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Operative Procedure PDF
Operative Procedure PDF
By :
Dr.Hanaa Al-Heidery
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6. Fractional curettage
7. Endocervical curettage
8. In pregnancy:
Abortion: therapeutic, missed, incomplete,
inevitable, septic
Molar pregnancy
Postabortive or postpartum bleeding
Technique
1. Evacuate the bladder
2. Anesthesia
3. Vaginal speculum & grasp the cervix
4. Sounding
5. Dilate the cervix
6. Curette
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Complications
1. Cervical laceration
2. Cervical incompetence
3. Perforation of the uterus
4. Spread of infection
5. Asherman syndrome
6. Persistence of bleeding: missing of an
endometrial polyp or remnants of conception
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ANTERIOR COLPORRHAPHY
Indications: Cystocele
Steps: 1. Anterior vaginal wall incision
2. The anterior vaginal wall is separated
from the bladder & the bladder is pushed to
its normal position as a pelvic organ
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Posterior colpoperineoraphy
Indication: Rectocele
Steps
1. Incision at the mucocutaneous junction.
2. The posterior vaginal wall is separated from the rectum
3. The 2 levator ani are approximated in front of the rectum
4. Redundant vaginal wall is removed
5. The superficial perineal muscles are approximated in the
midline
6. The vagina is closed
7. The skin of the perineum is closed
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FOTHERGILLS OPERATION
Indication
Combined vaginal & uterine prolapse with supravaginal
elongation of the cervix Steps
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MYOMECTOMY
Indication
Symptomatizing patient who did not complete her
family
Types
1. Abdominal
2. Vaginal
3. Hysteroscopic: submucous <5cm
4. Laparoscopic: Pedunculated subserous
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HYSTERECTOMY
Indications
I. Gynecological:
1. Fibroid
2. Advanced endometriosis &
adenomyosis
3. Malignant tumors of the cervix, body, tubes or
ovary
4. Recurrent DUB not responding to conservative
treatment
5. Chronic pyometra
6. Chronic inversion of the uterus
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Types
1.Abdominal
2.Vaginal
3.Laparoscopic
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• Cesarean hysterectomy:
• removal of the uterus after C.S e.g. atonic postpartum
hemorhage or placenta accreta.
• Hysterectomy-en-toto: Removal of the uterus with a
contained dead fetus without opening the uterus to
decrease blood loss e.g. couvelaire uterus
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Steps
1. Division & ligation of the round ligaments
2. Division & Ligation of the tubes & ovarian
ligaments if the ovaries will be left, or the infundibulo-
pelvic ligaments if the ovaries will be removed.
3. Incise the peritoneum of the vesicouterine pouch
by extending the incision in the anterior leaf of the
broad ligament, then dissect the bladder downward
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Indications
(1) Prophylactic (elective). Suspected
cervical incompetence. Cerclage at 14
weeks {early miscarriage caused by
other factors}.
(2) Urgent (therapeutic)
Asymptomatic women with sonographic evidence of
cervical shortening and/or funneling
(3) Emergency (salvage) cervical cerclage
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• Indications:
Cerclage
should only be considered when the history of
miscarriage is preceded by spontaneous rupture
of membranes or painless cervical dilatation
Contraindications:
1.Uterine contractions.
2.Uterine bleeding
3.Chorioamnionitis
4.Premature rupture of membranes
5.Fetal anomaly incompatible with life
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Cerclage
Before After
pregnancy pregnancy
Trans-
Trans- Abdominal
Lash
vaginal
Hefner Cervicoisthmi
McDonald Shirodkar
Modified
shirodkar
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Technique
No bladder dissection, and the cervix is closed using
four or five bites with the needle to create a purse
string around the cervix. placed high on the cervix,
with a non-absorbable suture or a 5 mm band of
permanent suture.
Burried technique
(Jenning, 1972)
The successive bites reenter the cervix at the
previous point of exit, so the suture remains
submucosal. Vaginal discharge & vaginitis are
less
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