Gynecology and Obstetrics

Gynecology and Obstetrics

Major Areas of Interest

Ovarian Cysts

Ovarian cysts are growths which develop from ovarian tissue, are relatively common, especially in women of reproductive age, and the vast majority of which are benign. Some ovarian cysts which especially appear in advanced age develop as a result of ovarian cancer. 

Generally speaking, if ovarian cysts negatively affect the daily life of a woman by creating various symptoms or it is uncertain if the cyst is benign or not, surgery is preferred. 

In the case of suspected cancer of an ovarian cyst, even if this probability is very low, it is preferable to carry out the operation in short time. 

It is recommended that cystic formations which appear especially in advanced age, occur as multiple or double -sided, contain solid components, cause fluid accumulation inside the abdomen, do not resolve spontaneously or which show growth at the end of a certain period, are accompanied by increases in some blood parameters called tumor markers are operated because of the possibility that they are cancerous.  

Cystic formations occurring during menopause or childhood should be removed surgically without waiting. 

The most important advantage of the operation is that the tissue removed can be pathologically examined and its nature can be clearly identified.

The main objective of an operation for cyst in a woman of reproductive age is to preserve ovaries and only remove the cyst. However, where the cysts is associated with cancer, it is not sufficient to remove the ovary. The uterus should also be removed.  Uterus has no known function other than accommodating the growing baby during pregnancy. Therefore, in the case of a woman who has completed her family, even though the cyst is believed to be benign, complete removal of both ovaries and even the uterus can be recommended rather than only resecting the cyst. 

Type and size of the cyst determine the removal method of ovarian cysts. The technique used to remove a cyst is another issue affecting the risks associated with the surgery. Surgery can be applied by laparotomy, i.e. open surgery entering through the abdomen or laparoscopy, i.e. a method applicable through fine tubes using a camera, without opening the abdomen. 

Ovarian Cancer

Even though ovarian cancer is mostly common in women at and over the age of 50, it may appear at any age. Ovarian cancer is a type of cancer with very strong hereditary characteristics. 

Ovarian cancer is a type of cancer early diagnosis of which is extremely difficult and which has already progressed to advanced stages in most cases when it is diagnosed first, and unfortunately, because of that, it is among those cancers with a high mortality rate.

For treatment, it is essential that uterus and ovaries are removed, tumor tissue in the surrounding tissues is cleaned in a very good way, and postoperative chemotherapy is applied. 

Cervical Cancer

Cervical cancer is the most common gynecological cancer.  It is caused by abnormal division and multiplication of cells in the cervix.

It virtually has no symptoms in the early stages.  Problem in the cervix may not be seen during a gynecological examination and with the naked eye.  However, it can be detected by a smear test. Final diagnosis can be made by a biopsy of tissue taken from suspected area. The clinical signs of the disease appear if it progresses. Such signs include bloody discharge, bleeding after intercourse, irregular bleeding, lower back and groin pain. 

In the early stage, patients can be treated by removing the diseased area of the cervix by a simple operation which takes 5-10 minutes, whereas a larger operation is needed when the disease has progressed. Also radiotherapy may also be required after the operation according to the prevalence of the tumor.  In more advanced cases, no surgery can be made. However, radiotherapy and chemotherapy are expected to help. When the disease is detected in the early stage, treatment success rate is 100 percent.  This rate is reduced as the disease progresses.

Asherman’s Syndrome

Uterine lining is a layer which covers internal surface of the uterus, thickens and regenerates as a result of ovarian hormones during each menstrual cycle and is regularly shed from the body during menstruation in a woman of reproductive age. This region accommodates the baby when a pregnancy occurs and provides the necessary environment for the baby to grow.

If this layer suffers damage for any reason, especially problematic abortion, when the front and back pieces adhere to each other, the region that has adhered cannot be used  anymore and be involved in any changes in menstruation cycle. 

In the case of mild adhesions, adhesions can be resolved by placing a coil inside the uterus and administering hormonal therapy for a definite period of time to ensure regeneration of uterine lining.

Today, the most effective treatment of intrauterine adhesions is performed by hysteroscopy. 

Birth

Birth is a process in which a baby ready to live in the external environment is expelled from the body of the baby’s mother.

Natural childbirth

Birth is not a process which is over and done with, especially the first delivery may take up to 20 hrs. However, delivery can be performed in a controlled manner and in shorter periods using medications.

In the hospital, whether delivery has started is understood by softening and dilation of the cervix. The contractions which signal that the birth has started  are regular and increase in frequency.

As known, birth is a painful process and pain relief methods  can be applied. Most frequently, epidural anesthesia is used; in this technique, lower part of the body of the pregnant woman is anesthetized and sense of pain is eliminated, facilitating delivery.

Delivery by Caesarean section

During delivery by Caesarean section, the baby is removed from the mother by a surgical procedure performed on the mother’s abdomen. It is usually performed when normal labor is risky. However, it can be applied upon request. 

Caesarean delivery may take 30-60 minutes depending on the situation .  Recovery may take up to 6 weeks. It is often performed under general anesthesia. 

Diagnostic Methods in Use

Pap smear

It is the most basic cancer screening test.  Its goal is to detect cervical cancer precursor lesions.  In addition, bacteria, fungi and HPV infection may be indirectly diagnosed. 

Pap smear is part of a gynecological examination and it involves removal of cervical secretion using a special spatula usually in the form of a brush during the examination. The secretion collected on the tip of the spatula is spread by the doctor on a microscope slide, called lamina, and it is stained using special dyes. Then it is carefully examined by a pathologist. 

Colposcopy

Colposcopy is a procedure to observe and examine the cervix and the tissues of the vagina and vulva using microscope or a special magnifying glass resembling binoculars. This illuminated and computerized tool called an colposcope provides an enlarged view of the cervix, allowing better examination and view of the cervix. By colposcopic examination, small pathologies (changes in cellular and vascular structures) which cannot be seen with a naked eye are detected, and further treatments can be provided.

Hysterosalpingography ( HSG)

Hysterosalpingography (HSG) uterus and tube film with contrast medium is a widely used procedure to investigate structural and functional properties of cervical canal, uterus and fallopian tubes. The procedure is based on imaging uterine cavity by administering a special fluid into the uterine cavity. 

Hysterosonograhy

In this method, the uterus is examined using ultrasound after a special liquid is administered into the uterus. 

Gynecological Ultrasonography

The following examinations are performed by ultrasonography:

  • During pregnancy, characteristics of the baby, the amniotic fluid in which the baby floats and placenta which nourishes the baby can be examined by ultrasonography in detail. 
  • By examining details of masses detected during examination of genital region, distinguishing whether the mass is solid or cystic(filled with fluid), its dimensions, position of the mass inside the organ, features indicating whether the mass is benign or malignant can all be established in ultrasonography. 
  • During assessment and treatment of the problem of inability to conceive, by a series of ultrasonographic examinations called folliculometry, the state of follicle that has matured inside the ovary can be tracked, and when this follicle will rupture, i.e. when the ovulation will probably take place can be established.
  • Thickness of uterus lining can be measured and its features can be assessed. Measurement of thickness is especially used to evaluate and treat the problem of inability to conceive, and evaluate the response of uterine lining of a woman who has taken a hormone drug during menopause period, to that drug. 

Mammography

Mammography is widely used as an auxiliary diagnostic test to determine the location and properties of a suspected mass found in the breast. Mammographic examination is performed using X-rays. 

Endometrial biopsy

Endometrial biopsy or curettage is a procedure performed to identify the cause of bleeding in a woman who has irregular or unexpected bleeding. The tissues retrieved are examined by a pathologist.

The procedure is a simple intervention which takes a few minutes and can be performed under local or general anesthesia and doesn’t isolate the woman from everyday life. 

Treatment Methods

Abortion

Abortion is one of the small surgical operations applied most frequently by obstetrics and gynecology specialists. It takes about 5 minutes under general anesthesia.

Cryotherapy (freezing treatment)

In cryotherapy, abnormal tissues are frozen. In general, a device called a probe is inserted through the cervix and the procedure is applied by sending gas through the probe to decrease ambient heat.   Liquid nitrogen and carbon dioxide are used for freezing procedure. 

Cryotherapy procedure is also utilized for abnormalities in the cervix. Cervical lesions may develop for various reasons over time. Cryotherapy procedure is applied to remedy these lesions. 

Cryotherapy cannot be applied in the case of lesions that have progressed into the cervical canal, lesions so big that probe area is insufficient, and during pregnancy. 

Cauterization (burning treatment)

In cauterization procedure, cervical lesion is burnt and killed using heat obtained by electric current provided from the tip of a pen-shaped probe.  The procedure takes about 5-6 minutes.

LEEP

It is applied to a patient who hasn’t responded to freezing or burning treatments, whose smear test has given suspected results and whose HPV is positive. In here, the patient is treated as well as a tissues is removed at the same time. 

Removal of the uterus (hysterectomy )

Hysterectomy is the surgical removal of the uterus.  It is applied most commonly for conditions including bleeding which don’t respond to treatment, myomas, growth of genital organs and cancer or suspected cancer.

Even though menstrual bleeding stops as a result of removal of the uterus, this is actually not a menopausal state. Menopause is the cessation of ovarian function so if ovaries have been left intact, as long as ovarian hormone secretion continues, a woman whose uterus has been removed isn’t considered to have entered menopause.

Hysteroscopy

Hysteroscopy is the inspection of the cervix and uterine cavity by inserting an optical device into the uterus. 

Hysteroscopy can be performed for diagnostic purposes including investigation of the causes of infertility as well as of abnormal vaginal bleeding, diagnosis of congenital abnormalities or for therapeutical purposes including resecting myomas or polyps which have been detected earlier, and operating congenital deformities.

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