Dr Lee Say Fatt

Endometriosis

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Endometriosis is a condition whereby tissues from the lining (endometrium) of the uterus becomes implanted in areas outside the uterus such as the outer surface of the uterus, the fallopian tubes or the ovaries. Rarely, the endometrial tissue may spread beyond the reproductive organs and pelvic region.

In a normal menstrual cycle, the endometrial tissues respond to cyclical female hormones and becomes progressively thicker and will eventually shed each month if the woman is not pregnant. It is discharged as menstrual flow at the end of each cycle. In endometriosis, this shedding and bleeding will occur outside the uterus as well, causing significant pain. Recurrent bleeding and healing cycle will eventually cause scar tissue formation and destruction of pelvic structures. The excessive blood will accumulate over a period of time and eventually forms a cyst in the ovary (called endometriotic cyst or endometrioma).  The 4 stages (classification) of endometriosis (minimal, mild, moderate or severe) are used to describe the location and the severity of the disorder.

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Vaccination and Pregnancy

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It is important to ensure that you are adequately protected against certain infectious diseases during your pregnancy. In the community, people are protected against infectious disease because they have had the infections before and developed immunity to it. Some are protected against chickenpox, for example, because they had it when they were kids, causing their immune systems to make antibodies to the chickenpox virus. However, over time the antibody level may decline to a very low levels and the person may lose the protection against that particular infectious agent.

Alternatively, many in the community have been vaccinated and developed antibodies to that specific infectious agent contained in the vaccine. Many countries now have an immunization schedule that tries to cover as many infectious disease as possible, hoping to reduce the disease burden to the community and the health care system.

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Laparoscopy in Gynaecology

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Laparoscopy is a procedure that allows visual examination and surgical treatments of the pelvic and abdominal organs pathology. The procedure is performed with a laparoscope, which is a small lighted telescope.

INDICATIONS – When is it necessary

  • Evaluation and treatment of women who has difficulty in conceiving.
  • Evaluation and treatment of known or suspected endometriosis.
  • Pelvic infections
  • Removal of diseased fallopian tubes, ovaries, cysts or uterus
  • Undiagnosed pelvic pain
  • Uterine fibroids
  • Voluntary sterilization (tubal ligation or occlusion for permanent family planning)
  • For diagnosis and treatment of a variety of other pelvic or abdominal disorders

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Caesarean Section

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WHAT IS IT?
Delivery of a baby through an incision in the mother’s lower abdominal and uterine walls and is performed when a vaginal delivery is not possible or is unsafe. This procedure is also called a C-section or Lower Segment Caesarean Section (LSCS).

 

 

 

REASONS FOR PROCEDURE

Danger to the mother or baby from one or more of many causes, including:

  • Baby’s head too large to pass through the birth canal.
  • Baby in the wrong orientation – head up (breech) or transverse.
  • Failure of cervix to dilate (failed induction of labour).
  • Abnormal placenta location obstructing the birth canal (placenta praevia).
  • Failure of normal labour progress.
  • Situation where urgent delivery is indicated such as fetal distress or severe illness in the mother (such as severe hypertension or sudden fits).
  • Infection such as HIV or acute herpes genitalis infection in the mother.

Special situations: pregnancy resulting from assisted reproductive technology (ART), maternal request

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Post-Natal Care – what to expect

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Most women stay in the hospital for 24 to 48 hours after giving birth (or 3 to 4 nights after a caesarean section). This will depend on the condition of the mother and baby.
The physical changes that occur with pregnancy usually resolve by the end of 6 weeks, although some may resolve much earlier than this. It is important to know all these changes, as it will help you cope better and lessen your worries. Emotional sup¬port and much needed help from your spouse and family members is equally important to assist you in facing these changes and coping with the arrival of a new member into the family. You will also get lots of advice from friends and relatives who visit you – some may be conflicting and may be harmful. There are many ways of doing things with no particular hard and fast rules on what is best for you. It is best to avoid traditional or Chinese herbs during this period. In the end, it is all boils down to common sense and you have to decide what is best for you and your baby. Do some reading and ask your doctor or midwife about your recovery during the postnatal period

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Ectopic pregnancy

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Ectopic pregnancy is one that develops outside the uterus. The egg (oocyte) and the sperm meet in the fallopian tube and fertilization occurs. The embryo is supposed to move back to the uterine cavity for implantation. However, in ectopic pregnancy this does not occur, and the embryo gets implanted elsewhere. The most common location is in one of the narrow tubes that connect each ovary to the uterus (fallopian tube). As the fertilized egg enlarges, the fallopian tube stretches and ruptures, causing life-threatening internal bleeding. Other locations include the ovary, cervix, space beside the uterus (broad ligament space) or in the abdominal cavity. About 1 in 100 pregnancies is an ectopic.

CAUSES AND RISK FACTORS

The occurrence of ectopic pregnancy is usually associated with an abnormal function of the fallopian tubes. Hence, tubal pregnancy is the most common type. Hormonal imbalances or abnormal development of the fertilized egg might also play a role. Certain condition may predispose to a higher chance of ectopic pregnancy such as:

  • Previous abdominal or pelvic infection
  • Pelvic inflammatory disease (PID), involving the fallopian tubes
  • Pregnancy after tubal ligation
  • Assisted reproduction techniques such as in vitro fertilization.
  • Adhesions (bands of scar tissue) from previous pelvic surgery.
  • Previous tubal pregnancy.
  • History of endometritis (infection of the inner uterine lining)
  • Malformed (abnormal) uterus or fallopian tubes
  • Pregnant with an intrauterine device (IUD) in place (failure of IUD)

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Fibroids removal (Myomectomy)

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A myomectomy is the removal of fibroids (leiomyomas, myomas) from the uterus. Patients can have a single or numerous fibroids. Myomectomy treatment for fibroids preserves the uterus. It is most often recommended to women who desire future pregnancy or wishes to retain her uterus. A patient undergoing the myomectomy procedure should be informed regarding the risk of hysterectomy. This may be necessary if excessive bleeding occurs, or if it is not possible to reconstruct the uterus because of the many defects left by the removal of multiple small fibroids or a single large fibroid.

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Uterine Fibroids

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It is an abnormal growth of cells in the muscle layer (myometrium) of the uterus. Uterine fibroids are common and usually benign (not cancerous). Fibroids range in size from very tiny to the size of an orange or larger.

INCIDENCE

Uterine fibroids are the most common pelvic growth in women. The actual incidence among all women is unknown but generally cited as 20 to 25 % in the general population and is highest between age 35 to 45 years old.

TYPES (based on location in the uterus)

 

  • Subserous which appear on the outside of the uterus.
  • Intramural, which is confined to the wall of the uterus.
  • Submucous which appears inside the uterus.
  • Pedunculated fibroids, which are attached to the uterine wall by stalks.
  • Broad ligament type which grows to the side of the uterus
  • Cervical type, which is rare.

 

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