria. Detection of precursors cytologic examination and their eradication laser vaporization or cone biopsy is the most effective method of cancer prevention. Invasive carcinomas range from microscopic foci of early stromal invasion to grossly conspicuous tumors encircling the os. Tumors encircling the cervix and penetrate into the stroma produce a which can be identified direct palpation. Tumors of Vulva Condylomas Condylomas fall into two distinctive biologic forms: Condylomatalata, (not commonly seen these days), are flat, moist, minimally elevated lesions that occur in secondary syphilis. Condylomata accuminata, (more common) may be papillary and distinctly elevated. They occur anywhere on the anogenital surface. Vulvar Intraepithelial Neoplasia and Carcinoma of the Vulva Carinoma of vulva represents about of all genital tract cancers in woman. of vulvar carcinomas are squamous cell and of them are HPV related and most common seen in relatively younger patients. vulvar squamous cell carcinoma occurs in older woman. either intraepithelial neoplasia or squamous cell carcinoma. Risk factors are similar to those for carcinoma of the cervix. usually occurring in woman older than 60 years. Associated Vaginal HPV infection in most cases. mothers cell adenocarcinoma, usually encountered in young woman in their late teens whose Vaginal took diethylstilbestrol during overall risk is 1 per of those exposed in utero. adenosis, are small glandular or microcystic inclusions appear in vaginal mucosa. 435 Unit 8 I and Management detect cervical intraepithelial neoplasia (CIN) before the development of an However, about 30 only a fraction of cases of CIN progress to invasive carcinoma. development CIN and invasive carcinoma are: CIN is of years, whereas that of invasive carcinoma is about 45 years. first intercourse multiple previous sexual partners Persistent human papilloma virus (HPV) the Cervix cervical carcinoma is squamous cell carcinoma adenocarcinoma and carcinoma and small cell neuroendocrine carcinoma with aggressive intraepithelial changes, the time interval may be considerably shorter, in woman CIN precursors may persist for life. The only reliable way to monitor the course the disease is with careful and repeated biopsies. Symptoms include vaginal bleeding, leucorrhea, painful coitus, and dysuria. Detection of precursors cytologic examination and their eradication laser vaporization or cone biopsy is the most effective method of cancer prevention. Invasive carcinomas range from microscopic foci of early stromal invasion to grossly conspicuous tumors encircling the os. Tumors encircling the cervix and penetrate into the stroma produce a which can be identified direct palpation. Tumors of Vulva Condylomas Condylomas fall into two distinctive biologic forms: Condylomatalata, (not commonly seen these days), are flat, moist, minimally elevated lesions that occur in secondary syphilis. Condylomata accuminata, (more common) may be papillary and distinctly elevated. They occur anywhere on the anogenital surface. Vulvar Intraepithelial Neoplasia and Carcinoma of the Vulva Carinoma of vulva represents about of all genital tract cancers in woman. of vulvar carcinomas are squamous cell and of them are HPV related and most common seen in relatively younger patients. vulvar squamous cell carcinoma occurs in older woman. either intraepithelial neoplasia or squamous cell carcinoma. Risk factors are similar to those for carcinoma of the cervix. usually occurring in woman older than 60 years. Associated Vaginal HPV infection in most cases. mothers cell adenocarcinoma, usually encountered in young woman in their late teens whose Vaginal took diethylstilbestrol during overall risk is 1 per of those exposed in utero. adenosis, are small glandular or microcystic inclusions appear in vaginal mucosa. 435
Gynecological diseases complicating pregnancy
Course: Bsc nursing (blaw 213)
University: Kerala University of Health Sciences
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