Gynecology & Obstetrics History, Female Anatomy & Pelvic Exam

what is obstetrics?

branch of medicine that studies the management of women during pregnancy, childbirth, and post-partum period

what is gynecology?

branch of medicine that studies the disease of the female reproductive organs, including breast disease

what info should be gathered when asking about menstrual history?

age of menarche, onset of menopause and symptoms, last menstrual period, cycle information

what menstrual cycle information should be gatehred?

symptoms, length and bleeding 

what is gathered in gynecological history?

disease, surgeries, pain, pap smear history, infertility, sexual history, breast disease history

what is GTPAL status?

gives information regarding a womans obstetric history

what is the G in GTPAL?

gravida # (pregnancy number)

what is the T in GTPAL?

term parity # (given birth full term) 

what is the P in GTPAL?

premature parity # (preterm births < 37 weeks)

what is the A in GTPAL?

abortion # (spontaneous and induced)

what is the L in GTPAL?

live babies #

what is the M in GTPAL?

multiple (twins etc) 

solve this GTPAL — G4T3P1A0L5M1

gave birth 4 times, 3 full term, 1 premature, no abortions, 5 babies, 1 set of twins

what else should be gathered in obstretric history?

type, location and outcome of deliveries 

what is gathered in prenatal history?

LMP or how many weeks along

symptoms

prenatal

first pregnancy? gather family history exercises and diet

if previous pregnancy, any complications

contraceptive history

what does gravidity mean?

pregnancy

what does nulligravida mean?

never been pregnant

what does primigravida mean?

first pregnancy / pregnant once 

what does multigravida mean?

pregnant more than once

what does grand multigravida mean?

5 or more pregnancies

what does para mean?

delivery

what does nullipara mean?

no delivery 

what does primipara mean?

first delivery or delivered once

what does multipara mean?

has delivered more than one baby

what does grandmultipara mean?

delivered more than 5 babies

what does the parturient period mean?

in labor 

what does puerpera mean?

post partum

what is the goal of a gynecological exam?

exam for prevention and early detection

what is considered external genitilia?

vulva / pudendu, perineal body, urethral orifice / uretheral introtius, vaginal orifice 

what makes up the vulva?

mons pubis, labia majora, labia minora, clitoral frenulum, clitoris, fourchette

what is found in the uretheral orifice?

skene’s glands

what is found in the vaginal orifice?

hymen and bartholin’s glands

what makes up the internal genitalia?

vaginal canal and fornix

what are the bartholin’s glands associated with?

gonorrhea 

what are the parts of the uterus?

fundus, body, isthmus, cervix

what is the length of the uterus?

3-4 inches

what is the width of the uterus?

2 inches

how thick is the uterus?

1,5 inches 

how much does the uterus weigh?

6 ounces

what are the layers of the uterus?

perimetrium, myometrium and endometrium

what are the three layers of the endometrium?

basal layer, spongiosa layer and compacta layer

what is the function of the fallopian tubes?

transport

what tissue type lines the fallopian tubes?

ciliated columnar epithelium

what are the 3 parts of the fallopian tubes?

isthmus, ampulla and infundibulum

what happens in the ampulla?

fertilization

what is found in the infundibulum?

fimbriae 

from the uterus to the ovaries, what is the order?

uterus → isthmus → ampulla → infundibulum

what are the two parts of the ovaries?

cortex and medulla

what is anterior to the vagina?

bladder and urethra

what is posterior to the vagina?

rectouterine pouch, rectum and anal canal 

what is lateral to the vagina?

ureters and levator ani muscle

what is the normal position of the uterus?

anteversion

what maintains the anteversion position of the uterus?

the round ligamnet attaches to the fundus and pulls it down

what are other positions of the uterus?

midposition, retroversion, anteflexion and retroflexion 

where does the broad ligament extend?

sideways to the lateral walls of the uterus

where does the round ligament extend?

from the uterine horns throwugh the borad ligament and through inguinal canal

what are the other ligaments around the femal reproductive system?

uterosacral and ovarian ligaments

what are the pelvic floor muscles?

levator ani, sphincters and transverse perineal 

what is the purpose of a pelvic exam?

to detect anatomical abnormalities, infections, pathologies and cancer

at what age should pap smears start?

21 (or within 3 years if they are sexually active)

what is the guideline for cervical cancer screening?

start at 21 to 29 and have a pap test every 3 years

what is the cervical cancer screening guidelines for women age 30-65?

have co-test pap and HPV every 3 years 

what are the cervical cancer screening guidelines for women 66+?

discontinue screening if you have a history of normal test results and are not at a higher risk for cervical cancer

what are the patient preparation steps to a pelvic exam?

should be outside of menstrual period and no douche or intercourse 48 hours prior

what is the name of the pelvic exam patient position?

lithotomy

what should be observes of external genitalia during pelvic exam?

check color, symmetry, lesions, discharge, odors, laceratiosn and scars 

what should be palpated externally during pelvic exam?

bartholin’s glands

why is the patient asked to bear down during external palpation?

to assess for pelvic organ prolapse and vaginal wall integrity

when is a pederson speculum used?

for nulliparous and postmenopasual women

when is a graves speculum used?

parous women 

what is inspected during the internal exam?

vaginal wall and cervix

what should be looked for during cervical inspection?

discharge, color, shape of os and lesions

what does an oval shape cervix indicate?

vaginal delivery

what are the 3 specimen smaples collected during pelvic exam?

cervical scrape, endocervical swab, vaginal pool 

what is the cervical cancer classification name?

cervical intraepithelial neoplasia (CIN classification)

what happens if there is a positive pap?

colposcopy, endocervical curettage, cervical biopsy, endometrial biopsy, DandC

what organs are examined with internal palpation?

vaginal wall, cervix, uterus, ovaries

what are we examining in the cervix palpation?

firm, tenderness, mobile, soft