Gynaecology | Master Of Medicine

Category Archives: Gynaecology

Fetal Biophysical profile.

Fetal biophysical profile is also known as Mannings score.

BPP is used to check fetal fetal well-being.

Components of BPP

  1. Non Stress test(NST)
  2. Amniotic fluid index(AFI)
  3. Fetal breathing movements
  4. Fetal tone
  5. Fetal gross body movements

Winslow Scoring test/Modified BPP

Modified BPP has only two components of BPP.

  1. NST
  2. AFI


Types of pelvis

Gynaecoid-True female pelvis(post sagittal diam slightly shorter than ant sagittal diam)

Android-Post sagittal diameter at inlet much shorter than ant sagittal diameter, no space for head of fetus



Staging of Ca Cervix,Ca endometrium, Ca Ovary

Carcinoma Cervix

The TNM staging system for cervical cancer is analogous to the FIGO stage.

  • Stage 0 – full-thickness involvement of the epithelium without invasion into the stroma (carcinoma in situ)
  • Stage I – limited to the cervix
    • IA – diagnosed only by microscopy; no visible lesions
      • IA1 – stromal invasion less than 3 mm in depth and 7 mm or less in horizontal spread
      • IA2 – stromal invasion between 3 and 5 mm with horizontal spread of 7 mm or less
    • IB – visible lesion or a microscopic lesion with more than 5 mm of depth or horizontal spread of more than 7 mm
      • IB1 – visible lesion 4 cm or less in greatest dimension
      • IB2 – visible lesion more than 4 cm
  • Stage II – invades beyond cervix
    • IIA – without parametrial invasion, but involve upper 2/3 of vagina
    • IIB – with parametrial invasion
  • Stage III – extends to pelvic wall or lower third of the vagina
    • IIIA – involves lower third of vagina
    • IIIB – extends to pelvic wall and/or causes hydronephrosis or non-functioning kidney

    Stage IV-Distant spread

  • IVA – invades mucosa of bladder or rectum and/or extends beyond true pelvis
  • IVB – distant metastasis

Key Points:4stages, each having two subdivisions A and B.No mention of LN status,Ascites.


Tumour <5mm-Conization(to preserve fertility)or hysterectomy

Invasive lesions not extending to abdominal viscera or distal vagina-Hysterectomy+Chemotherapy+Radiotherapy

Recurrent disease- Radiotherapy.

Carcinoma Endometrium.

Stage I-Tumour limited to uterine corpus

  • Stage IA: tumor limited to the endometrium
  • Stage IB: invasion of less than half the myometrium
  • Stage IC: invasion of more than half the myometrium

Stage II-Tumour confined to uterus and cervix

  • Stage IIA: endocervical glandular involvement only
  • Stage IIB: cervical stromal invasion

Stage III-Local spread confined to the pelvis

  • Stage IIIA: tumor invades serosa or adnexa, or malignant peritoneal cytology
  • Stage IIIB: vaginal metastasis
  • Stage IIIC: metastasis to pelvic or para-aortic lymph nodes

Stage IV-Distant spread/organ invasion

  • Stage IVA: invasion of the bladder or bowel
  • Stage IVB: distant metastasis, including intraabdominal or inguinal lymph nodes

Key Points:4 stages Stage I and III has 3 subdivisions A,B,C.LN spread mentioned only in STAGE III AND IV

FIGO staging of Ca endometrium

  • IA Tumor confined to the uterus, no or < ½ myometrial invasion
  • IB Tumor confined to the uterus, > ½ myometrial invasion
  • II Cervical stromal invasion, but not beyond uterus
  • IIIA Tumor invades serosa or adnexa
  • IIIB Vaginal and/or parametrial involvement
  • IIIC1 Pelvic node involvement
  • IIIC2 Para-aortic involvement
  • IVA Tumor invasion bladder and/or bowel mucosa
  • IVB Distant metastases including abdominal metastases and/or inguinal lymph nodes


Stage I and II-TAH+BSO,stage II may also need adjuvant radiotherapy.

Stage III and IV-TAH+BSO+postoperative radiotherapy

Carcinoma Ovary

  • Stage I – limited to one or both ovaries
    • IA – involves one ovary; capsule intact; no tumor on ovarian surface; no malignant cells in ascites or peritoneal washings
    • IB – involves both ovaries; capsule intact; no tumor on ovarian surface; negative washings
    • IC – tumor limited to ovaries with any of the following: capsule ruptured, tumor on ovarian surface, positive washings
  • Stage II – pelvic extension or implants
    • IIA – extension or implants onto uterus or fallopian tube; negative washings
    • IIB – extension or implants onto other pelvic structures; negative washings
    • IIC – pelvic extension or implants with positive peritoneal washings
  • Stage III – microscopic peritoneal implants outside of the pelvis; or limited to the pelvis with extension to the small bowel or omentum
    • IIIA – microscopic peritoneal metastases beyond pelvis
    • IIIB – macroscopic peritoneal metastases beyond pelvis less than 2 cm in size
    • IIIC – peritoneal metastases beyond pelvis > 2 cm or lymph node metastases
  • Stage IV – distant metastases to the liver or outside the peritoneal cavity

Para-aortic lymph node metastases are considered regional lymph nodes (Stage IIIC).

Key Points:4 stages, First 3 stages have subdivisions A,B,C.IVth stage has no sudivisions.

The ovarian cancer stages are made up by combining the TNM categories in the following manner:

  • Stage I: T1+N0+M0
    • IA: T1a+N0+M0
    • IB: T1b+N0+M0
    • IC: T1c+N0+M0
  • Stage II: T2+N0+M0
    • IIa: T2a+N0+M0
    • IIB: T2b+N0+M0
    • IIC: T2c+N0+M0
  • Stage III: T3+ N0+M0
    • IIIA: T3a+ N0+M0
    • IIIB: T3b+ N0+M0
    • IIIC: T3c+ N0+M0 or Any T+N1+M0
  • Stage IV: Any T+ Any N+M1



Postoperative chemotherapy

Neoadjuvant chemo



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