What does obstetrics and gynecology treatment mean?
The branch of medicine pertaining to childbirth and dealing with the anatomy and physiology of female reproductive system is called as obstetrics and gynecology respectively. A variety of disorders such as infections, tumors and connective tissue diseases may affect the reproductive parts in women at any stage of their life. These parts are as follows:
- A pair of ovaries on either side of uterus
- A pair of ducts called fallopian tubes for each ovary
- Mammary glands and breast
MedcureIndia provides guidelines to its readers on the various aspects of issues and treatment in following lines.
Causes of obstetrics and gynecology disorders:
Mental disturbance, emotional stress and hormonal imbalance have always been blamed for the irregular and pathological functioning of the female reproductive system.
- Tumors and cysts may arise in the uterus or ovaries as a result of hormonal disturbances, trauma in the pelvis or some unknown etiology
- Uterine fibroids, fibroadenoma of the breast also follow the same principle
- Bacterial/viral/fungal infections may cause vaginal or cervical diseases due to poor hygiene maintenance.
- Fallopian tubal blockages prevent fertilization and thus termination of pregnancy
- Weak/under nourished or pathological uterus often leads to miscarriages.
Signs & symptoms of obstetrics and gynecology disorders:
Different gynecological problems may produce similar signs and symptoms. These include:
- Delayed menarche i.e onset of menstrual cycle
- Painful cycle, abdominal cramps, dizziness, nausea
- Irregular cycles, excessive to reduced to nil blood flow
- Foul and frequent vaginal discharge
- Frequent urge to urinate, painful urination
- Redness, itching, soreness in the vaginal area
- Fever, pain in the abdomen, nausea, vomiting following vaginal/cervical infections
- Bleeding after intercourse
- Swelling and pain in the breasts, discharge from nipples
- Early menopause, emotional imbalances, mood swings, weakness, pale appearance
- Miscarriages, infertility
Diagnostic tests for gynecology disorders:
- Blood/urine test: These are done to evaluate the levels of hormones such as estrogen, progesterone and human chorionic gonadotropin. Urine is also looked for presence of any abnormal or pus cells.
- Biopsy: It is a procedure followed to distinguish a benign tumor from a malignant one, study the nature, type and progress of the tumor/cancer mass. A small portion of the mass is excised and sent to the labs for histological examination. Routinely done for tumor masses in the breast, uterus and ovaries.
- Fine needle aspiration cytology FNAC: For any cysts in the breast, uterus or ovarian region, a long tubular needle can be inserted to aspirate the cystic contents into it again to study the type, nature and progress of the cystic cavity.
- Mammography: It is an x-ray based method to determine the structure of the breasts, evaluation of fibroids, cysts, nodules and cancer mass cells in the breast connective tissues.
- PAP test: It is also a histological method in which smears are prepared from the samples obtained from biopsy and FNAC to study the type and structure of cells present in the pathologic condition.
- Ultrasound USG: It is a non ionizing radiation technique which uses sound waves to study the internal structure of organs. Any abnormal mass in the reproductive system, lymph nodes draining them can be detected with the help of it.
- Hysteroscopy: A long thin tube like structure is inserted into the uterus via the vagina and the entire uterine walls with the endometrium can be seen projected outside on a screen.
- Trans-vaginal ultrasound: It is done exclusively to determine the vaginal opening, vaginal length and study the vaginal walls.
Types of gynecology disorders:
- Involving the breast:
- Cysts and abscess in the areolar connective tissue of breast is quite common in middle aged women. These are fluid filled sacs, can be present in any number and variable size and all over the breast region. The lymph nodes draining the pectoral region often become infected, hard and palpable. On the other hand, fibroedenoma happens to be a solid mass of cells containing cells derived from the breast tissues and fibres. It is a quite prevalent in women between 25 to 40 years of age. Owing to unknown etiologies any of the above condition may turn into a malignancy causing breast cancer.
- Intra ductal papillomas are small benign tumors which occur in the milk ducts leading to their partial or complete obliteration. They are composed of fibres and blood vessels derived from the breast tissues. They may lead to foul discharge from the nipples, soreness and redness around the nipples, dimpling of skin over the breasts. Mastitis is common in breastfeeding mothers which occurs due to infection in the breast lining. This is accompanied by swelling in the breasts, pain and tenderness along with fever and discomfort while feeding.
- Involving the uterus:
- It is hollow muscular organ located in the pelvic region. It is the site for implantation of the fetus and marks the onset of pregnancy. A number of connective tissue disorders may affect the uterine mass called endometrium. Uterine fibroids also called as myomas or liomyomas are hard masses consisting of smooth muscles and fibres. They may or may not be symptomatic and often may go undiagnosed. Uterine cancer might be the ultimate cause if the mass increases in size and number obliterating the uterine functions.
- Endometrial polyps may also develop where atypical cells multiply at abnormal pace. They are mole or wart like bumps in the endometrium. Polpys usually cause friction and lead to internal bleeding, however also possess a tendency to turn into malignancy. Endometrial hyperplasia on the other hand occurs due to excessive levels of estrogen in the blood. This hormone produced by the ovaries, is responsible for the growth of endometrial lining. High levels of it cause abnormal swelling and layering of the uterine lining.
- Quite interchangibly, fibromas, cysts, polyps, inflammation and hyperplasias also may occur in the cervix (birth canal) and vagina which are the narrower and descending parts of uterus. Cervical cancer being the most common and popular, may occur post parturition or may also show unknown etiology, often accompanied by severe lower body pain, cervical and vaginal discharges, pain on urination in addition to the abnormal multiplication of atypical cells in the cervix.
- Involving the ovaries:
- One of the most common ovarian diseases in females in the 18 to 40 age group, polycystic ovarian disorder/syndrome i.e PCOD/PCOS, occurs due to higher than normal levels of androgens in blood which prevent ovaries from releasing eggs at a normal rate and time. The follicles in turn develop into rudimentary cysts, result in irregular menses, abnormal hair growth and acne. Ovarian cysts develop within the follicles and may cause swelling of the ovaries, irregular bleeding, pain and tenderness in the lower abdomen region.
Treatment of gynecology disorders:
- Surgical approach: Uterine, ovarian and breast fibromas, cysts are often resolved with a surgical approach. This often is the choice when after medications the pathology does not subside and the pain persists. However there may be a chance that the same condition may recur post operatively. The procedure may or may not be performed under general anesthesia, for example in cases of excisional biopsy of firbroadenoma or fibroids of breast, approach is done 2 cm away from the site and the fibroid removed under local anesthesia.
- Mastectomy: It involves the removal of either one or both the breasts in tote when the cancer has spread and covered a major portion of the mammary connective tissue. It is the only choice of treatment in malignancy, since chemotherapy and radiation therapy hardly have any effect on mammary tissues.
- Hysterectomy: It is the entire removal of uterus, generally an option in older women who are yet to attain menopause. The ovaries with fallopian tube are left in the place, ligated in the pelvic region. Hysterectomy procedure may also be an option in extensive cases of uterine and cervical cancer.
- ubectomy: It is a procedure of ligation of the fallopian tubes in order to prevent the eggs from fertilizing with the sperm and travelling to the uterus for implantation. It is more of a contraceptive procedure than the one treating any pathology of the reproductive system.
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- Radiation therapy and chemotherapy: Radiation therapy makes use of radiation in cases of uterine and ovarian cancer in order to cause damage and ultimately death of the tumor cells. The radiation doses however have to be kept at bare minimum levels considering the sensitivity of reproductive system. Chemotherapy in turn uses a combination of drugs which prove lethal to the cancer cells. Again the dose and frequency of such drugs must be kept at moderate levels in order to prevent iatrogenic damage to the other organs.
- Fertility treatment: Infertility occurs in females owing to tubal blockages, uterine weakness, tumors and cysts. In the recent past, a variety of modalities have been introduced to treat such cases. For example, in artificial insemination, the seminal fluid is injected artificially directly into the fallopian tube. Here the egg directly released from the ovaries is available for the sperms. This method is adopted when the vaginal health and environment does not permit the travel of sperm uptil the fallopian tube.
- In vitro fertilization IVF is the process of induced fertilization outside the mother’s body in a test tube, after which the zygote is implanted into the female’s uterus and thus begins the gestational period. Intracystoplasmic sperm injection ICSI is the procedure in which seminal fluid is injected into the uterus. This semen may or may not be of the father, donor semen may also be used. It is the resort when it is the father is not fertile or the sperm count and motility is too low to penetrate the female egg. In Gamete intrafallopian transfer GIFT, ovaries are stimulated to produce eggs and one such healthy egg is placed in the fallopian tube alongwith sperm from male. The process of fertilization is allowed to take place in the tube and proceed to the uterus for implantation. Zygote intrafallopian transfer ZIFT is the process in which eggs from female and sperm from male can be extracted and fertilized in vitro. This zygote can then be placed in the fallopian tube to allow the natural process of pregnancy to take place.
Complications & risk factors associated with obstetrics and gynecology disorders:
- Habits such as smoking, alcohol aggravate the existing condition
- Unnecessary exposure to radiation also adds to the complications
- Systemic conditions such as hypertension, diabetes have to be controlled and monitored prior and during the surgical approaches.
- Arthritis, osteoporosis generally occur in women post hysterectomy due to deficiency of calcium
Success Rate in India:
Success rate pertaining to the removal of cysts and tumors of the breast and ovaries is 98.67 percent, with a mild chance of recurrence. Procedures like mastectomy and hysterectomy have excellent results with complete regression of the pathological symptoms. Management of fertility issues using the mentioned approaches show a variable success in the range of 56 to 67.89 percent with respect to females.
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