Uterine Leiomyomas And Stenosis Of The Right Oviduct

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Case Study 15-1: Total Abdominal Hysterectomy With Bilateral Salpingo-Oophorectomy

M.T., a 60-year-old gravida 2, para 2, had spent 3 months under the care of her gynecologist for treatment of postmenopausal bleeding and cervical dysplasia. She had had several vaginal examinations with Pap smears, a uterine ultrasound, colposcopy with endocervical biopsies, and a D&C with cone biopsy. She wanted to take hormone therapy, but her doctor thought she was at too much risk with the abnormal cells on her cervix and the excessive bleeding.

She had a TAH & BSO under general anesthesia with no complications and an uneventful recovery. Her uterus had been prolapsed on abdominal examination, but there was no sign of malignancy or PID. The pathology report revealed several leiomyomas of the uterus and stenosis of the right oviduct. She was discharged on the second postoperative day with few activity restrictions.

Case Study 15-2: In Vitro Fertilization

C.A. had worked as a technologist in the IVF lab at University Medical Center for 4 years. Her department was the Advanced Reproductive Technology Program. Although her work was primarily in the laboratory, she followed up each patient through all five phases of the IVF and embryo transfer treatment cycle: follicular development, aspiration of the preovulatory follicles, sperm preparation, IVF, and embryo transfer. Her department does both GIFT (gamete intrafallopian transfer) and ZIFT (zygote in-trafallopian transfer) procedures.

While the female patient is in surgery having an ultrasound-guided transvaginal oocyte retrieval, C.A. examines the recently donated sperm for motility and quantity. She prepares to inoculate the sample into the cytoplasm of the ova as soon as she receives the cells from the OR. After inoculation, she places the sterile Petri dish with the fertilized oocytes into an incubator until they are ready to be introduced into the female patient.

Case Study 15-3: Cesarean Section Birth

A.Y., a gravida 2, para 1 at 39 weeks gestation, had been in active labor for several hours, fully effaced and dilated, yet unable to progress. She had had an uneventful pregnancy with good health, moderate weight gain, good fetal heart sounds, and no signs or symptoms of pregnancy-induced hypertension. X-ray pelvimetry revealed CPD with the fetus in right occiput posterior position. Changes in fetal heart rate indicated fetal distress. A.Y. was transported to the OR for emergency C-section under spinal anesthesia.

After being placed in the supine position, A.Y. had a urethral catheter inserted and her abdomen was prepped with antimicrobial solution. After draping, a transverse suprapubic incision was made. Dissection was continued through the muscle layers to the uterus, with care not to nick the bladder. The uterus was incised through the lower segment, 2 cm from the bladder. The fetal head was gently elevated through the incision while the assistant put gentle pressure on the fundus. The baby's mouth and nose were suctioned with a bulb syringe, and the umbilical cord was clamped and cut. The baby was handed off to an attending pediatrician and OB nurse and placed in a radiant neonate warmer bed. The Apgar score was 9/9. The placenta was gently delivered from the uterus, and the scrub nurse checked for three vessels and filled two sterile test tubes with cord blood for lab analysis. A.Y. was given an injection of Pitocin to stimulate uterine contraction. The uterus and abdomen were closed, and A.Y. was transported to the PACU (postanesthesia care unit).

Case Studies, continued

CASE STUDY QUESTIONS

Multiple choice: Select the best answer and write the letter of your choice to the left of each number.

a. she has four children from two pregnancies b. she has had two pregnancies and two births c. she has had four pregnancies and two births d. she has had two pregnancies and two sets of twins e. she has one set of twins

_ 2. An endocervical biopsy is:

a. a tissue sample from the cul-de-sac b. a cone-shaped tissue sample from the uterine fundus c. a tissue sample from within the neck d. a tissue sample from the lining of the cervix e. a scraping of tissue cells from the vaginal wall

a. suturing b. scraping c. cutting d. examination e. incision

_ 4. A colposcopy is an endoscopic examination of the:

a. vagina b. fundus c. intraperitoneal pelvic floor d. pouch of Douglas e. uterus and fallopian tubes

a. ectopic pregnancy b. uterine fibroid c. myoma d. a and b e. b and c

_ 6. Pregnancy-induced hypertension is also called:

a. tubal pregnancy b. congenital mutation c. ectopic pregnancy d. pre-eclampsia e. placenta previa

Case Studies, continued

_ 7. The occiput of the fetus is the:

a. forehead b. foot c. back of the head d. chin e. shoulder

_ 8. Pitocin is the trade name for:

a. progesterone b. estrogen c. chorionic gonadotropin d. FSH

e. oxytocin

Write a term from the case studies with each of the following meanings: 9. displaced _

10. cell produced by fertilization _

11. measurement of the pelvis _

12. upper rounded portion of the uterus _

13. method for rating a newborn's physical condition _

14. afterbirth _

Define each of the following abbreviations:

15.

D&C

16.

BSO

17.

PID

18.

HRT

19.

IVF

20.

CPD

21.

OB

22.

GYN

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A Beginner's Guide to Healthy Pregnancy. If you suspect, or know, that you are pregnant, we ho pe you have already visited your doctor. Presuming that you have confirmed your suspicions and that this is your first child, or that you wish to take better care of yourself d uring pregnancy than you did during your other pregnancies; you have come to the right place.

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