Gynecological INVESTIGATIONS

Blood work   CBC : evaluation of abnormal uterine bleeding, preoperative investigation Beta-hCG investigation of ...

Blood work

 

1. CBC : evaluation of abnormal uterine bleeding, preoperative investigation
2. Beta-hCG
• investigation of possible pregnancy or ectopic pregnancy,
  work-up for GTN
• monitored after the medical management of ectopic and in GTN to assess for cure and recurrences
3. LH, FSH, TSH, PRL  : amenorrhea, menstrual irregularities, menopause, infertility, etc...

 

Imaging

 

Ultrasound

1. Transvaginal ultrasound provides enhanced details of structures located near the apex of the vagina; i.e. intrauterine and adnexal structures
2. may be used for
• acute or chronic pelvic pain
• rule in or out ectopic pregnancy, intrauterine pregnancy
• assess uterine, adnexal, ovarian masses (i.e. solid or cystic) uterine thickness
• follicle monitoring during assisted reproduction

 

Hysterosalpingography

1. an x-ray is taken after contrast is introduced through the cervix into the uterus
2. contrast flows through the tubes and into the peritoneal cavity if the tubes are patent
3. used for evaluation of size, shape, configuration of uterus, tubal patency or obstruction

 

Sonohystography

1. saline infusion into endometrial cavity under ultrasound visualization expands endometrium, allowing visualization of uterus and fallopian tubes
2. useful for investigation of abnormal uterine bleeding,uncertain endometrial findings on vaginal U/S, infertility,congenital/acquireduterine abnormalities (i.e. uterus  didelphys, uni/bicornate, arcuate uterus)
3. easily done, minimal cost, extremely well-tolerated, sensitive and specific
4. more accurate than hysterosalpingography and frequently avoids need for hysteroscopy
   

Genital Tract Biopsy

 

Vulvar biopsy

1. under local anesthetic
2. Keyeís biopsy or punch biopsy
3. hemostasis achieved with local pressure, Monsel solution or silver nitrate

 

Vaginal and cervical biopsy

1. punch biopsy or biopsy forceps
2. generally no anesthetic used
3. hemostasis with Monsel solution

 

Endometrial biopsy

1. in the office using an endometrial suction curette (Pipelle)
• hollow tube guided through the cervix used to aspirate fragments of endometrium (well-tolerated)
2. a more invasive procedure using cervical dilatation and curettage may be done in the office

Endometrial sampling using the pipelle instrument. A flexible hollow plastic tube is inserted and held in the uterine cavity as the stylet is withdrawn creating a vacuum and resulting in aspiration of tissue

 

Colposcopy

 

Diagnostic use

1. provides a magnified view of the surface structures of the
   vulva, vagina and cervix
2. special green filters allow better visualization of vessels
3. application of 1% acetic acid wash dehydrates cells and reveals white areas of increased nuclear density (abnormal) or areas with epithelial changes
4. biopsy of visible lesions or those revealed with the acetic acid wash allows early identification of dysplasia and neoplasia

 

Therapeutic use

1. cryotherapy
• tissue destruction by freezing
• for dysplastic changes, genital warts
2. laser
3. cervical conization
• encompasses the cervical transformation zone and
  into the endocervical canal
• methods include cold knife, laser excision, or electrocautery