100 Cases in Obstetrics and Gynaecology (A Hodder Arnold by Cecilia Bottomley

By Cecilia Bottomley

A 24-year-old lady is referred from the emergency division with unexpected onset of left iliac fossa soreness and also you are the medic on duty...

100 circumstances in Obstetrics and Gynaecology offers a hundred in most cases noticeable obstetric and gynaecological eventualities. The patient's background, exam and preliminary investigations are provided besides questions about the prognosis and administration of every case. the reply contains a exact dialogue on every one subject, supplying a necessary revision reduction in addition to a pragmatic advisor for junior clinicians.

Making medical judgements is without doubt one of the so much demanding and hard elements of teaching to turn into a physician. those circumstances will train medics and scientific scholars to acknowledge vital obstetric and gynaecological stipulations and aid them enhance their diagnostic and administration talents.

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5–11 ϫ 109/L 150–440 ϫ 109/L Findings at hysteroscopy are shown in Fig. 1. 1 Hysteroscopy. See Plate 3 for colour image. Questions • What is the diagnosis? • How would you manage this patient and counsel her about the management and its potential risks? 43 100 Cases in Obstetrics and Gynaecology ANSWER 17 The ultrasound scan shows a submucosal fibroid and this is confirmed by the hysteroscopy image. At hysteroscopy, a fibroid is a solid smooth immobile structure, whereas a polyp appears pink and fleshy and mobile.

KEY POINTS • Women with postmenopausal bleeding (PMB) should be considered to have endometrial cancer until proven otherwise. • Endometrial thickness, endometrial biopsy and hysteroscopy are used to investigate PMB. • Atrophic vaginitis can be treated with courses of topical oestrogens 28 General gynaecology CASE 12: PAINFUL PERIODS History A 43-year-old woman is referred from her general practitioner (GP) with painful periods. She says that her periods have always been quite heavy and painful but that in the last 2–3 years they have become almost unbearable.

There is no other gynaecological or medical history of note. Examination Abdominal examination is normal. On vaginal examination there is minimal uterovaginal descent and no anterior or posterior vaginal wall prolapse. INVESTIGATIONS Midstream urinalysis: protein negative, blood negative, leucocytes negative, nitrites negative Urodynamics: the first urge to void was reported at 150 mL bladder filling. Involuntary detrusor contractions were noted while the patient was attempting to inhibit micturition.

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