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Endoscopy in Infertility - Part II - A Perspective on Laparoscopy - ECAB
Historically, gynecologic endoscopy began in the 1930s with the development of diagnostic laparoscopy, but today gynecologic endoscopy, both laparoscopy and hysteroscopy, has become an essential part of gynecologic surgery. In present practice, the benefits of laparoscopy, hysteroscopy, and minimally invasive surgical procedures have become safely entrenched behind undeniable facts, to the patients as well as the hospitals. The endoscopic gynecologic surgery now involves the whole gamut of fetal surgery, embryoscopy, outpatient local anesthetic laparoscopy, total laparoscopic hysterectomy, and embolization of myomas. Another interesting fact to come to the fore is that, increasingly, the traditional treatments for infertility are being rendered obsolete by advanced reproductive technologies and gynecologic endoscopy. Endoscopy in Infertility has addressed the relevant issues with dexterity by substantiating with relevant clinical experiences of its authors, who are among the pioneers in this field.
Medical Disorders in Pregnancy - ECAB
The management of medical disorders in pregnancy has undergone significant changes in the recent years. The pattern of disease has changed with improvements in socio-economic conditions. For example, the incidence of antenatal anemia has decreased progressively in the past few decades, and pulmonary tuberculosis (which used to be prevalent) is now seen only rarely. Chronic rheumatic heart disease has also become less common. On the other hand, gestational diabetes has become more common. This may be due partly to the setting up of screening services for gestational diabetes in many hospitals. The four most common medical disorders complicating pregnancy are anemia, diabetes mellitus, cardiac...
Endoscopy in Infertility - ECAB
Historically, gynecologic endoscopy began in the 1930s with the development of diagnostic laparoscopy, but today gynecologic endoscopy has become an essential part of gynecologic surgery. In present practice, the benefits of hysteroscopy have become safely entrenched behind undeniable facts, to the hospitals as well as the patients. Hysteroscopy can be regarded as the gold standard for the evaluation of the uterine cavity in cases of abnormal uterine bleeding, infertility, recurrent pregnancy loss, and suspected intrauterine out-growth. It can be performed in the office setting (outpatient hysteroscopy) or as a day-case procedure, under general anesthesia (inpatient hysteroscopy). Outpatient...
Threatened Miscarriage - ECAB
Even though it seems simple the ability of the mother’s body to retain and nurture the fetus, which is of a non-identical genetic makeup, throughout the gestational period requires a delicate balance of hormonal orchestration to achieve the required immunological permissiveness. The obvious outcome of a failure to achieve this is rejection of the fetal "semi-allograft", which manifests as threatened miscarriage. The occurrence of threatened miscarriage or symptoms suggestive of it is fraught with anxiety both for the patient and the obstetrician, especially if the baby is eagerly awaited. In such a situation, a correct diagnosis and prompt evaluation is imperative to start immediate interv...
Polycystic Ovary Syndrome - ECAB
PCOS is a complex endocrinopathy with wide-ranging variations and clinical manifestations. In the field of gynecology, the clinician is called upon to treat problems of menstrual irregularity, acne and hirsutism, infertility, obesity, and for education on long-term consequences. The mainstay of pharmacological treatment aims at ovarian suppression of androgen secretion. The most effective medical therapy for hirsutism in these cases thus appears to be antiandrogen drugs. The patients need to undergo the therapies for long periods and also understand the need of maintenance. Electrolysis and laser photothermolysis are considered the most effective cosmetic procedures. PCOS is a heterogeneous ...
Managing Infertility - ECAB
Assisted reproduction refers to a number of advanced techniques that aid fertilization in a couple diagnosed to have reduced fertility such as in women who have irreversible damage to their fallopian tubes or cervical mucous problems. These techniques can also benefit couples with unexplained infertility. Before 1978, infertility diagnosis and treatment revolved around surgical interventions such as fallopian tube(s) repair or inserting sperms into the uterus. Thus, the management was applicable and aimed at removing the mechanical blockage that prevented the fertilization of egg. Then ca.me Louise Brown and Dr. Patrick Steptoe, a couple who were destined to be associated forever in the infe...
Gynecologic Endocrinology - ECAB
The diagnostic approach as well as the management of several endocrinological disorders underwent major modifications. Gynecological endocrinology made no exception, and light was finally thrown on a scarcely known area, so heavily influenced by ignorance and prejudices. Here some authoritative experts have addressed the several possibilities of hormonal interventions in the field of gynecology. The most recent research development has led to the better understanding of the physiopathological rationale, underlying appropriate treatments and even evaluation of the new routes of hormone administration. Current medical therapy of different conditions has been thoroughly reviewed, including prec...
High-Risk Labor and Delivery - ECAB
The high-risk pregnant patient can present to the labor and delivery setup with significant complications that can result in morbidity and mortality. The goal of the obstetricians is always to have a safe outcome for both the mother and the baby, irrespective of the severity of the illness. Therefore, a thorough understanding of the underlying problems and expert management by the obstetrician are extremely important. Further, these parturient can be critically ill, requiring intensive care management. So, good communication among the various teams and the latest information on the management of such patients are critical in order to provide the highest possible level of care. The information in this text will hopefully give the reader the best and most up-to-date knowledge with regard to management of problems and challenges in dealing with a high-risk parturient. This book brings together an outstanding group of authors from the discipline of Obstetrics and Gynaecology in an attempt to present a comprehensive and current summary of high-risk labor and delivery and will be useful to both the practitioner in academic medicine and in private practice.
Endometriosis - ECAB
Endometriosis is a condition that often leads to a variety of symptoms that range from pain complaints to infertility. Endometriosis is also found in women who are asymptomatic. The diagnosis of endometriosis can be made clinically with reliability similar to that of one made surgically. Medical treatment options are effective, as are surgical treatment options. Complications associated with surgery, however, push the balance in favor of medical therapy whenever possible. Based on the body of evidence available at present, women with endometriosis-related complaints should be treated with a first-line medical therapy. If that fails, a second-line medical therapy is warranted under most conditions. Laparoscopic surgery should be reserved for patients in whom second-line medical therapy has failed or is contraindicated by desire to conceive immediately or as soon as possible.
Thyroid Dysfunction and Pregnancy - ECAB
It is an established fact that thyroid hormones play an important role in the metabolism of the body. Pregnancy is a state of significant hormonal as well as metabolic changes, and thyroid hormones have a significant impact on maternal metabolism and fetal development during pregnancy. The fetus relies on maternal thyroid hormone for the development of the CNS, especially in the early stages of gestation, and uncorrected maternal hypothyroidism in this period can leave the child with permanent life-long neurological deficits. From the maternal point of view, a thyroid dysfunction encountered during pregnancy may continue even after delivery as postpartum thyroiditis. Hence, any thyroid dysfu...
