Obstetrics and Gynecology Notes

Obstetrics and Gynecology

Introduction

• Gynecology diagnoses and treats conditions of the female reproductive organs.

• Obstetrics is concerned with childbirth and the care of pregnant women.

• Most physicians in the field train as both gynecologists and obstetricians.

Female Reproductive System Function

• The female reproductive system has many organs:

  • Two ovaries produce eggs and female sex hormones.

  • Two uterine tubes carry eggs from the ovaries to the uterus.

  • The uterus provides a place for a baby to grow and develop.

  • The vagina serves as a passage to the outside world.

  • The breasts secrete milk to nourish a newborn.

Fertilization and Development

• Fertilization is the joining of an egg from the female and a sperm from the male.

  • Fertilization typically occurs in the uterine tube.

  • The fertilized egg is known as an embryo.

• The embryo implants in the uterus.

  • It remains there as it grows and develops.

  • From the third month until birth, the embryo is a fetus.

• During birth, the fetus passes from the uterus to the outside world through the vagina.

Combining Forms

• Combining Form: A word part that is the main meaning of the word. It appears in most medical terms.

• amni/o means amnion (amniotic fluid)

• cervic/o means cervix

• chori/o means chorion

• colp/o means vagina

• embry/o means embryo

• episi/o means vulva

• fet/o means fetus

• gynec/o means female

• hyster/o means uterus

• lact/o means milk

• lapar/o means abdomen

• mamm/o means breast

• mast/o means breast

• men/o means menses (menstruation)

• metr/o means uterus

• nat/o means birth

• o/o means ovum (egg)

• oophor/o means ovary

• ovari/o means ovary

• salping/o means uterine tube

• uter/o means uterus

• vagin/o means vagina

Other Combining Forms

• carcin/o means cancer

• cyst/o means bladder, sac

• fibr/o means fiber

• hem/o means blood

• olig/o means scanty

• or/o means mouth

• pelv/o means pelvis

• rect/o means rectum

• tox/o means poison

Suffix Review

• Suffix: A word part attached to the end of a word to modify its meaning.

• -al pertaining to

• -algia pain

• -an pertaining to

• -arche beginning

• -ary pertaining to

• -cele hernia

• -centesis surgical puncture to remove fluid

• -cyesis pregnancy

• -cyte cell

• -ectomy surgical removal

• -genesis producing, forming

• -genic producing, originating

• -gram record

• -graphy process of recording

• -gravida pregnancy

• -ic pertaining to

• -ine pertaining to

• -itis inflammation

• -logist one who studies

• -logy study of

• -lytic to reduce, destroy

• -metry process of measuring

• -nic pertaining to

• -oid resembling

• -oma tumor, mass

• -osis abnormal condition

• -otomy cutting into

• -para to bear (offspring)

• -partum childbirth

• -pexy surgical fixation

• -plasty surgical repair

• -rrhagia excessive discharge of blood

• -rrhaphy to suture

• -rrhea discharge

• -rrhexis rupture

• -scope instrument for viewing

• -scopy process of visually examining

• -tic pertaining to

Prefix Review

• Prefix: A word part that is attached to the front of a word to modify its meaning.

• a- without

• ante- before

• dys- difficult, painful

• endo- inner

• intra- within

• multi- many

• neo- new

• nulli- none

• post- after

• pre- before

• primi- first

• pseudo- false

• trans- across, through

Organs Treated in Obstetrics and Gynecology

• Ovaries:

  • Almond-shaped organs on either side of the uterus.

  • Connected to the uterus by the uterine tubes.

  • Produce ova and release one ovum approximately once every month.

  • Produce estrogen and progesterone.

• Uterine Tubes:

  • Narrow ducts that run from the area around each ovary to the uterus.

  • Ova travel from an ovary to the uterus through a uterine tube.

  • Normal fertilization occurs in the uterine tube.

• Uterus:

  • A hollow, pear-shaped organ in the lower pelvis.

  • Three portions:

  • Fundus: The upper portion where the uterine tubes enter the uterus.

  • Body: The largest central portion.

  • Cervix: The narrow lowest portion that opens into the vagina.

• Endometrium:

  • The inner layer of the uterus.

  • Thickens over the course of a month in anticipation of receiving an embryo.

  • If an embryo does not implant, the endometrium is sloughed off during the menstrual period.

• Myometrium:

  • The thick muscular wall of the uterus that contracts during childbirth.

• Vagina:

  • A muscular tube that runs from the uterus to the outside of the body.

  • Serves as a passageway for menstrual flow and the fetus during childbirth.

  • Receives the penis and semen during intercourse.

• Breast:

  • A collection of glands that produce milk to nourish an infant.

  • The areola is the pigmented area around the nipple.

• Vulva:

  • The external female genitalia.

  • Contains the labia majora, labia minora, and clitoris.

  • The labia majora and minora are skin folds that protect the vaginal opening, urinary meatus, and clitoris.

  • The clitoris is female erectile tissue aroused during sexual activity.

Building Obstetrics and Gynecology Terms

• amni/o means amnion (amniotic fluid)

  • amniorrhea: flow of amniotic fluid

  • amniorrhexis: rupture of the amnion

• cervic/o means cervix

  • cervical: pertaining to the cervix

  • cervicitis: inflammation within the cervix

• chori/o means chorion

  • choriocarcinoma: cancerous tumor of the chorion

• colp/o means vagina

  • colposcope: instrument for viewing the vagina

  • colpectomy: surgical removal of the vagina

• -cyesis means pregnancy

  • pseudocyesis: false pregnancy

  • salpingocyesis: pregnancy in the uterine tube

• embry/o means embryo

  • embryogenic: producing an embryo

  • embryology: study of the embryo

• episi/o means vulva

  • episiorrhaphy: surgical repair of the vulva

• fet/o means fetus

  • fetal: pertaining to the fetus

  • fetoscope: instrument for viewing the fetus

• -gravida means pregnancy

  • nulligravida: no pregnancies

  • primigravida: first pregnancy

  • multigravida: many pregnancies

• gynec/o means female

  • gynecologist: one who studies the female

• hyster/o means uterus

  • hysteropexy: surgical fixation of the uterus

  • hysterorrhexis: ruptured uterus

  • hysterography: process of recording the uterus

• lapar/o means abdomen

  • laparotomy: cutting into the abdomen

• mamm/o means breast

  • mammary: pertaining to the breast

  • mammoplasty: surgical repair of the breast

• mast/o means breast

  • mastalgia: breast pain

• men/o means menses (menstruation)

  • amenorrhea: without menstrual discharge

  • oligomenorrhea: scanty menstrual discharge

• metr/o means uterus

  • endometritis: inner uterus inflammation

  • metrorrhea: discharge from uterus

• nat/o means birth

  • neonatal: pertaining to a newborn

  • neonatologist: one who studies the newborn

• o/o means ovum (egg)

  • oocyte: ovum cell

  • oogenic: produces an ovum

• oophor/o means ovary

  • oophoropexy: surgical fixation of the ovary

• ovari/o means ovary

  • ovarian: pertaining to the ovary

  • ovariosalpingitis: ovary and uterine tube inflammation

• -para means to bear (offspring)

  • nullipara: no births

  • multipara: many births

• -partum means childbirth

  • antepartum: before childbirth

  • postpartum: after childbirth

• salping/o means uterine tube

  • salpingography: record of the uterine tube

• uter/o means uterus

  • uterine: pertaining to the uterus

  • intrauterine: pertaining to within the uterus

• vagin/o means vagina

  • transvaginal: pertaining to across the vagina

Medical Specialties

• Gynecologist: A physician who specializes in diagnosing and treating diseases and disorders of the female reproductive system.

• Obstetrician: A physician who specializes in providing medical care to women during pregnancy, during childbirth, and immediately thereafter.

• Obstetric Nurse: An RN with specialized training in obstetrics and gynecology who can perform normal deliveries.

• Neonatologist: A physician specializing in treating disorders of the newborn.

• Perinatologist: Works with women whose pregnancy is high risk.

• Fertility Specialist: Helps couples by diagnosing and treating problems associated with conception and maintaining pregnancy.

Pregnancy Terms

• Antepartum: Before birth.

• Postpartum: After birth.

• Multipara: A person who has given birth to infants two or more times.

• Nullipara: A person who has not given birth to a live infant.

• Primipara: A person who has given birth to a live infant once.

• Gravida: Number of pregnancies a woman has experienced.

• Nulligravida: A person who has not been pregnant.

• Multigravida: A person who has been pregnant many times (two or more).

• Primigravida: A person who is pregnant for the first time.

Signs and Symptoms

• amenorrhea: absence of menstruation

• Amniorrhea: flow of amniotic fluid

• Dysmenorrhea: painful menstruation

• Dyspareunia: painful sexual intercourse

• Menorrhagia: excessive menstrual bleeding

• Menorrhea: normal menstruation

• Metrorrhagia: bleeding between periods

• Menometrorrhagia: irregular and excessive bleeding

• Amniorrhexis: flow of amniotic fluid when the amnion ruptures.

• Dyspareunia: condition of having painful sexual intercourse.

• Dystocia: difficult labor and childbirth.

• Leukorrhea: whitish yellowish vaginal discharge, may be caused by vaginal infection.

Vocabulary

• Puberty: Period of time in which a child becomes an adult; development of adult body, production of eggs or sperm; person is now capable of reproduction.

• Menarche: First menstrual period of puberty; in the US, the average age for menarche is 12-½ years.

• Menopause: Period of time associated with the ending of menstrual activity and childbearing years.

• Premenstrual Syndrome (PMS): Symptoms that develop just prior to the onset of the menstrual period; may include irritability, headache, tender breasts, and anxiety.

Conditions of the Uterus

• Anteversion: Forward displacement of the body of the uterus towards the pelvis (pubic bone).

• Retroversion: Uterus is tipped backwards and the opposite of anteversion.

• Anteflexion: The fundus of the uterus is bent forwards.

• Retroflexion: The fundus is bent backwards.

Fetal Presentations

• Cephalic Presentation: The top of the head, the brow, the face, or the chin presents itself at the cervical opening during labor.

• Breech Presentation: The buttocks, knees, or feet are presented during labor at the cervical opening.

• Shoulder Presentation: Baby is across the long axis of the mother’s body, shoulder is presented at the cervical opening.

Conditions Related to Pregnancy

• Abruptio Placentae: Emergency condition in which the placenta tears away from the uterine wall prior to delivery of the infant; requires immediate delivery of the baby.

• Placenta Previa: A placenta that is implanted in the lower portion of the uterus and, in turn, blocks the birth canal.

• Ectopic Pregnancy: Pregnancy occurring outside of the uterus, usually in the uterine tubes; the growing fetus will rupture the uterine tube requiring a salpingectomy; also called salpingocyesis.

• Stillbirth (SB): Birth in which a viable-aged fetus dies shortly before or at the time of delivery.

• Gestational Diabetes: Development of difficulty with carbohydrate metabolism and high blood sugar during a pregnancy; usually resolves after delivery.

• Preeclampsia: Metabolic condition of pregnancy; symptoms include hypertension, headaches, protein in urine, and edema; if untreated, may progress to eclampsia; also called toxemia or pregnancy-induced hypertension (PIH).

• Eclampsia: Worsening of preeclampsia symptoms with development of seizures and possibly coma; may occur between the 20th week of pregnancy and up to six weeks postpartum.

Disease Conditions

• Ovarian Cyst: A cyst that develops within the ovary; may be multiple cysts and may rupture, causing pain and bleeding.

• Polycystic Ovary Syndrome: Condition in which many cysts accumulate in the ovaries, and the patient often fails to ovulate.

• Vesicovaginal Fistula: Presence of a tube-like passageway between the urinary bladder and vagina; results in urine leaking out of the vagina.

• Candidiasis: Yeast infection of skin and mucous membranes that can result in white plaques on tongue and vagina.

• Dysplasia: Precancerous stage that begins with a change in shape, growth, and number of cells in any organ.

• Cervical Cancer: Malignant tumor of the cervix; some cases are caused by the human papillomavirus (HPV), a sexually transmitted virus for which there is now a vaccine; regular Pap smears are used for early detection.

• Endometrial Cancer: Cancerous tumor that forms in the lining of the uterus.

• Ovarian Carcinoma: Cancerous tumor formed within the ovary.

• Endometriosis: Condition when endometrial tissue appears throughout the pelvic or abdominal cavity; causes recurring pain and scarring.

• Pelvic Inflammatory Disease (PID): Chronic or acute infection, usually bacterial, that ascends through the female reproductive tract and out into the pelvic cavity; can result in scarring that interferes with fertility.

• Toxic Shock Syndrome (TSS): Rare and sometimes fatal bacterial infection that occurs mainly in menstruating women; initial infection occurs in the vagina and is associated with prolonged wearing of a super-absorbent tampon; toxins secreted by bacteria then enter the bloodstream.

• Fibroid Tumor: Benign tumor of fiber-like tissue; the most common type of tumor in women, most common tumor during childbearing age.

• Fistula: Abnormal passageway between two structures; vesicovaginal fistula is between the urinary bladder and the vagina; rectovaginal fistula is between the rectum and the vagina.

• Atresia: Lack of a normal body opening; for example, hysteratresia is closing of the cervix, usually from scarring.

• Infertility: Inability to produce children; generally defined as no pregnancy after properly timed intercourse for one year.

Prolapse Conditions

• Rectocele: Occurs when the vaginal wall becomes thinner, allowing the rectum to press against it enough to create a bulge into the vagina; may be large enough to block the vagina.

• Hysteroptosis: Fallen uterus that can cause the cervix to protrude through the vaginal opening; also called prolapsed uterus.

• Cystocele: Hernia or outpouching of the urinary bladder protrudes into the vagina; can cause urinary frequency and urgency and block the vagina.

Abortions

• Abortion (AB): Discharge of an embryo from the uterus before about the 20th week of gestation.

  • Spontaneous abortion (miscarriage) is unplanned and due to the death of the embryo.

  • Induced abortion is the legal termination of a pregnancy.

  • Therapeutic abortion is necessary for the mother’s health.

Breast Conditions

• Lactation: Production of milk by the breast to provide nourishment for the newborn.

• Breast Cancer: Malignant tumor of the breast; usually forms in the milk glands or the lining of the milk ducts.

• Fibrocystic Breast: Benign cysts in the breast tissue; not precancerous.

Disease Conditions of the Newborn

• Hemolytic Disease of the Newborn (HDN): Condition developing in a fetus when the mother’s blood type is Rh-negative and the baby’s blood is Rh-positive; antibodies in the mother’s blood enter the fetus’ bloodstream through the placenta and destroy the fetus’ red blood cells; causes anemia, jaundice, and enlargement of the spleen; treated with intrauterine blood transfusion; also called erythroblastosis fetalis.

• Premature: Birth of a fetus before 37 weeks of gestation.

Diagnosis

• Papanicolaou (Pap) Smear: Test for early detection of cervical cancer; named after test developer George Papanicolaou, a Greek physician; cells are removed from the cervix by simple scraping and examined under a microscope.

• Colposcopy: Direct visual inspection of the cervical canal and uterine cavity using an endoscope passed through the vagina.

• Laparoscopy: Examination of the abdominal cavity with a laparoscope through one or more small incisions in the abdominal wall.

• Chorionic Villus Sampling (CVS): Removal of a small piece of the chorion for genetic analysis; may be done at an earlier stage of pregnancy than an amniocentesis.

• Amniocentesis: A surgical procedure in which a needle is passed through the abdominal and uterine walls to obtain a small amount of amniotic fluid for lab analysis to detect fetal genetic defects.

• Fetal Monitoring: Use of electronic equipment placed on the mother’s abdomen or the fetus’ scalp to check fetal heart rate (FHR) and fetal heart tone (FHT) during labor; normal FHR ranges from 120 to 160 beats per minute; a drop in fetal heart rate indicates fetal distress.

Treatment

• Cesarean Section (CS, C-section): Surgical delivery of a baby through an incision into the abdominal and uterine walls; named for the Roman emperor, Julius Caesar, who is said to have been the first person born by this method.

• Conization: Surgical removal of a core of cervical tissue for biopsy.

• Dilation and Curettage (D&C): Surgical procedure consisting of widening the cervix and scraping or suctioning out the endometrial lining of the uterus; often performed after a spontaneous abortion or to stop excessive bleeding from other causes.

Contraception

• Intrauterine Device (IUD): Device placed into the uterus through the cervix by a physician for the purpose of contraception.

• Oral Contraceptive Pills (OCPs): Form of birth control that uses low doses of female hormones to block ovulation; commonly called birth control pills.

• Tubal Ligation: Surgical tying off of the uterine tubes to prevent pregnancy.

Treatment

• Hormone Replacement Therapy (HRT): Medication to replace hormones secreted by the ovaries; hormones may be missing due to menopause or loss of ovaries.

• In Vitro Fertilization (IVF): Infertility treatment; ova removed from a woman are fertilized by sperm externally; resulting embryos are returned to the uterus for development; commonly called a test-tube baby.

• Endometrial Ablation: Laser removal of the endometrium using extreme cold, electricity, hot fluid, microwaves, or high-energy radio waves to destroy the endometrium; treats abnormally heavy menstruation.

• Hysteropexy: Surgical fixation of a displaced uterus.

• Episiotomy: Cutting into the perineum to facilitate the delivery process; can prevent irregular tearing of tissue during birth.

• Perineorrhaphy: Suturing the perineum; postpartum procedure to repair episiotomy or any tears occurring during labor.

Hysterectomies

• Supracervical Hysterectomy: The uterus is removed, but the cervix remains.

• Total Hysterectomy: Is the removal of the uterus and cervix.

• Vaginal Hysterectomy: The uterus is removed through the vagina.

• Total Abdominal Hysterectomy and Bilateral Salpingo-Oophorectomy (TAH-BSO): The uterus and both ovaries and uterine tubes are removed.

Breast Surgeries

• Lumpectomy: Surgical removal of only a breast tumor and tissue immediately surrounding it.

• Mammoplasty: Surgical repair or reconstruction of the breast.

• Mastectomy: Surgical removal of the breast.

• Simple Mastectomy: Surgical removal of only breast tissue; all underlying tissue is left intact.

• Radical Mastectomy: Surgical removal of breast tissue plus chest muscles and axillary lymph nodes; the term radical is used to describe the extensive surgical procedure designed to remove the root cause of disease.

Obstetrics and Gynecology Abbreviations

• AB = Abortion

• BSE = Breast Self-Exam

• CS, C-section = Cesarean Section

• CVS = Chorionic Villus Sampling

• Cx = Cervix

• D&C = Dilation and Curettage

• EMB = Embryo

• ERT = Estrogen Replacement Therapy

• FHR = Fetal Heart Rate

• FHT = Fetal Heart Tone

• FTND = Full-Term Normal Delivery

• GI, grav I = Gravida 1 (first pregnancy)

• GYN, gyn = Gynecology

• HDN = Hemolytic Disease of the Newborn

• HPV = Human Papillomavirus

• HRT = Hormone Replacement Therapy

• HSG = Hysterosalpingography

• IUD = Intrauterine Device

• IVF = In Vitro Fertilization

• LMP = Last Menstrual Period

• NB = Newborn

• OB = Obstetrics

• OB-GYN = Obstetrics and Gynecology