Benign ovarian cysts

The ovaries are the female reproductive organs that contain eggs and will release them on a regular basis (usually monthly in the majority of the women). It also produces female and male hormones. An ovarian cyst is abnor¬mal growth in the ovary and can be either solid or cystic. It can be divided into either a benign (non-cancerous) or malignant (cancerous) type. Benign or non-cancerous cysts do not invade neighboring tissue the way malignant cyst does. The exceptionally large ovarian cyst often turns out to be benign.

The term ovarian cyst refers to abnormal growth in the ovary that contains mainly fluid, although occasionally some solid component may be present as well.

Symptoms and signs

Many women with ovarian growths do not have symptoms and is only detected during routine screening. Some may present with the following symptoms:

  • Mild pelvic pain.
  • Pain in the lower back.Discomfort with sexual intercourse.
  • Abnormal menstruation, including changes in menstrual flow, length of bleeding and intervals between periods.
  • If a large ovarian cyst twists or ruptures, the following will occur in the lower abdomen—severe pain, tender lower abdomen, and swelling.
  • Some ovarian growth may produce excessive hormones and the clinical effects will depend on the type of hormones that are being produced such as:
    Effects of excessive female hormones – present with abnormal menstruation, precocious puberty (early onset of puberty in young girls)
    Effects of excessive male hormones – present with acne, oily skin, increased male type of hair distribution, hoarseness of voice, breast atrophy, clitoral enlargement.

Types of cysts

Common types of benign ovarian cysts are:

  • Endometriotic cysts
  • Dermoid cyst (mature cystic teratoma)
  • Cystadenoma

Some ovarian cysts may arise from a normal physiological process, such as a corpus luteal cyst that develops following ovulation. Bleeding may occur into this cyst or into the pelvic area, causing pain. If bleeding occurs into this cyst, it will be labeled as haemorrhagic corpus luteal cyst. If the bleeding spills into the pelvic cavity, it is called a ruptured corpus luteal cyst. The pain is usually acute and of variable intensity. The bleeding can be variable, from minimal to a large volume, leading to admission and possible surgical intervention. If symptoms are mild, surgery is unnecessary and can be managed with painkillers and rest. These cysts will usually resolve spontaneously following the next menstrual cycle.

Causes

  • Usually unknown but may be related to abnormalities of female hormone production and secretion.
  • Endometriosis.

Prevention

There are no specific or effective preventive measures at the moment. The use of combined oral contraceptives pills may help to decrease the risk.

Complications

  • Sudden onset of severe abdominal pain, either due to rupture, bleeding or twisting of the ovarian cyst. This would require an emergency abdominal surgery.
  • Progressive enlargement, requiring open surgery and a larger incision.
  • Cancerous change

Investigation and diagnosis

  • A cervical cytology smear (Pap smear) is routinely advised for women who are at risk if it has not been done recently.
  • Diagnostic tests include laboratory blood studies.
  • Ultrasound scan is required for diagnosis and to help determine the nature and type of ovarian growth. In some cases, a CT scan or MRI may be recommended. These imaging modalities will be useful to decide the best management plan.

Treatment

  • Treatment may not be necessary for those who are without any symptoms and the ovarian cyst is small. Regular follow-up is advised so that the size and growth of the cyst can be monitored via ultrasound scan.
  • Some cysts require surgery to diagnose accurately, to rule out cancer, or for definitive treatment purposes. For most benign ovarian growths, the operation of choice is cystectomy. This is a procedure whereby only the growth is removed while retaining the ovary. This is recommended only if the growth is benign and the woman is young. However, the whole ovary (together with the growth) may need to be removed if there is suspicion of cancer or the ovary is no longer healthy due to various reasons (such as twisting of the ovary causing gangrenous change or infection). If one ovary must be removed, normal conception and childbirth is possible as long as a normal ovary remains on the other side. The approach to cystectomy alone or removal of the ovary can be either via laparoscopy or laparotomy.
  • Laparoscopy – This is the procedure of choice if it is feasible. Laparoscopy (telescope inserted through the navel) is a minimally invasive surgical procedure that can diagnose and treat ovarian cysts at the same time. Instruments are inserted through additional tiny incisions in the abdomen and are used to cut and remove the cyst. Click here to read more about it.
  • Laparotomy – this is a surgical opening made into the abdomen. The skin incision is much longer than laparoscopy. It is indicated in the following circumstances: if the ovarian cyst is very big, when there is a previous operation making laparoscopy risky or when there is suspicion of cancer.
  • Combined oral contraceptives pills can be prescribed and may help shrink the cyst, particularly those physiological cysts that are related to ovulation.
  • There are no restrictions on activity or diet unless surgery is necessary.

See your doctor immediately if there is:

  • Sudden onset of severe abdominal pain, with or without abdominal disten¬tion.
  • Progressive abdominal swelling.
  • Poor appetite, abdominal discomfort, nausea or vomiting, significant weight loss.

 

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Breast Cancer: The importance of Self Breast Examination

Breast cancer is the most common type of cancer affecting women. In Malaysia, the overall lifetime risk of developing Breast cancer is 1 in 27, with 1 in 22 for Chinese, 1 in 23 for Indians and 1 in 30 for Malays.

Breast cancer is curable if detected early and treated appropriately. One must be mindful of how our breast feels. What is normal for one person, may not be normal for someone else. Only YOU know what is normal for You. Hence Self Breast Examination (SBE) is particularly important. It is quite easy to do and can be done by any woman independently. Self Breast Examination is best done 10 days after one’s period or if you are post-menopause, then pick any day of the month as a routine.

 

Steps to check your breast

Step 1 – Stand in front of the mirror and look at your breast (picture 1). Look for changes in shape and size, any dimpling in the skin, any hyper pigmentation. Look at your nipple and look for skin changes. Raised both your hands above your head and look to see if your breast moves symmetrically. Then bend forward to see the shape and size again

 

 

Step 2 – Place your arm behind your head and use your opposite hand (using only the flat surface of your fingers) gently move from outward to inward covering every quadrant of your breast. (see picture 2 for the direction of movement).

 

 

 

 

 

Following this, then move your fingers in circular movements over the breast and nipple. (See the circular motion and the directions in picture 3). Do not forget to check under the arm as well (picture 4). Gently squeeze the nipple, checking for discharge. Repeat the process on the other breast.

Step 3 – All of step 2 can be done while lying down flat, with your arm behind your head. Or can be done during shower.

What are you looking for when you examine your breast?
• any difference in the shape and size
• any lumps
• any dimpling in the skin
• any nipple and areolar changes, like sinking in of your nipple, nipple discharge, thickening of the skin over the areola or a rash

Be Mindful of Your Breast
• Practise Self Breast Examination after the age of 20
• Schedule a clinical breast examination by your physician annually after the age of 40
• Schedule a Mammogram biannually after the age of 40

 

 

Early Detection Saves Lives

Article contributed by:

Dr Daphne Anthonysamy (Consultant Breast and Endocrine Surgeon)
Subang Jaya Medical Centre
August 2020

 

 

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Hysterosalpingogram (HSG)

Hysterosalpingogram (HSG) is an x-ray examination that is used to evaluate the uterine cavity and to check for patency of the fallopian tubes (whether the tubes are blocked).

INDICATIONS (REASONS FOR PROCEDURE)

  • Infertility (difficulty in conceiving).
  • Confirm tubal and uterine abnormalities.
  • Recurrent miscarriages.
  • Follow-up to some surgical procedures.

CONTRA-INDICATIONS TO THE PROCEDURE

  • Undiagnosed vaginal bleeding.
  • Pelvic inflammatory disease (PID).
  • Pregnancy.
  • Recent curettage or active genital tract infection.

PREPARATION FOR THE PROCEDURE

  • It is best to schedule the procedure following completion of menstrual flow and before the tenth day. Please discuss this with your doctor if you are unsure or if you suspect that you may be pregnant.
  • If you have abnormal vaginal discharge, please inform your doctor. The procedure should be deferred until the infection has been ruled out or has been adequately treated.
  • No fasting is required. However, it is not advisable to take a full meal just prior to the procedure.
  • You should inform the doctor if you have a history of asthma, allergy to seafood, medications, or contrast.
  • Oral pain-killer medications and antibiotics may be given one hour prior to the procedure. This will help to reduce the pain and risk of infections. Additional doses may be given for you to take home. Please follow the instructions carefully when taking these medications.
  • Call the hospital to schedule an appointment for this procedure once your menstrual flow starts. This is to enable the hospital to schedule it before your tenth day (counting from the first day of menstrual flow).
  • Please abstain from unprotected sexual intercourse before the procedure or use a safe method such as condoms.
  • It is advisable to get an accompanying person to drive you home after the procedure.

DESCRIPTION OF PROCEDURE

  • The procedure is quick; usually takes about 15 to 20 minutes from start to finish.
  • No specific anaesthesia is required. You will be conscious during the procedure.
  • A speculum is inserted into the vagina and the cervix is visualized. The cervix and vagina are clean with an antiseptic.
  • A disposable balloon catheter is inserted into the uterine cavity and a dye (contrast medium) is slowly inserted into the uterus. X-rays are taken before and during the injection of dye. There may be some cramping or discomfort felt as the dye is injected. You may be asked to change positions for different x-ray views.
  • The x-rays will show the outline of the uterus and fallopian tubes as the dye fill them and spill into the abdominal cavity.
  • At the end of the procedure, all instruments are removed.
  • The results will be available immediately.

EXPECTED OUTCOME

  • Normal findings reveal a symmetrical uterine cavity, with the dye flowing through unblocked fallopian tubes, and there is no leak of dye from the uterus.
  • The x-rays may help reveal an abnormality in the shape/size of the uterine interior, scarring, tumors (fibroids), endometrial polyps, or a blockage in the fallopian tubes.
  • Conditions detected by the hysterosalpingogram may require further testing for confirmation; this may include a laparoscopy or hysteroscopy (use of a small lighted telescope to view internal organs).

POSSIBLE COMPLICATIONS

  • Allergic reaction to the solution used in the test.
  • Uterine perforation.
  • Infection.

POST PROCEDURE CARE

  • Mild cramping, a slow pulse, some nausea, or dizziness may occur during or following the procedure. These are temporary.
  • Expect some vaginal spotting after the procedure but no heavy vaginal bleeding. Also, the solution used to clean the vagina and cervix and some of the dye itself will leak out through the vagina after the procedure. Wear a sanitary napkin for one or two days.
  • Antibiotics may be prescribed to prevent infection prior to or after the procedure.
  • Following the procedure, mild painkillers medications can be continued if the pain is present.
  • There are no dietary or activity restrictions once any temporary symptoms disappear.
  • You may return to work the following day if you are well.

SEE YOUR DOCTOR IMMEDIATELY IF YOU HAVE:

  • Increased pain in the lower abdomen or in the genital area.
  • Signs of infection: headache, muscle aches, dizziness, or general ill feeling and fever.
  • Persistent or heavy vaginal bleeding.
  • Persistent and abnormal vaginal discharge

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Hysterectomy (removal of the uterus)

Hysterectomy is the surgical removal of the uterus (womb) resulting in inability to become pregnant and immediate cessation of menstruation. It is a common operation and may involve removal of the cervix, ovaries and fallopian tubes at the same time.
Please discuss all aspects of this surgical procedure, its risks and benefits, and any possible alternative therapies. Your health care provider will help you decide which type of hysterectomy is appropriate for you, depending on your indications for surgery and your medical history.

Types of hysterectomy

  1. Total or simple hysterectomy (and removal of both tubes) – involves the removal of the entire uterus, including the cervix. At the same time, it is advisable to remove both fallopian tubes as well because this will be able to reduce your chance of developing ovarian and fallopian tube cancer later. This procedure is called salpingectomy. Both the fallopian tubes are usually removed at the same time to reduce the risk of ovarian cancer.
  2. Subtotal (partial; supracervical) hysterectomy – removal of the uterus above the cervix, leaving the cervix intact. In this case, regular Pap smear (Thin Prep) is advised after the surgery. This type of surgery is seldom performed now and usually done in situation whereby there are dense adhesions surrounding the cervix and removal of the cervix pose additional risk of injuries to ureters and bladder.
  3. Radical hysterectomy – removal of the uterus, cervix and surrounding tissues. This is usually done for treatment of pelvic organs cancer.
  4. Total hysterectomy with bilateral salpingo-oophorectomy – removal of the uterus, cervix, both fallopian tubes, and both ovaries. When both ovaries are removed, you will experience what is called surgical menopause. A unilateral oophorectomy procedure leaves one ovary behind.

 

Reasons for the procedure

  • Endometriosis
  • Uterine fibroids
  • Heavy menstrual bleeding (after failed medical therapy and not suitable for other minimally invasive alternatives)
  • Uterine prolapse
  • Endometrial hyperplasia
  • Severe, chronic (long-term) infections, such as pelvic inflammatory disease
  • Chronic pelvic pain
  • Ovarian growths, if persistent or symptomatic
  • Pelvic adhesions
  • Cancer of the uterus, cervix, ovaries, or fallopian tubes

Description of the procedure

  • A general anaesthetic will be administered. The procedures may take 1 to 2 hours.
  • Antibiotics to prevent post surgical infection is usually given at the start of surgery.
  • A urinary catheter is placed into the bladder after the general anaesthesia.
  1. With an ABDOMINAL HYSTERECTOMY, an incision is made in the abdomen (either horizontal in lower abdomen or vertical, depending on the diagnosis and/or size of the uterus). The abdominal organs are examined. The uterus and cervix are cut free and removed. Other organs and tissue may be removed. The vagina is often closed with sutures at its deeper end. The surgical wound (including the skin) is closed in layers with sutures.
  2. With VAGINAL HYSTERECTOMY, the procedure is done vaginally. An incision is made in the upper end of the vagina. The cervix is separated from the bladder in front. The ligaments containing the blood vessel to the uterus are clamped with a surgical clamp, cut and tied with sutures. The uterus and other structures are brought out through the vagina, and the cut end of the vagina is sutured. This technique is often used in cases of uterine prolapse or when vaginal repairs are necessary for related conditions. When a vaginal hysterectomy is performed, any sagging of the vaginal walls, urethra, bladder, or rectum can be surgically corrected at the same time. This is also known collectively as pelvic floor repair. For example, anterior colporrhaphy is a vaginal procedure to reestablish the supports between the bladder and vagina to fix a cystocele (descend of the bladder). If there is herniation of the rectum into the vagina (called rectocoele), a posterior colporrhaphy will be required to correct this defect.
  3. LAPAROSCOPIC ASSISTED VAGINAL HYSTERECTOMY (LAVH) is a combined procedure that can aid in the removal of the uterus vaginally when it otherwise would require an abdominal incision. This procedure is performed with the aid of a laparoscope (a tiny telescope that is hook up to a monitor), which is inserted through the navel. Instruments are inserted through additional tiny incisions in the abdomen and are used to cut and separate the uterus from the surrounding attachments (usually the upper structures of the uterus including the fallopian tubes, ovaries plus the ligation of the blood supply). Once this is completed, an incision is made in the upper end of the vagina and the pelvis entered from vagina. The surgery is completed vaginally. The uterus and other structures are removed vaginally. Closure of the vagina can be done either vaginally or through the laparoscope.
  4. TOTAL LAPAROSCOPIC HYSTERECTOMY (TLH) is similar to LAVH discussed above except that the whole procedure is done through the laparoscope. At the end of the procedure, the uterus and structures are removed vaginally, and closure of the vaginal incision is done via the laparoscope. Not all cases are suitable for LAVH or TLH especially those with big uterus or fibroids, cancer surgery and those with severe pelvic adhesions.

Both ovaries and the fallopian tubes may be removed at the same time in certain women especially those with suspected or proven cancer cases, endometriosis or nearing menopause or already menopause.

Possible complications

In general, the risk of complications is low in those fit and healthy women undergoing surgery for benign conditions. The risk is increased if there is associated medical illness (poor fitness for surgery), elderly women, women undergoing repeated abdominal surgery or the presence of cancer. The complications are:

  • Excessive bleeding (may require a blood transfusion)
  • Surgical wound infection
  • Inadvertent injury to the bowel, bladder or ureters (which is the tubes going from the kidneys to the bladder), or nerve damage
  • Anaesthetic complications
  • Urinary tract infection
  • Respiratory infection, particularly pneumonia
  • Urinary retention, requiring continued use of a catheter
  • Bowel obstruction
  • Post-operative pelvic pain
  • Blood clots in calf veins (deep vein thrombosis), which can travel to the lung, causing lung damage
  • Fistula (abnormal opening) between the vagina and bladder or rectum.

Before the operation

  • Consent for operation should be signed.
  • Relevant investigation that may be taken will depend on your medical illness and age. This may include blood tests, ECG (electrocardiogram) and chest X-ray
  • A small enema or laxatives is given one or two nights before or on the morning of the surgery to empty the bowel. Shaving of the operative site is done before surgery (for abdominal approach).
    For complicated surgery whereby bowel adhesions is suspected, a full bowel preparation with Fortrans is required. This will help in cleansing of the intestines from fecal matter and secretions. It is important to have a clean and empty bowel to minimize complications during difficult pelvic surgery.
  • You are required to fast for at least 6 hours before surgery (no food or drinks at all for 6 hours). For example, if the surgery is in the morning, you should skip breakfast. If it is in the afternoon, you can have an early light breakfast (eg. tea/coffee/milo and toast) but make sure that this is taken at least 6 hours before the surgery. Please reconfirm this with your doctor.

Post-operative care

  • Hospital stay maybe 3 to 5 days.
  • Food is not allowed immediately following the surgery. Adequate hydration will be given via an intravenous line. You may be allowed to start clear fluid after returning from operating theatre. Your doctor will review periodically to decide when to start orally. Initially, start with clear liquid diet and then followed by nourishing fluid. Once you can tolerate orally and the gastrointestinal tract start to function again, you will be given soft diet and later progress to solid food. There are no dietary food restrictions. You should eat a well-balanced diet to promote healing. However, you should avoid herbal remedies as these can have side effects and may promote bleeding.
  • Depending on the diagnosis and the extent of surgery, a small drain (tubing) may be inserted into the abdominal cavity after the surgery to allow any excess blood to drain out. This is usually removed in 24 to 48 hours later when drainage is minimal.
  • There will be a urinary catheter in the bladder to allow drainage of urine and is usually removed the one to two days later.
  • Pain relief medication will be given via injection and later change to oral tablet. Epidural analgesia for post-operative pain relief can be offered in selected cases.
  • Antibiotics is given at time of operation and may be continued if there is a risk of infection.•
  • Abdominal or pelvic surgery can predisposes the woman to a higher risk of deep vein thrombosis and pulmonary embolus. A deep-vein thrombosis (DVT) is a blood clot that develops within a deep vein, most commonly in the leg. Symptoms of a DVT include pain, swelling, and tenderness, usually in the calf, and a rope-like hardness running down the back of the lower leg A pulmonary embolus is a blood clot within the lung, which is often a clot that has dislodged from one of the deep veins of the leg and made its way to the lung. Both conditions are rare. You may be given an injectable medication to reduce your risk of developing deep vein thrombosis and pulmonary embolus. This type of medication is a blood-thinning agent, which helps to prevent blood clots. However, side effects will include excessive bleeding, wound haematoma and bruising from the injection sites. The decision to give is based on various medical guidelines and your risk profiles. Other measures to reduce this risk are wearing compression stockings immediately after surgery, early mobilization (preferable on the following day), ensure adequate hydration and intermittently moving your lower limbs while sitting or lying down. You should continue doing these even when you are at home. The risk is much lower with a straight forward uncomplicated hysterectomy and those done via either vaginal or laparoscopic route.
  • Getting up from bed on the following day – it is easier if you roll to your side at the edge of the bed. Put your head on your elbow, then slowly dropping both legs over the side of the bed. At the same time, slowly push yourself up sideways with your elbow and sitting up slowly into a sitting position. Try to use the other hand for support by crossing it over your body. Sit for a while on the bed to get your balance and then slowly stand up. You can do the opposite to get back into bed (in reverse order). By using this method, you will put less pressure on the stitches and abdomen.
  • Gas pain (abdominal wind) can be a problem following the operation for some women. Early mobilization will help to reduce the wind. If the problem persists, medication can be prescribed for relief.
  • Wound dressing will be removed to assess the wound prior to discharge. A new dressing will be applied before home.
  • For Abdominal Hysterectomy, non-absorbable sutures are usually removed from the skin incision on the seventh day. If absorbable suture is used, then the suture need not be removed. It will dissolve by itself after a few weeks. During wound healing, a firm ridge may form along the incision. As it heals, the ridge will gradually recede. Numbness around the incision site is common. This occurs because of the cutting of the nerves when making the incision to enter the abdominal cavity. The nerves will grow back. Over time, you may also feel a mild tingling sensation and then slowly returns to normal over several months. Some women may be prone to form a thick type of scar called a keloid. If you are concern, please ask your doctor about this and your doctor may recommend some scar prevention therapy, either the gel type (apply twice a day) or a special adhesive waterproof plaster. It should be started from 7 to 14 days after abdominal hysterectomy and needs to be done for at least 3-4 months to see an effect.
  • For Laparoscopic or Vaginal Hysterectomy, absorbable suture is often used. Therefore, the stitches need not be removed.
  • Once home, someone should be available to help care for you for the first few days.
  • Avoid douching, swimming, and soaking baths for a few weeks.
  • Shower as usual. Wipe dry the incision site with a clean dry towel after the shower.
  • Vaginal bleeding will last for a few days to one week. Use sanitary napkins to absorb blood or drainage. Once minimal, you can change to panty liner. Tampon use is not advisable.
  • Your appointment for follow-up is usually on the seventh or eighth post-operative day.
  • After effects of surgery may include constipation, urinary symptoms and fatigue.
  • Following the removal of the uterus, you will no longer have your monthly periods or be able to become pregnant.
  • It is still necessary to have regular pelvic examinations after hysterectomy, especially if the ovaries or the cervix are conserved; if you still have your cervix, you’ll still need to have a Pap smear (Thin Prep) regularly.
  • For those who have monthly pre-menstrual like symptoms prior to surgery, these symptoms may persist after the hysterectomy with conservation of the ovaries even though there is no longer monthly menstrual bleeding.
  • For those who had uterus, cervix, both fallopian tubes and ovaries removed, they may start to develop post-menopausal symptoms such as hot flushes, chills, night sweats, sleep problems, and mood changes. If severe enough, do consult your doctor to discuss medical (oestrogen replacement therapy) and/or non-medical therapies for the relief of menopausal symptoms.

Abdominal binder

An abdominal binder is a broad compression belt that encircles your abdomen. It is usually made from elastic and nylon materials with Velcro, hoop, or loop closures. It comes in various shapes, sizes and softness of materials. You may want to wear one after your abdominal hysterectomy, especially if you have a pendulous abdomen (hanging belly). It may help to reduce post-operative pain and helps you to move around easily. The compression provided by the binder will also reduce the pain when you cough or sneeze. It can support your surgical incision especially if it is a midline incision. Do take note that some women do not find it useful. You should try it if you think there is a need for you. In the end, you may or may not like it.

It is not necessary if you had a laparoscopic or vaginal hysterectomy. When choosing an abdominal binder, it is important to get the right size and wear it properly. Do make sure it is not too tight and you are able to breathe and sit comfortably.

Activity

  • To help recovery and aid your well-being, resume daily activities, including work as soon as you are able. Heavy lifting and strenuous activity should be avoided.
  • Recovery at home may take 2 to 3 weeks, with full activities resumed in 6 to 8 weeks. Incisional numbness, occasional aches and pains may last for another few weeks. For laparoscopic hysterectomy and vaginal hysterectomy recovery time is much quicker than abdominal hysterectomy.
  • You can resume driving usually after 3 to 4 weeks, provided full mobility has returns and pain-killers medications are no longer required. It will be much earlier if you undergo either laparoscopic or vaginal hysterectomy. Please ask your doctor if you are not sure.
  • Sexual relations may be resumed in 6 to 8 weeks (or longer depending on your doctor assessment). Please discuss this during your post-operative follow-up visit. Most women experience no change in sexual function; some report improvement, while others have a worsening sexual function, specifically loss of libido (sexual desire). Intercourse may be uncomfortable for a period of time. You may feel bruised or sore, the vagina sensation may feel different and vaginal dryness can occur. Time, patience, trying different techniques and good communication with your partner should help alleviate any problems and increase your pleasure during intercourse. Contraception is not required now.

See your doctor if there is:

  • Increasing pain, swelling, redness, discharge or bleeding in the surgical area.
  • Vaginal bleeding which soaks more than 1 pad or tampons each hour.
  • The urge to urinate frequently, especially if associated with pain and abnormal urine colour.
  • Persistent and abnormal vaginal discharge.
  • Increasing nausea and vomiting, with or without abdominal distention.
  • Short of breath or feel faint.
  • Signs of infection, including headache, muscle aches, dizziness or a general ill feeling and fever.

To download and print a pdf copy, CLICK HERE

To read more about laparoscopic surgery, CLICK HERE

To read more about general anaesthesia for surgery, CLICK HERE

To view videos of laparoscopic hysterectomy video, CLICK HERE

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Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) refers to a spectrum of clinical problems due to hormonal and metabolic imbalance, which can affect the reproductive and endocrine systems.

 

 

How Common?

PCOS affects 5-10% of all women of childbearing age regardless of race or nationality. It may begin during puberty and become more severe with time.

Read morePolycystic Ovary Syndrome (PCOS)

Hysteroscopy (diagnostic and operative)

The hysteroscope is a small lighted telescope used for visual examination of the cervix and the uterus to help diagnose and treat abnormalities in the cervical canal or the uterine cavity. If it is used to look for the cause of the presenting problem, it is term as diagnostic hysteroscopy. If it involves some form of surgical procedures such as removal of growths (endometrial polyps or fibroids), removal of the lining or separation of adhesions, then it is called operative hysteroscopy. In many cases, both procedures are done concurrently – the so-called “see and treat” approach.

Reasons for the procedure

  • Evaluation and treatment of abnormal uterine bleeding.
  • To look for the displaced and removal of the intrauterine device (IUD).
  • Evaluation for infertility (difficulty in conceiving) or recurrent miscarriage.
  • Uterine polyps, fibroids or adhesions (which is called Ashermann’s syndrome).
  • Obstructed fallopian tubes.
  • Congenital malformations of the uterus

Read moreHysteroscopy (diagnostic and operative)

Anaesthesia and Analgesia in Obstetrics and Gynaecology

Dr. William Morton demonstrated the first public administration of ether anaesthesia in the operating theatre of the Massachusetts General Hospital on the 16th October 1846
That day is remembered as a milestone in anaesthesia and celebrated as World Anaesthesia Day.
From that date onward, many progresses have been made in the field of anaesthesia, and more so specifically for the practice of obstetrics and gynaecology.

On the 16th August 1897, a German surgeon by the name of Dr. August Bier administered the first spinal anaesthetic. Spinal anaesthesia becomes one of the most popular methods of administering a patient pain free from surgery of the lower limbs, lower abdomen and Caesarean sections and is still widely used.

Read moreAnaesthesia and Analgesia in Obstetrics and Gynaecology

Suction evacuation for miscarriage

Suction & evacuation is a technique of emptying the uterus of a pregnancy. It can be used to terminate a pregnancy or to remove a fetus that has died. It involves the removal of a fetus and accompanying tissue of the pregnancy from the uterus with instrumental evacuation through the vagina and is usually performed in the first trimester of pregnancy.

Reasons for procedure

Read moreSuction evacuation for miscarriage