Introduction:

Sexual reproduction is the union of the nuclei of the female sex cell (ovum) and the male sex cell (sperm) that results in the creation of a new individual. The ovum and sperm cell are specialized cells differing primarily from normal body cells in one important way. Each sex cell (also called a gamete) contains exactly half the number of chromosomes that a normal body cell contains. When the nuclei of ovum and sperm cell unite, the cell produced receives half of its genetic material from its female parent and half from its male parent; thus it contains a full, normal complement of hereditary material.

Gametes are produced in special organs called gonads in both males and females. The female gonads are the ovaries, and the male gonads are the testes. An ovum, after leaving the ovary, travels down a duct (fallopian tube) leading to the uterus (womb). If coitus (copulation, sexual intercourse) has occurred, and sperm cells are present in the fallopian tube, union of the ovum and sperm may take place. The union is called fertilization. The embryo (called the fetus after the 2nd month) then begins a 40-week (approximately 9-month) period of development (gestation, pregnancy) within the uterus.

The female reproductive system consists of organs that produce ova and provide a place for the growth of the embryo. In addition, the female reproductive organs supply important hormones that contribute to the development of female secondary sex characteristics (body hair, breast development, structural changes in bones and fat).

Ova mature and are released from the ovary from the onset of puberty (beginning of the fertile period when secondary sex characteristics develop) to menopause (cessation of fertility and diminishing of hormone production). Women are born with all the eggs that they will possibly release. However, it is not until the onset of puberty that the eggs mature and leave the ovary. If fertilization occurs at any time during the years between puberty and menopause the fertilized egg may grow and develop within the uterus. Various hormones are secreted from the ovary and from a blood-vessel-filled organ (placenta) that grows in the wall of the uterus during pregnancy. If fertilization does not occur, hormone changes result in the shedding of the uterine lining, and bleeding, or menstruation, occurs.

The names of the hormones of the ovaries that play important roles in the processes of menstruation and pregnancy, and in the development of secondary sex characteristics, are estrogen and progesterone. Other hormones that govern the functions of the ovaries, breasts, and uterus are secreted by the pituitary gland, which is located behind the bridge of the nose at the base of the brain.

Gynecology is the study of the female reproductive system (organs, hormones, and diseases); obstetrics (obstetrics means midwife) is a specialty concerned with pregnancy and the delivery of the fetus; and neonatology is the study and treatment of the newborn child.

Organs of the Female Reproductive System

Uterus, Ovaries, and Associated Organs

The ovaries are a pair of small, almond-shaped organs located in the lower abdomen. The fallopian tubes lead from each ovary to the uterus, which is a muscular organ situated between the urinary bladder and the rectum. The uterus is normally in a bent-forward position and about 3 inches in length in a nonpregnant woman. Midway between the uterus and the rectum is a region in the abdominal cavity known as the cul-de-sac. This region is often examined for the presence of cancerous growths.

The vagina is a tube extending from the uterus to the exterior of the body. Bartholin glands are two small, rounded glands on either side of the vaginal orifice. These glands produce a mucous secretion that lubricates the vagina. The clitoris is an organ of sensitive, erectile tissue located anterior to the vaginal orifice and in front of the urethral meatus. The clitoris is similar in structure to the penis in the male.


The region between the vaginal orifice and the anus is called the perineum. The perineum can be torn in childbirth and cause injury to the anus. To avoid a perineal tear, the obstetrician often cuts the perineum posteriorly before delivery. This incision is called an episiotomy. The perineum is then sewn together (repaired) after childbirth.

The external genitalia (organs of reproduction) of the female are collectively called the vulva. The labia majora are the outer lips of the vagina, and the labia minora are the smaller, inner lips. The hymen is a mucous membrane that normally partially covers the entrance to the vagina. The clitoris and Bartholin glands are also parts of the vulva. Each ovary is held in place on either side of the uterus by a utero-ovarian ligament.

Within each ovary are thousands of small sacs called graafian follicles. Each graafian follicle contains an ovum. When an ovum is mature, the graafian follicle ruptures to the surface and the ovum leaves the ovary. The release of the ovum from the ovary is called ovulation. The ruptured follicle fills first with blood, and then with a yellow, fat-like material. It is then called the corpus luteum (meaning yellow body).

Near each ovary is a duct, about 5-1/2 inches long, called a fallopian tube. Collectively, the fallopian tubes, ovaries, and supporting ligaments are called the adnexa (accessory structures) of the uterus. The egg, after its release from the ovary, is caught up by the finger-like ends of the fallopian tube. These ends are called fimbriae. The tube itself is lined with small hairs that, through their motion, sweep the ovum along. It usually takes the ovum about 5 days to pass through the fallopian tube.

It is within the fallopian tube that fertilization takes place if any sperm cells are present. If coitus takes place near the time of ovulation and no contraception is used, there is a high likelihood that sperm cells will be in the fallopian tube when the egg cell is passing through it. If coitus has not taken place, the ovum remains unfertilized and, after a day or two, disintegrates.

The fallopian tubes, one on either side, lead into the uterus, a pear-shaped organ with muscular walls and a mucous membrane lining filled with a rich supply of blood vessels. The rounded upper portion of the uterus is the fundus, and the larger, central section is the corpus (body of the organ). The specialized epithelial mucosa of the uterus is the endometrium; the middle, muscular layer is the myometrium, and the outer, membranous tissue layer is the uterine serosa. A serosa is the outermost coat or layer of an organ that is in the abdomen or thorax. The narrow, lower portion of the uterus is the cervix (meaning neck). The cervical opening leads into a 3-inch-long tube called the vagina, which opens to the outside of the body.

The Breast (Accessory Organ of Reproduction): The breasts are two mammary glands located in the upper anterior region of the chest. They are composed of glandular tissue, containing milk glands, which develop in response to hormones from the ovaries during puberty. The breasts also contain fibrous and fatty tissue, special lactiferous (milk-carrying) ducts, and sinuses (cavities) that carry milk to the opening or nipple. The breast nipple is called the mammary papilla, and the dark-pigmented area around the mammary papilla is called the areola.


During pregnancy, the hormones from the ovaries and the placenta stimulate glandular tissues in the breasts to their full development. After parturition (giving birth), hormones from the pituitary gland stimulate the production of milk (lactation).

Menstruation and Pregnancy

Menstrual Cycle

The beginning of menstruation at the time of puberty is called menarche. Each menstrual cycle is divided into 28 days. These days can be grouped into four time periods, which are useful in describing the events of the cycle. The approximate time periods are:

Days 1-5 (menstrual period): These are the days during which bloody fluid containing disintegrated endometrial cells, glandular secretions, and blood cells is discharged through the vagina.

Days 6-12: After the menstrual period ends, the endometrium begins to repair itself as the hormone estrogen is released by the maturing graafian follicle in the ovaries. This is also the period of the growth of the ovum in the graafian follicle.

Days 13-14 (ovulatory period): On about the 14th day of the cycle, the graafian follicle ruptures (ovulation) and the egg leaves the ovary to travel slowly down the fallopian tube.

Days 15-28: The empty graafian follicle fills with a yellow material and becomes known as the corpus luteum. The corpus luteum functions as an endocrine organ and secretes two hormones, estrogen and progesterone, into the bloodstream. These hormones stimulate the building up of the lining of the uterus in anticipation of fertilization of the egg and pregnancy.

If fertilization does not occur, the corpus luteum in the ovary stops producing progesterone and estrogen and regresses. At this time, owing to the lowered levels of progesterone and estrogen, some women have symptoms of depression, breast tenderness, and irritability prior to menstruation. These symptoms are known as premenstrual syndrome (PMS). About 5 days after the fall in hormones, the uterine endometrium breaks down and the menstrual period begins (days 1-5).
Pregnancy

If fertilization does occur in the uterine tube, the fertilized egg travels to the uterus and implants in the uterine endometrium. The corpus luteum in the ovary continues to produce progesterone and estrogen, which support the vascular and muscular development of the uterine lining.

The placenta, a vascular organ, now forms within the uterine wall. The placenta is derived from maternal endometrium and from the chorion, the outermost membrane that surrounds the developing embryo. The amnion is the innermost of the embryonic membranes, and it holds the fetus suspended in an amniotic cavity surrounded by a fluid called the amniotic fluid. The amnion and fluid are sometimes known as the “bag of water,” which usually ruptures (breaks) during labor.

The maternal blood and the fetal blood never mix during pregnancy, but important nutrients, oxygen, and wastes are exchanged as the blood vessels of the baby (coming from the umbilical cord) lie side by side with the mother’s blood vessels in the placenta. Embryo has two enveloping membranes–chorion and amnion.

The placenta produces its own hormone as it develops in the uterus. This placental hormone is called human chorionic gonadotropin (HCG). HCG is the hormone tested for in the urine of women who suspect that they are pregnant. HCG stimulates the corpus luteum to continue producing hormones until about the 3rd month of pregnancy, when the placenta itself takes over the endocrine function and releases estrogen and progesterone. Progesterone maintains the development of the placenta. Low levels of progesterone can lead to spontaneous abortion in pregnant women and menstrual irregularities in nonpregnant women.

The uterus normally lies in the pelvis. During pregnancy, the uterus expands as the fetus grows, and the superior part rises out of the pelvic cavity. By about 28–30 weeks, it occupies a large part of the abdominopelvic cavity and reaches the epigastric region.

The onset of true labor is marked by rhythmic contractions, dilation of the cervix, and a discharge of bloody mucus from the cervix and vagina (“show”). In a normal delivery position, the head appears first (cephalic presentation) and helps to dilate the cervix. After the baby is delivered, the umbilical cord is expelled and cut. The expelled placenta is known as the afterbirth.

Hormonal Interactions

The events of menstruation and pregnancy are dependent not only upon hormones from the ovaries (estrogen and progesterone) but also on hormones from the pituitary gland. These pituitary gland hormones are follicle-stimulating hormone (FSH) and luteinizing hormone (LH). After the onset of menstruation, the pituitary gland begins to secrete FSH and LH, so that their levels rise in the bloodstream. FSH and LH stimulate the maturation of the ovum and ovulation. After ovulation, LH in particular influences the maintenance of the corpus luteum and its production of estrogen and progesterone.

During pregnancy, the high levels of estrogen and progesterone affect the pituitary gland itself by shutting off its production of FSH and LH. This means that while a woman is pregnant, additional eggs do not mature and ovulation cannot occur. This hormonal interaction wherein a high level of hormones (estrogen and progesterone) acts to shut off the production of another set of hormones (FSH and LH) is called the negative feedback. Negative feedback is the principle behind the action of birth control pills. The pills contain varying amounts of estrogen and progesterone. As they are taken, the level of hormones rises in the blood. Negative feedback occurs, and the pituitary does not release FSH or LH. Without FSH or LH, ovulation cannot occur and a woman does not become pregnant. Currently, subdermal implants containing estrogen and progesterone can be effective for up to 5 years. The most common device is called Norplant.

Other female contraceptive measures include the IUD (intrauterine device) and the diaphragm. The IUD is a small coil placed inside the uterus by a physician. It prevents implantation of the fertilized egg in the uterine lining. Use of the IUD carries risks including ectopic uterine pregnancy, infection, uterine perforation, and severely increased and painful menstrual flow. The diaphragm is a rubber, cup-shaped device inserted, before coitus, on the outside of the cervix to prevent the entrance of sperm into the uterus.

When the secretion of estrogen from the ovaries lessens and fewer egg cells are produced, menopause begins. Menopause is the gradual ending of the menstrual cycle and is a natural process resulting from the normal aging of the ovaries. Other names for menopause are change of life and climacteric. Premature menopause occurs before age 35, whereas delayed menopause occurs after age 58. Artificial menopause can occur if the ovaries are removed by surgery or made nonfunctional by radiation therapy or some types of chemotherapy.

During menopause, when estrogen levels fall, many women experience hot flashes (the temperature regulation mechanism in the brain is disturbed) and vaginal atrophy (the lining of the vagina dries and thins, predisposing it to irritation and discomfort during sexual intercourse). Estrogen replacement therapy (ERT), given orally or as a transdermal patch, is sometimes used to relieve uncomfortable symptoms of menopause, and when combined with progesterone in low doses, it is believed to protect a woman from uterine cancer, the development of porous bones (osteoporosis), and heart disease. ERT has been associated with an increased risk of breast cancer in younger women who take it for longer periods.

Pathology: Gynecological / Breasts, Pregnancy, Neonatal

Gynecological and Breast

Uterus

carcinoma of the cervix – Malignant cells within the cervix (cervical cancer). Cervical carcinoma is more common in women who have sexual intercourse at an early age, multiple sexual partners, a history of sexually transmitted diseases, and evidence of an HPV (human papilloma virus) infection. Early neoplastic changes in the cervix vary from dysplasia (abnormal cell growth) to carcinoma in situ (CIS) (localized cancer growth). Preinvasive neoplastic lesions (dysplasia and carcinoma in situ) are also called CIN (cervical intraepithelial neoplasia) and are graded from I to III as viewed on a Pap smear (microscopic examination of cells scraped off the cervical epithelium). Pap smears give important diagnostic information because CIN may be curable with resection. Further biopsy and resection (conization) may be necessary to diagnose and treat CIS. Surgery (hysterectomy) or radiation therapy (irradiation) or both are used to treat more extensive and metastatic disease.

cervicitis – Inflammation of the cervix. This condition can become chronic because the lining of the cervix is not renewed each month as is the uterine lining during menstruation.

Common pathogens infecting the cervix are bacterial (Chlamydia trachomatis and Neisseria gonorrhoeae), but many infections are nonspecific and the pathogenesis is not understood. Acute cervicitis is marked by cervical erosions, or ulcers, which appear as raw, red patches on the cervical mucosa. Leukorrhea (clear, white, or yellow pus-filled vaginal discharge) is also a symptom of cervical erosion.

After excluding the presence of malignancy (by Pap smear or biopsy), cryocauterization (destroying tissue by freezing) of the eroded area and treatment with antibiotics may be indicated.

carcinoma of the endometrium (endometrial cancer) – malignant tumor of the uterus (inner lining). The major symptom of adenocarcinoma of the uterus (endometrial cells lining the uterine cavity) is postmenopausal bleeding. Endometrial cancer is more common in women who are exposed to high levels of estrogen from exogenous estrogen (pills), estrogen-producing tumors, or obesity (estrogen is produced by fat tissue) and in nulliparous women. Dilation (opening the cervical canal) and curettage (scarping the inner lining of the uterus) is the best method of diagnosing the disease. If the tumor is confined to the uterus, it is curable by surgery (hysterectomy). Radiation therapy is prescribed for patients with more advanced disease.

endometriosis – Endometrial tissue is found in abnormal locations, including the ovaries, fallopian tubes, supporting ligaments, or small intestine. Abnormal growth of endometrium can produce scar tissue, which causes dysmenorrhea, pelvic pain, infertility (inability to become pregnant), and dyspareunia. Most cases develop as a result of bits of menstrual endometrium that pass backward through the lumen (opening) of the fallopian tube and into the peritoneal cavity. Often, when the ovaries are involved, large blood-filled cysts, called chocolate cysts, may develop. Treatment ranges from symptomatic relief of pain and drugs that suppress the menstrual cycle to surgical removal of ectopic endometrial tissue and hysterectomy.

fibroids – Benign tumors in the uterus. Fibroids, also called leiomyomata or leiomyomas (lei/o = smooth, my/o = muscle, and –oma = tumor), are composed of fibrous tissue and muscle. If fibroids grow too large and cause symptoms such as metrorrhagia, pelvic pain, or menorrhagia, hysterectomy is indicated.

Ovaries

ovarian carcinoma – Malignant tumor of the ovary (adenocarcinoma). Carcinomas of the ovary account for more deaths than those of cancers of the cervix or the uterus together. The tumor, which may be cystic or solid in consistency, is usually discovered in an advanced stage as an abdominal mass and may produce few symptoms in its early stages. In most patients, the disease metastasizes within or beyond the pelvic region before diagnosis. Surgery (oophorectomy and salpingectomy), radiotherapy, and more important, chemotherapy are used as therapeutic measures.

ovarian cysts – Collections of fluid within a sac (cyst) in the ovary. Some cysts are lined by cells that are typical, normal lining cells of the ovary. These cysts originate in unruptured graafian follicles (follicle cysts) or in follicles that have ruptured and have immediately been sealed (luteal cysts). Other cysts may be lined with tumor cells (cystadenomas and cystadenocarcinomas). Occasionally it is necessary to remove these cysts to distinguish between benign and malignant tumors.

Dermoid cysts are lined with a variety of cell types, including skin, hair, teeth, and cartilage, and arise from immature egg cells in the ovary. They are often called benign cystic teratomas (terat/o = monster) because of the strange assortment of tissue in the tumor. Surgery to remove a dermoid cyst is curative.

Fallopian Tubes

pelvic inflammatory disease (PID) – Inflammation in the pelvic region; salpingitis. The leading causes of PID are gonorrhea and chlamydial infection. They often occur at the same time, and repetitive episodes of these infections can lead to adhesions and scarring within the fallopian tubes. Women have an increased risk of ectopic pregnancies and difficulty getting pregnant after PID. Symptoms are vaginal discharge, pain in the abdomen (LLQ and RLQ), fever, and tenderness on palpation (examining by touch) of the cervix. An intrauterine device is the most common iatrogenic cause of PID. Antibiotics are used as treatment.

Breast

carcinoma of the breast – Malignant tumor of the breast (arising from milk glands and ducts). This tumor first spreads to the lymph nodes located in the axilla (armpit) adjacent to the affected breast and then to the skin and chest wall. From the lymph nodes it may spread to any of the other body organs, including bone, liver, lung, or brain. The tumor is usually removed for purposes of diagnosis and as a primary means of treatment.

There are two objectives in the surgical treatment of breast cancer: first, to remove the tumor; and second, to sample the axillary lymph nodes to determine whether the tumor has spread beyond the breast. Various operations may be performed to accomplish these objectives. For small primary tumors the lump may be removed (lumpectomy), with the remainder of the breast left intact. This operation is usually followed by radiotherapy to the breast to kill remaining tumor cells. Alternatively, the surgeon may remove the entire breast (simple or total mastectomy). With either of these operations a separate incision is made to remove axillary lymph nodes to determine whether spread beyond the breast has taken place. Another surgical procedure is removal of the breast, lymph nodes, and some adjacent chest wall muscles (pectorals) in a single procedure called a modified radical mastectomy. If additional tumor is found in the axillary lymph nodes, the patient can then be treated with drugs (adjuvant chemotherapy) to prevent recurrence, and cure is possible.

After mastectomy, a plastic surgical procedure called a trans-rectus abdominis musculocutaneous flap (TRAM flap) may be performed to reconstruct the breast. A muscle from the lower abdomen is tunneled under the abdominal and thoracic wall to its new location at the mastectomy scar. Most surgeons perform the nipple reconstruction at a later time.

It is also important to test the breast cancer tumor for the presence of estrogen receptors. These receptors are proteins that indicate that the tumor will respond to hormone therapy. If metastases should subsequently develop, this information will be valuable in selecting further treatment. SERMs are selective estrogen receptor modulators, a class of drugs that functions like estrogen in some tissues, but blocks estrogen’s effect in others. The best known is tamoxifen. It blocks the potentially harmful action of estrogen in the breast (especially in women with estrogen receptor positive tumors), but preserves estrogen’s benefits for bone maintenance and cardiovascular effects. Unfortunately, it retains estrogen’s tendency to promote endometrial cancer. Another SERM, raloxifene, appears to have similar benefits but less risk of promoting uterine cancer.

fibrocystic disease – Small sacs of tissue and fluid in the breast. This is a common benign condition of the breast. The patient notices a nodular (lumpy) consistency of the breast, often associated with premenstrual tenderness and fullness. Mammography and then surgical biopsy may be indicated to differentiate fibrocystic changes from carcinoma of the breast.

Pregnancy

abruptio placentae – Premature separation of the implanted placenta. Abruptio means a breaking or tearing away from, and placentae means of the placenta. This can occur secondary to trauma, such as a fall, seat belt injury, or assault or because of vascular insufficiency resulting from hypertension, cocaine use, or preeclampsia. Symptoms of abruptio placentae include a sudden searing (burning) abdominal pain and bleeding. This is an obstetrical emergency.

choriocarcinoma – Malignant tumor of the pregnant uterus. The tumor may appear following pregnancy or abortion. Cure is possible with surgery and chemotherapy.

ectopic pregnancy – Implantation of the fertilized egg in any site other than the normal uterine location. The condition occurs in up to 1 percent of pregnancies, and 90 percent of these occur in the oviducts (tubal pregnancy). Rupture of the ectopic pregnancy within the fallopian tube can lead to massive hematosalpinx. Surgery is indicated to remove the implant and preserve the fallopian tube before rupture occurs. Other sites of ectopic pregnancies include the ovaries and abdominal cavity, and all are surgical emergencies.

placenta previa – Placental implantation over the cervical os (opening) or in the lower region of the uterine wall. This condition can result in less oxygen supply to the fetus and increased risk of hemorrhage and infection for the mother. Maternal symptoms include painless bleeding, hemorrhage, and premature labor. Cesarean delivery is usually recommended.

preeclampsia – A condition that occurs during pregnancy or shortly after and is marked by high blood pressure, proteinuria, and edema. If seizures occur, the condition is known as eclampsia or toxemia. Mild preeclampsia can be managed by bed rest, but the more serious form of the illness is often more difficult to treat, and women are placed on medications such as magnesium sulfate and Dilantin to prevent seizures while in labor.

Neonatal

The following terms describe a few of the conditions or symptoms that may affect the newborn. The Apgar score is a system of scoring an infant’s physical condition 1 and 5 minutes after birth. Heart rate, respiration, color, and muscle tone, and response to stimuli are rated 0, 1, or 2. The maximum total score is 10. Infants with low Apgar scores require prompt medical attention.

Down syndrome – Chromosomal abnormality (trisomy-21) results in mental retardation, retarded growth, a flat face with a short nose, low-set ears, and slanted eyes.

erythroblastosis fetalis – Hemolytic disease in the newborn caused by a blood group (Rh factor) incompatibility between the mother and the fetus.

hyaline membrane disease – Respiratory problem primarily in the premature neonate; lack of protein in the lining of the lung tissue causes collapse of the lungs. This condition is also known as respiratory distress syndrome. Hyaline refers to the shiny (hyaline means glassy) membrane that forms in the lung sacs.

hydrocephalus – Accumulation of fluid in the spaces of the brain. In an infant, the entire head can enlarge because of bones of the skull are never completely fused together at birth. The soft spot, normally present between the cranial bones of the fetus, is called a fontanelle. Hydrocephalus occurs because of a problem in the circulation of fluid within the brain and spinal cord.

kernicterus – High levels of bilirubin in the bloodstream of a neonate; leads to brain damage and mental retardation. Kern- means nucleus, referring to a collection of nerve cells in the brain. Icterus means yellow color or jaundice.

Pyloric stenosis – Narrowing of the opening of the stomach to the duodenum. Surgical repair of the pyloric opening may be necessary.

Clinical Tests, Procedures, and Abbreviations

Clinical Tests

Pap smear – The physician, after inserting a vaginal speculum (instrument to hold apart the vaginal walls), uses a wooden spatula and a cotton swab to take secretions from the cervix and vagina. Microscopic analysis of the cell smear (spread on a glass slide) can detect the presence of cervical or vaginal carcinoma.

pregnancy test – Blood or urine test to detect the presence of HCG.

Procedures

X-Rays

hysterosalpingography – Contrast material is injected into the uterus and fallopian tubes, and x-rays are taken. X-rays are taken of the breast. It is recommended that women have a baseline mammogram around the age of 50 for later comparisons if needed. Every 1 or 2 years a mammogram is recommended for women over the age of 50 to screen for breast cancer.

Ultrasound

pelvic ultrasonography – A record of sound waves as they bounce off organs in the pelvic region. This technique can evaluate fetal size, maturity, and organ development as well as fetal and placental position. Uterine tumors and other pelvic masses, including abscesses, can also be diagnosed by ultrasonography. Transvaginal ultrasound allows the radiologist a closer, sharper look at normal and pathological structures within the pelvis. The sound probe is placed in the vagina instead of across the pelvis or abdomen.

Gynecological Procedures

aspiration – Fluid is withdrawn by suction from a cavity or sac with a needle. Aspiration biopsy is a valuable technique for the evaluation of a patient with breast disease.

cauterization – Destruction of abnormal tissue with chemicals (sliver nitrate) or an electrically heated instrument. It is used to treat cervical dysplasia or cervical erosion. LEEP is a loop electrocautery excision procedure to biopsy abnormal cervical tissue.

colposcopy – Visual examination of the vagina and cervix using a colposcope (a lighted, magnifying instrument resembling a small, mounted pair of binoculars). This procedure is more accurate than a Pap smear because it can identify the specific areas in which abnormal cells are located. A biopsy then can be taken from those areas for accurate diagnosis.

conization – Removal of a cone-shaped section of the cervix for biopsy (diagnosis). The cone is cut out with a cold knife (blade) or laser (a device that produces a very thin beam of light in which high energies are concentrated) so as not to distort the tissue for histological examination.

cryosurgery – Use of cold (cry/o means cold) temperatures to destroy tissue. The freezing temperature is produced by a probe containing liquid nitrogen. Also called cryocauterization.

culdocentesis – needle aspiration (through the vagina) of fluid from the cul-de-sac. Presence of blood may indicate a ruptured ectopic pregnancy.

dilation (dilatation) and curettage (D&C) – Dilation (widening) of the cervical opening is accomplished by inserting a series of probes of increasing size, Curettage (scraping) is then performed using a curette (a metal loop at the end of a long, thin handle) to remove the lining of the uterus. This procedure is performed to diagnose uterine disease (obtaining tissue for microscopic examination) or to stop prolonged or heavy uterine bleeding. It is also used for the purpose of terminating a pregnancy or emptying the contents of the uterus.

exenteration – Removal of internal organs. Pelvic exenteration is the removal of the uterus, ovaries, fallopian tubes, vagina, bladder, rectum, and lymph nodes.

laparoscopy – Visual examination of the abdominal cavity by making a small incision near a woman’s navel and introducing a laparoscope (a thin tube containing a viewing instrument and light). The procedure is performed for diagnosis of disease or for tubal ligation.

tubal ligation – Blocking of the fallopian tubes by burning or cutting them and tying them off. This sterilization (making an individual incapable of reproduction) technique involves making a small incision into the abdomen and inserting a laparoscope through which the instrument to block the tubes can be introduced.

Procedures During Pregnancy

abortion – Premature termination of pregnancy before the embryo or fetus is able to exist on its own. Major methods for abortion are vaginal evacuation by D&C or vacuum aspiration (suction) and stimulation of uterine contractions by injecting saline (salt) into the amniotic cavity (second trimester).

amniocentesis – Surgical puncture (transabdominal) of the amniotic sac to withdraw amniotic fluid for analysis. The cells of the fetus, found in the fluid, are cultured (grown), and cytological and biochemical studies are made.

cesarean section – Removal of the fetus by abdominal incision into the uterus (hysterotomy). Indications for cesarean section are cephalopelvic disproportion, hemorrhage from abruptio placentae or placenta previa, fetal distress (fetal hypoxia), and breech or shoulder presentation. The procedure takes its name from the Latin word caedere, to cut.

chorionic villus sampling – Transcervical sampling of chorionic villi (placental tissue) for prenatal diagnosis at 9-12 weeks of gestation. Fetal tissue is aspirated under ultrasound guidance.

fetal monitoring — Use of ultrasonography and electrocardiography to record the fetal heart rate (FHR) during labor.

pelvimetry – Measurement of the dimensions of the mother’s pelvis to determine its capacity to allow passage of the fetus through the birth canal. Usually this is a part of the prenatal examination, but it is also of vital importance during protracted labor or with breech presentation.