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

Anthropoid-AP>TRANS

Platypelloid-Transv>AP

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.

Treatment

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

Treatment

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

Treatment

TAH+BSO+OMENTECTOMY

Postoperative chemotherapy

Neoadjuvant chemo

Radiotherapy

Immunotherapy.

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