46(1) - Our topics today Uterine prolapse Amenorrhea Dysfunctional uterine bleeding PCOS Infertility Peri-menopause period syndrome Zhao aimin

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01/21/12 1 Our topics today Uterine prolapse Amenorrhea Dysfunctional uterine bleeding PCOS Infertility Peri-menopause period syndrome Zhao aimin MD.Ph.D SSMU
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01/21/12 2 Uterine prolapse
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01/21/12 3 Definition The uterus gradually descends in the axis of the vagina taking the vaginal wall with it. It may present clinically at any level, but is usually classified as one of three degrees.
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01/21/12 4
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01/21/12 8 Degrees of uterine prolapse First degree : cervix still inside vagina
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01/21/12 9 Degrees of uterine prolapse Second degree : the cervix appears outside the vulva. The cervical lips may become congested and ulcerated
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01/21/12 10 Degrees of uterine prolapse Third degree : complete prolapse.In the picture the uterus is retroflexed,and the outline of bladder can be seen.This is sometimes called complete procidentia.
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01/21/12 11 Causes The stretching of muscle and fibrous tissue Increased intra-abdominal pressure
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01/21/12 12 In recent years,the incidence of prolapse is greatly reduced .The more liberal use of caesarean section and the elimination of labours are probably the two most important factors.
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01/21/12 13 Symptoms Something coming down Backache Increased frequency of micturition A ‘bearing down’ sensation Stress incontinence Coital problems Difficulty in voiding urine
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01/21/12 18 Treatment Pessary treatment Indications Patient prefers a pessary. Pelvic surgery risks Prolapse amenable to pessary The patient is not fit for surgery Patient wishes to delay operation
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01/21/12 22
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01/21/12 23 Surgery Anterior colporrhaphy (and repair of cystocele) Posterior colpoperineorrhaphy (including repair of rectocele) Manchester repair Vaginal hysterectomy
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01/21/12 24 Dysfunctional Uterine Bleeding (DUB)
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01/21/12 25 Definition an abnormal uterine bleeding without an obvious organic abnormality (neoplasma, pregnancy, inflammation, trauma, blood dyscrasia,hormone adminstration , at el) unnormal releasing of sex hormones
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01/21/12 26 Anovulatory functional bleeding ovulatory functional bleeding DUB occur in before the menopause(50%) after menarche(20%) in reproductive times(30%).
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01/21/12 27 Anovulatory functional bleeding
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01/21/12 28 Etiology of DUB: 1. disorders of hypothalamus---pituitary ---ovary axis immature of feedback regulation in young women ovarian function failure in climacteric women 2.other Factors: the effects of sex hormones nervous circumstance PCOS,TSH↑,PRL↑ excessive physical exercise
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01/21/12 29 Pathology Change in the endometrium simple hyperplasia(Cystic hyperplasia , benign) complex hyperplasia(Adenomatous hyperplasia ,precursor of carcinoma) atypital hyperplasia(10%-25%→ carcinoma) proliferative phase of endometrium (no secretive change ) atrophic endometrium
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