Gynecology

METHODS OF DIAGNOSTICS

Ginecological ultrasonic examination

Ultrasonnic investigation (USI) is an irreplaceable method of  examination in the field of female diseases. Either abdominal (on stomach), or transvaginal (by uterine tract) ultrasounds are used for this puspose.

1 – Abdominal ultrasonic investigation

As vaginal method is not suitable in unmarried patients, their ultrasonic control is made only abdominally. For this purpose, a patient’s urinary bladder should be full. A full urinary bladder ensures that uterus and ovaries are seen exactly as an acoustic window.

2 – Transvaginal ultrasound investigation

During transvaginal ultrasound investigation a woman is required to empty her urinary bladder entirely. It enables to closely examine internal organs through uterine tract and obtained views are more precise. But problems existing in pelvis, big cysts may be seen insufficiently during vaginal ultrrasonic examination and in this situation, a patient may be examined through 2 methods of ultrasonic investigation.

Details obtainable during ginecological ultrasonic investigattion:

1 – Related with uterus and uterine tract:

– sizes and structure of uterus, whether its structure is unigenital or not, may be  identified;

– sizes and location of myomas, if any,  may be identified;

– endometrium (mucus membrane of uterus) may be evaluated, its thickness measured, polyp and polyp-like structures, if any, detected;

– inborn anomalies of uterus may be evaluated;

– a spiral observation inside uterus cavity, its position may be evaluated;

– Naboti cysts and other tumors existing in uterus neck may be taken off;

2 – Related with ovaries:

– size and structure of ovaries may be evaluated:

– sizes and structures of cysts and tumors in ovaries, peculiarities of liquid and solid parts inside them may be evaluated;

– blood flow peculiarities of cycts existing in ovaries, whether they are nonmalignant or malignant,  may be evaluated via Doppler ultrasonic examination;

– mature of ovulation time in childless patients may be evaluatd;

3 – Related with uterus pipes:

–  in diagnostics of ectopic pregnancy, especially a transvaginal ultrasonic examination is very valuable;

– presence of hydrosalpinx (tubes being full of fluid) may be identified;

– presence of pyosalpinx (tube being full of pus) may be identified.

4 – Related with pelvis:

– fluid and tumors in pelvis, i.e. in lower part of abdominal cavity where uterus and ovaries are situated (pelvic outlet), may be seen during ultrasonic examination;

– tumors developing from organs of pelvis (uterus, ovaries, intestine, tubes, urinary bladder) may be tracked.

COLPOSCOPY

Colposcopy – is an examination made by a colposcope. Colposcope – is a special device zooming in a view 15-30 times during control.  Special solutions (3% vinegary solution, Lugol solution) are used during control. These solutions are spread on uterus neck and impacts on squamous epithelium. Normal and pathologically changed cells react differently, thanks to which abnormal (pathological) areas are detected. Furthermore, cytology (PAP test) and biopcy from suspected areas may be carried out during the procedure.

PAP SMEAR AND HPV (papilloma) VIRUS DETECTION

HPV virus – is an infection which has over 100 types. Each type of HPV may cause generation of warts in genital, perineal areas of body, in hands, feet, mouth cavity. Some types of HPVinfections may cause uterus neck cancer. This virus is sexually transmitted. HPV infection is not felt according to absence of warts or other damages in a patient. Thus the patient’s symptoms may differ by type of HPV infection s/he is bearing.

Genital warts:  are germs of body/flesh (or pink) color and small in size, gathering of some warts together may be seen as a cauliflower. 6 and 11 types of HPV virus causes this.  These HPV types are absolutely connected with cancer. In women these warts may be frequently seen in vulva, around anus, inside uterine tract or uterus neck. Certain HPV types may give birth to more serious, atyical changes. These atypical cases appear mainly in PAP smear test.  Lower-degree atypical cases are resulted generally in normalizing of cells without need in treatment.  High-degree atypical cases are not inclined to a normal state and some of them may lead to cancer of uterus neck. Usually, 16 and 18 types of HPV infection results in this type of high-degree atypical cases. Abnormal vaginal bleedings (mainly, during sexual congresses) are signs for cancer of uterus neck.  Almost in most cases, cancers of  uterus neck are generated due to HPV virus.

In order to detect HPV virus in proper time, women need regularly undergo smear test. Smear test is the best way for detection of a HPV virus which may be changed ito cancer of uterus neck.

Risk factors:  abundance of sexual partners,  sexually active women under age of 20 (young women may be more sensible against the virus), women with weak imune system.

The following tets may be required for diagnosis of HPV infection:

Visual examination: warts or injuries are detected.
Vinegary solution test during wide colposcopy: a doctor administers a vinegary solution to uterine tract and consequently, areas infected in HPV turn white.
Smear test: during vaginal examination a doctor collects a cellular samples from uterus neck and sends to a laboratory for analysis.
DNT test: This test may detect altogether 13 high-risk HPV viruses including 16 and 18 types.
If the last PAP-Smear test results of a woman are normal and she is at age of over 30, then the doctor may require HPV DNT in addition to smear tests.  If every 2 tests are negative, then the woman should undergo further Smear+DNT tests 3 years later. If Smear test is negative, but DNT test is positive, then the doctor may desire to examine the patient at an earlier date.

HPV infection has no treatment.  In most cases, immune system may increase and warts disappear without treatment. For getting rid of warts sooner, there are some methods of treatment. These are directed towards reducting density of HPV, but are not able to eliminate the virus entirely, e.g. even though your genital warts have disappeared, the virus is still transmittable to your partner during sexual congress.  Treatment of genital warts includes their burning with trichloroacetic acid, cryotherapy, their burning with laser and radiowaves.

Diagnostic and surgical hysteroscopy

Hysteroscopy  –  is a method for examination of uterus neck. This is conducted by a device called hysteroscope. Hysteroscope enables to make diagnosis of and cure some diseases of uterus. The device consists of:  light and camera is passed through a light metallic pipe. A doctor dilates uterus neck and inserts the camera into the uterus neck. Then a view out of camera appears in the screen and the doctor can see everything there. Together with that pipe, necessary surgical tools are inserted as well. Hysteroscopy – is a small operation conducted under spinal or general anaesthesia. It has 2 types: diagnostic and surgical.

Diagnostic hysteroscopy – may be used for diagnosis of some pathological states inside the uterus. Sometimes is used together with other tools and techniques. Instructions for diagnostic hysteroscopy: are applied in the first week following menses.

1 – Abnormal bleeding – includes cases longer than normal menses and cramping bleeding, bleeding inbetween menses, or bleeding occurring in a period of menopause. Thanks to hysteroscopy a doctor finds out the reason of abnormal bleeding and may do biopsy if required.

2 – Childlessness – In some cases, childlessness may be connected with defect in uterus. E.g. endometrial partition (a tender touch may divide uterine cavity into two parts). Such problems may be detected exactly during hysterscopy.

3 – Recurrent premature borns. – Although some women achive in pregnancy, their babies hardly grows up to 20th week due to interrupted pregnancy. To understand a reason  for this, a hysteroscopy may be applied.

4 – Cicatrizations inside uterus – This case is called Asherman syndrome. These cicatrizations may lead to childlessness and changes of menses. State due to which these cicatrizations happen: abortions, scratching of uterine cavity, endometritis, adenomysosis etc.

5 – Tumors inside uterus – Sometimes unmalignant tumors such as polyp and submucous myoma may be detected by hysteroscopy. During hysteroscopy suspected tumors are taken biopsy and tumors are investigated whether to be malignant.

Surgical hysteroscopy –  is used for treatment purposes.  In some situations, hysteroscopy may be used instead of open abdominal operations. This procedure is applied in surgical wards of hospitals, under general anaesthesia.  During surgical hysteroscopy, endometrial cicatrizations, endometrial partition, polyps, submucous myomas are taken off. A procedure of endometrial ablasia (burning of internal mucous layer of uterus) is conducted by the hysteroscope.  Ablasia is made with a view to eliminate acute bleedings. During this procedure, alongside with the hysteroscope, other tools such as a laser or a resectoscope may be used as well.  Instructions for ablasia:  recurrent endometrial hyperplasia, bleeding.

In some cases, for more complex procedures, laparoscopy also may be used so that outside the uterus could be seen. As a result, hysteroscopy is a reliable operation.