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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