Investigations in gynaecology

1. Common investigations used in gynaecology

• Blood values
• Imaging techniques
• Urine examination
• Endometrial sampling
• Vaginal,cervical swabs
• Exfoliative cytology
• Endoscopy
• Colposcopy
• Hormonal assays

2. BLOOD ROUTINE Hemoglobin estimation-Excessive bleeding, Total and differential count PID, ESR, PlSerology-VDRL, Australia Antigen, HIV

3. URINALYSIS. Urine routine and microscopy, Physical examination, Chemical estimation of protein and sugar, Pus cells,casts. Culture and drug sensitivity, Urine pregnancy test– for diagnosis of pregnancy

4. Methods of urine collection Midstream collection, Catheter collection.

CATHETERIZATION

Suprapubic bladder puncture

7. URETHRAL DISCHARGE Method of collection: Urethra squeezed against symphysis pubis from behind forwards using sterile gloved fingers, Discharge through external urethral meatus collected with sterile swabs, Swabs—microscopy and culture

8. Vaginal discharge Method of collection: Patient not to have vaginal douche for 24hrs, Cusco’s bivalve speculum introduced, Discharge from posterior fornix or cervical canal taken with a swab. Microscopic examination-Discharge is mixed with normal saline culture.

9. Identification of organisms in the slide. Normal discharge-normal vaginal cells with doderlein bacilli, Trichomonal vaginalis—hanging drop preparation shows motile flagellated organisms of varying shape, Gardnerella vaginosis(bacterial/nonspecific vaginitis)—clue cells, few inflammatory cells, free floating clumps of gardnerella, scanty lactobacilli..

10. Vaginal candidasis Vaginal discharge + equal amount of 10% KOH, Caustic potash dissolves all cellular debris, leaving behind more resistant yeast like organisms, Typical hyphae, budding spores or mycelia detected.

11. EXFOLIATIVE CYTOLOGY- PAPANICOLAOU TEST Pap test-Screening test for cancer ervix, LBC Pap smear-screening of cancer PROCEDURE Should be obtained prior to vaginal examination, Patient placed in dorsal position with labia separated, Cusco’s self retaining speculum inserted without lubricants. Cervix exposed , squamocolumnar junction scraped with concave end of Ayre’s spatula by rotating all around, Thin smear is prepared on a glass slide and fixed by equal amounts of 95% alcohol and ether Liquid based cytology-cancer screening Plastic spatula after scraping placed in buffered methanol solution-hemolytic and mucolytic, Cells separated by centrifugation and gently sucked through a filter membrane, Filter pressed onto a glass slide to form thin monolayer which is stained

12. ENDOMETRIAL BIOPSY Most reliable method to study endometrium, Endometrial tissue obtained by curretage and subjected for histopathology. Indications, suspected cases of Endometritis ,endometrial cancer, Infertility, Abnormal menstrual bleeding, Diagnosis of corpus luteal phase defect

13. CERVICAL BIOPSY Confirmatory diagnosis of cervical pathology.

14. COLPOSCOPY Colposcope-binocular microscope- 10-20 X, Use-colposcope directed biopsy colposcopic examination of cervix and vagina

15. CULDOCENTESIS, Transvaginal aspiration of peritoneal fluid from the pouch of douglas. PROCEDURE Patient-l ithotomy position, Hold Posterior lip of cervix-downwards and forwards with vulsellum forceps, Speculum-retracts posterior vaginal wall, Area disinfected, Aspiration syringe inserted into the pouch and aspirated, Done best in OT under full asceptic precautions and to proceed laproscopy/laprotomy if indicated

15. CULDOCENTESIS, Transvaginal aspiration of peritoneal fluid from the pouch of douglas. PROCEDURE Patient-l ithotomy position, Hold Posterior lip of cervix-downwards and forwards with vulsellum forceps, Speculum-retracts posterior vaginal wall, Area disinfected, Aspiration syringe inserted into the pouch and aspirated, Done best in OT under full asceptic precautions and to proceed laproscopy/laprotomy if indicated

16. HORMONAL ASSAYS FSH, LH, PRL, ACTH, T3, T4, TSH, progesterone, oestradio, testosterone, aldosterone, cortisol, hCG, dehydroepia ndrosterone,andostenedione