Gynecology and pregnancy
PREGNANCY
It is understood, nowdayas, that there is no more important and more sensitive period in anyone’s life, for their entire health, than the prenatal period. There are more and more proofs that development disorders during fetal life represent a significant risk factor for development of diabetes, cardiovascular and cerebrovascular disorders, later in lifetime. The fact that quality of life depends on medical care during fetal life shows the responsibility of parents-to-be and physicians in the struggle for healthy offspring. Medical care in prenatal period has its aim in early detection and correction of fetal abnormalities, chronic diseases and fetal death prevention. Therefore, „Jevremova” dispensary offers to its patients:
Ultrasound diagnostic during pregnancy:
- Pregnancy checks
- High risk pregnansy checks
- Labaratory analysis
- Microbiolgical and virological tests
- Outpatient diagnostic interventions that are made in the purpose of gaining information related to genetic material, infections, diseases...
- CTG test, that enables us the information on hart rate of the fetus, wheather it gets enough of oxigen, and on the contraction of the uterus.
- Therapy interventions in pregnancy such as aplication of cerclage for preventing the miscariage, and many other methods and tests
Gynecology
Colposcopy | Hysteroscopy | Laparoscopy | Surgical interventions
Our consultants have available for you:
1. Ultrasound diagnostic:
- Transabdominal ultrasound examinations
- Transvaginal ultrasound examinations
- Transrectal ultrasound examinations
- Sonoscopic testing of patency of the Fallopian tubes (Sonohistersalpingography)
- Puncture of cysts under sonographic control
- Ultrasound of breasts
2. Gynecological examination- standard, with sampling for
- Complete microbiological and virological tests:
- -vaginal discharge
- -cervical smear
- Hormone and other laboratory tests
- Papanicolau test (PAPA)
Our experts can also help you with the problems in
- Menopause
- Endocrinology
- Contraception
- Examination and Treatment of Infertility
- Breast pathology
- Outpatient surgical interventions
Diagnostic and correction of certain anomalies in gynecology required complex surgery and recovery period lasting from a few days to several weeks. Nowadays, laparoscopy and hysteroscopy are convenient both to patients and physicians, because these procedures are easier, quicker and bare less risk in achievement of the desired effect.
Colposcopy
Colposcopy is a microscopic examination of the cervix and vulva. Colposcopy and cytology (PAPA test) represent the „gold standard” in screening and both procedures can detect with the certainty of 99% pre-malignant lesions and early cervical cancer. Sometimes, it is necessary, for obtaining the most accurate diagnose, to fulfill this examination with the cervical biopsy (taking the small sample of tissue in the suspected area) and with explorative curettage (taking the sample of tissue from the uterus). The obtained material is then sent to histopathology evaluation. It is recommended that these examination should be preformed once a year.
Hysteroscopy
Hysteroscopy is very important part in examination of sterility, repeated misscarriages and/or abnormal bleeding from uterus. It can be diagnostic and operative. Hysteroscopy is an intervention where hysteroscope (a narrow telescope, 3 to 9 mm) is passed through vagina and cervix into the uterine cavity. Modern telescopes are so thin that they pass through the cervix with no dilatation thereto. Inside of uterus consists of two layers of endometrium (uterine mucous membrane) closely attached to each other. They can be examined when separated and that is frequently carried out by introducing liquid between them. Hysteroscopy is usually carried out immediately after menstrual bleeding as the most suitable period for direct visualisation of uterine cavity.
Diagnostic hysteroscopy is direct visualisation of the inside of uterus, i.e. uterine cavity and mucous membrane, possible septums and/or pelvic adhesions, polyps, myomas or other abnormalities.
Operative hysteroscopy is often a continuation of the diagnostic hysteroscopy. In operative hysterscopy abnormalities can be directly removed (adhesions or tumors in the uterus, polyps, myomas) some undefined changes passing into uterine cavity and preventing conception, pregnancy and causing some other difficulties during periods. This intervention corrects the shape of uterine cavity. Taking the samples deep inside the mucous membrane of uterus (deep biopsy of endometrium) and hystopathological analysis of these samples indicates the morphology of uterine mucous membrane and the influence of hormones on the membrane. Microbiological testing of these samples can reveal possible so called hidden infections, i.e. infections, although present in the tissue, cannot be detected with any other method. These give no latent difficulties but can cause sterility and infertility problems.
Many women of mature reproductive age have heavy menstrual bleeding. When these heavy bleedings give no rection to hormone therapy, the choice would be hysteroctomy or hysteroscopy. Certainly, hysteroscopy has many advantages, as the patient avoids a difficult operation, removal of the uterus and the Fallopian tubes as well as numerous potential dangers that such an operation carries along. This operation is known as endometrium ablation. Electrical ablation of mucous membrane is carried out by means of hysteroscopy and therefore repeted menstrual and intermenstrual bleeding is prevented.
Hysteroscopy risks
Complications of diagnostic hysteroscopy are very rare. Statistically, these happen with 2 % of carried out interventions and those are:
- uterine wall perforation. With regard to the width of instruments these perforations are very small and in most cases they scar spontaneously.
- complications with regard to the liquid used for widening uterine cavity are leaking of the liquid into the abdominal cavity and blood vessels, all that can induce problems with arterial pressure and electrolytic disbalance....
Great majority of patients feel no difficulties during and upon the intervention. However, there exist certain difficulties that can happen during intervention. The most common difficulty is a pain that patients feel upon the hysteroscopy. The pain can be compared to somehow stronger pains during menstrual pains and is not disturbing. There are serious risks, and even though these are rare we have to mention them:
- heavy bleeding
- infection
- risks related to anesthesia.
Laparoscopy
Sometimes clinical examination, ultrasound or roentgen examination are not sufficient to determine the condistion or inner organs. With some women there are problems that can be diagnosed and /or removed by laparoscopy method. In those cases laparoscopy, diagnostical and opertive as well is of great significance. Laparoscopy is a minimally invasive surgical intervention where through the incisions (smaller than 1 cm) optical instruments are introduced into the abdominal cavity for direct visualisation and operation of internal organs and other tissues. The most frequent reasons for laparoscopy are testing and eventual removing of some of the causes of sterility, ambiguous abdominal pains, diagnostic and/or surgical removal of endometriosis, ectopic pregnancy, cysts and tumours.
Laparoscopy enables us to:
- see the organs of true pelvis and detect possible anomalies
- examine the patency of the Fallopian tubes in the scope of sterility testing
- remove the existing adhesions
- carry out biopsy (taking the sample of tissue which we want to examine)
- remove the existing cysts and tumours
- remove ectopic pregnancy which is one of the most ugent conditions in medicine
Surgical interventions
Operating room in SGH „Jevremova”
- HYSTERECTOMY
is the surgical removal of the uterus, alone or with one or both ovaries. This procedure is usually performed in patients, after reproductive age, with abnormal bleeding disorders, myomas... Indications for hysterectomy are also malignant lesions on the cervix, on uterine cavity and the body of uterus, as well as certain changes on ovaries. Pre surgical procedures requires one day, the surgical intervention lasts about two hours, and postoperative care requires hospitalization for 4-5 days after the intervention. Hysterectomy can be performed as open surgery, via laparotomy, or laparoscopy. - OOPHORECTOMY
is a surgical removal of an ovary or ovaries (when removed with Fallopian tubes and surrounding tissue- it is adnexectomy), in patients with cystic, solid, or mixed lesions on ovaries. Pre surgical procedures requires one day, the surgical intervention lasts about an hour, and postoperative care requires hospitalization for 3-4 days after the intervention. Oophorectomy can be performed via laparotomy or laparoscopy. - MYOMECTOMY
refers to the surgical removal of non cancerous uterine fibroids, also known as myomas. The presence of myomas can cause irregular and heavy bleeding or can cause infertility. Myomas can be located inside the cavity of the uterus (intramural myomas), outside the wall of the uterus (subserous) and submucous that are partially in the cavity and partially in the wall of the uterus. Pre surgical procedures requires one day, the surgical intervention lasts about an hour, and postoperative care requires hospitalization for 3-4 days after the intervention. Oophorectomy can be performed via laparotomy or laparoscopy, or in combining these two procedures. - CONIZATION
of cervix with curettage of cervical canal refers to surgical procedure that involves the removal of a triangle of cervical tissue in pre malignant lesions and in carcinoma in situ of the cervix. Cervical conization is both diagnostic and treatment tool. Pre surgical procedures requires one day, the surgical intervention lasts about an hour, and postoperative care requires hospitalization for one day after the intervention.