Investigational Methods in Gynecology Michal Mára Dept. of Obstetrics & Gynecology, 1 st Medical Faculty of Charles University Prague
basicbasic inflammatory diseases / pelvic paininflammatory diseases / pelvic pain gyn-endocrinologygyn-endocrinology infertility & ARTinfertility & ART urogynecologyurogynecology gyn-oncologygyn-oncology Investigational Methods in Gynecology
Basic methods external physical examination (vitals !, acute abdomen !, external genitalia)external physical examination (vitals !, acute abdomen !, external genitalia) spec.spec. vag. (bimanual)vag. (bimanual) rectalrectal lablab USGUSG
Ultrasonography findings, not diagnosisfindings, not diagnosis abdominalabdominal transvaginaltransvaginal transperineal, rectaltransperineal, rectal Doppler !Doppler ! other imaging methods (non-gynecologists)other imaging methods (non-gynecologists)
Interdisciplinary approach sub-specialists inside OB&GYNsub-specialists inside OB&GYN IC specialistsIC specialists surgeonssurgeons urologistsurologists othersothers nurses, midwifesnurses, midwifes
basicbasic inflammatory diseases / pelvic paininflammatory diseases / pelvic pain gyn-endocrinologygyn-endocrinology infertility & ARTinfertility & ART urogynecologyurogynecology gyn-oncologygyn-oncology Investigational Methods in Gynecology
colpitis (vulvo-vaginitis), cervicitiscolpitis (vulvo-vaginitis), cervicitis not always pathologynot always pathology mycosis (C.albicans)mycosis (C.albicans) BVBV native microscope, culturesnative microscope, cultures special exams (PCR)special exams (PCR) Vaginal discharge
PIDPID wide ddx ! (gyn x non-gyn)wide ddx ! (gyn x non-gyn) history & clinical picturehistory & clinical picture USG, culturesUSG, cultures lab.: inflammatory markers !lab.: inflammatory markers ! laparoscopylaparoscopy (Sub)Acute pelvic pain
Endometriosis (or normal finding)Endometriosis (or normal finding) wide ddx !!! (gyn x non-gyn)wide ddx !!! (gyn x non-gyn) history & clinical picturehistory & clinical picture USG, cultures, lab tests (Ca 125)USG, cultures, lab tests (Ca 125) invasiveness !invasiveness ! ATB !ATB ! laparoscopylaparoscopy Chronic pelvic pain
basicbasic inflammatory diseases / pelvic paininflammatory diseases / pelvic pain gyn-endocrinologygyn-endocrinology infertility & ARTinfertility & ART urogynecologyurogynecology gyn-oncologygyn-oncology Investigational Methods in Gynecology
children (puberty)children (puberty) tests before COC or HRTtests before COC or HRT PCOsPCOs CAHCAH premature ovarian failurepremature ovarian failure climacteric medicineclimacteric medicine RIARIA Endocrinology
basicbasic inflammatory diseases / pelvic paininflammatory diseases / pelvic pain gyn-endocrinologygyn-endocrinology infertility & ARTinfertility & ART urogynecologyurogynecology gyn-oncologygyn-oncology Investigational Methods in Gynecology
primary x secondaryprimary x secondary infertility x repeated abortions (terminology)infertility x repeated abortions (terminology) social problem (10-20%)social problem (10-20%) Infertility
tuboperitoneal (HSG, laparoscopy)tuboperitoneal (HSG, laparoscopy) anovulation (BT, USG, progesterone)anovulation (BT, USG, progesterone) male factor (sperm analysis)male factor (sperm analysis) basal hormones assay (FSH, LH, E2, PRL, TSH, androgens from 2 nd till 4th day of cycle)basal hormones assay (FSH, LH, E2, PRL, TSH, androgens from 2 nd till 4th day of cycle) genetics, reprod. immunology (PCT), …genetics, reprod. immunology (PCT), … Infertility & ART
basicbasic inflammatory diseases / pelvic paininflammatory diseases / pelvic pain gyn-endocrinologygyn-endocrinology infertility & ARTinfertility & ART urogynecologyurogynecology gyn-oncologygyn-oncology Investigational Methods in Gynecology
urinary incontinence (stress + urgent)urinary incontinence (stress + urgent) R/O infectionR/O infection historyhistory functional tests (pad-weight)functional tests (pad-weight) urodynamicsurodynamics USGUSG Urogynecology
basicbasic inflammatory diseases / pelvic paininflammatory diseases / pelvic pain gyn-endocrinologygyn-endocrinology infertility & ARTinfertility & ART urogynecologyurogynecology gyn-oncologygyn-oncology Investigational Methods in Gynecology
depends on locationdepends on location screening !??screening !?? tumor markerstumor markers imaging methods + furtherimaging methods + further pre-bioptic tests / LEEP cervixpre-bioptic tests / LEEP cervix US, D&C, hysteroscopy endometriumUS, D&C, hysteroscopy endometrium US / Ca 125, surgery ovaryUS / Ca 125, surgery ovary Oncology
colposcopycolposcopy cytologycytology PAP smear (I-V) PAP smear (I-V) Bethesda system Bethesda system Pre-bioptic tests (cervix)
Diagnosis & Tx (minimally invasive surgery)Diagnosis & Tx (minimally invasive surgery) Hysteroscopy, LaparoscopyHysteroscopy, Laparoscopy Colposcopy, culdoscopyColposcopy, culdoscopy Fetoscopy, faloscopy, fertiloscopy (TVHL)Fetoscopy, faloscopy, fertiloscopy (TVHL) Gyn-endoscopy