Procedures

Alpha-fetoprotein test

Alpha-fetoprotein is a globulin produced by liver and other tissues of the fetus and the newborn. Its level normally declines after one year of age. An elevation of alpha-feto­protein may suggest hepatocellular carci­noma, viral hepatitis, hepatic cirrhosis, and various teratocarcinomas and embryonal car­cinomas of gonadal origin. Elevation of al­pha-fetoprotein (AFP) occurs in neural tube defects (anencephaly, spina bifida).

Amniocentesis

Amnion is the innermost membrane envel­oping the embryo. Sometimes, to test the fe­tal abnormalities, a hollow needle is inserted into the uterus of a pregnant woman and tis­sue samples are drawn out. This puncture of amniotic sac and removal of amniotic fluid is known as amniocentesis. The tissue samples are cultured for biochemical and cytological studies.

Chorionic villus sampling

Chorionic villus sampling or CVS is used to detect chromosomal abnormalities and bio­chemical disorders of the fetus. A catheter is inserted into the cervix and in the outer por­tion of the cervix, and a sample of chorionic villi is obtained.

Colposcopy

Colposcope is a stationary low-power micro­scope used in conjunction with a vaginal speculum to inspect the cervix. Colposcopy facilitates the identification of cervical dys­plasia in women with abnormal Pap smears and as an aid in biopsy and excision proce­dures.

C-section

C-section is carried out in cases of cepha­lopelvic disproportion, presence of STDs, fetal distress, and breech presentation. The abdomen and the uterus are incised (abdominal hysterotomy) to remove the fetus.

Culdoscopy

An endoscopic inspection of the cul-de-sac or the pouch of Douglas is known as culdos­copy.       Cul-de-sac is the lowermost part of the peritoneal cavity and lies between the uterus and the rectum. Culdoscopy is performed under anesthesia, and the instrument, culdoscope, is inserted vaginally.

Dilatation and Curettage

The cervical canal is widened with a graded dilator, and the uterine endometrium is scraped with a curette. This procedure is re­sorted to in cases of cytologic examination, abnormal uterine bleeding, and as a thera­peutic measure for incomplete abortion. This procedure is generally done in the operating room under anesthesia.

Endometrial smear/endometrial biopsy

Endometrial smear or endometrial biopsy refers to the microbiologic study of tissue samples from the endometrium. This histo­logical study detects any abnormality or malignancy in the high-risk patients. Endometrial smear is performed during a gy­necologic examination. This procedure is performed under local anesthesia and a thin, hollow curette is used to extract the endome­trial tissue, which is then sent for laboratory studies.

Exfoliative cytology

Exfoliative cytology is the microscopic examination of the stained cells, which are usually brushed or scraped from the uterine cervix or the interior of the stomach. This cytology detects any malignant or premalig­nant changes.

Laparoscopy

Laparoscopy implies inspection of the ab­dominal cavity. An incision is made through the abdominal wall and an endoscope is in­serted. This endoscope, which is a tubular instrument with illumination and magnifica­tion facility, is inserted though the incision, and the pelvic viscera are explored for any abnormality.

Papanicolaou test or Pap test

In this test, superficial cells are removed from the vagina and cervix for a cytologic exami­nation. Hormonal effects are determined and abnormal cell changes detected. The reasons are generally traced to inflammation, infec­tion, dysplasia, and sometimes actual malig­nancy. The samples of the exfoliative cells are taken from the following areas: the vagi­nal vault, the squamocolumnar junction, and the endocervical canal. Squamocolumnar junction refers to the transition line between the squamous epithelium of the vagina and the columnar epithelium of the endocervical canal. The specimens from the vaginal vault and the squamocolumnar junction are taken with the help of a wooden spatula (Ayre spatula in case of squamocolumnar junc­tion). A bristle brush is used to secure the sampling of the columnar cells from the en­docervical canal. The results are explained as per the Bethesda system. The adequacy of the specimen is assessed and effects of estro­gen and progesterone are determined. In­flammatory, degenerative, dysplastic, and malignant changes in cells are identified. Other infections, like candida, trichomonas, herpes simplex, are detected.

Pregnancy test

The detection of chorionic gonadotropin in the serum is the basis for most serum preg­nancy tests in current use. The result of this qualitative test may be reported as simply positive or negative. Urine pregnancy test depends on identification of chorionic go­nadotropin in urine. Serum hCG levels rise rapidly in early gestation. Human chorionic gonadotropin can be measured by the follow­ing tests: bioassay, agglutination immunoas­say, radioimmunoassay, radioreceptor assay, and immunometric assay. Immunoassay is one of the most important, rapid, inexpensive, and relatively reliable tests for pregnancy.

Tubal ligation

Tubal ligation is a contraceptive method (sterilization surgery) in which the continuity of uterine tubes or oviducts is interrupted by cutting, cautery, or by a plastic or metal device to prevent a future conception.

Ultrasonography

Ultrasonography is a radiographic proce­dure, during which ultrasonic waves are used to produce an image or photograph of a tis­sue or organ. Ultrasonic waves are passed through the tissues having different densi­ties and resultant images are recorded. This is a non-invasive technique to evaluate the female reproductive system and the fetus.

Pharmacology

Contraceptives (steroidal, chemical)

Contraceptives inhibit ovulation and there­by act as a deterrent against pregnancy. They are available in the form of steroids and chemicals. Steroids are generally oral contra­ceptive pills (OCPs), a combination drug of estrogen and progesterone. On the other hand, chemical contraceptives come as foam, gel, cream, or other spermicidals, which are placed in the vagina before the intercourse. They prevent pregnancy by killing the sperms. Some of the oral contraceptives used are ethinyl estradiol and levonorgestrel, mestranol and norethindrone.

Estrogen hormones

Estrogen hormones are used as oral contra­ceptives as well as in the treatment of post­menopausal osteoporosis. They act by binding the estrogen nuclear receptors. How­ever, prolonged use of this hormone can lead to skin rash, thromboembolism, and en­dometrial cancer. Estradiol (Estrace), estrogens and medroxyprogesterone (Prempro) are some ex­amples.

Oxytocin

Oxytocin is a neurohypophyseal hormone that causes myometrial contractions at term and promotes milk release during lactation. Oxytocin is used for induction or stimula­tion of labor. They are also used to manage the postpartum hemorrhage and atony, e.g. Pitocin.

Important things to know:

·                    Female reproductive organs lie inside the bony pelvis, while male organs lie mainly outside the pelvis.

·                    Menstruation occurs due to loss of functional layer of the endometrium if conception does not take place. It lasts for an average of 3 to 6 days.

·                    The study of female reproductive system is called gynecology and the physician who specializes in it is called a gynecologist.

·                    In females, the reproductive cycle is called a menstrual cycle and is of approximately 28 days' duration; the ova is released in mid cycle.

·                    Obstetrics is the specialty concerned with pregnancy, parturition, or delivery of fetus and physician who specializes in this branch is known as obstetrician.

Chapter VII - Obstetric Procedures