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GYNECOLOGICAL INFECTIONS . . . CONT.

Notes

e r y t h e m a , i n d u r a t i o n , t e n d e r n e s s , d i s c h a r g e i n v o l v i n g v a g i n a l c u f f t r e a t i f f e v e r a n d l e u k o c y t o s i s w i t h b r o a d s p e c t r u m a n t i b i o t i c s , i . e . c l i n d a m y c i n a n d g e n t a m y c i n d r a i n i f e x c e s s i v e p u r u l e n c e o r l a r g e m a s s i n t r a a b d o m i n a l a n d p e l v i c a b s c e s s

Prophylactic Antibiotics for Gynecologic Surgery aim to decrease numbers below critical level for infection benefit in: vaginal hysterectomy, TAH, D&C, and abortion cefazolin for most procedures (IV bolus 30 minutes before procedure and repeat if surgery > 2-3 hours long) bowel prep for procedures in which fecal contamination is possible • Go-Lytely, etc..., to clear bowel • ampicillin + gentamicin IV or IM 30 minutes before procedure and q8h • vancomycin + gentamicin for penicillin-allergy • amoxicillin PO 1hour before procedure if low-risk patient • cefoxitin IV pre-op and q4h if emergency • clindamycin, ampicillin, and cephalosporins are most often associated with C. difficile colitis

PELVIC RELAXATION

due to weakness or defect in the cardinal and uterosacral ligaments which normally assist in maintaining the uterus in an anteflexed position and prevent it from descending through the urogenital diaphragm (i.e. levator ani muscles) related to • trauma of childbirth • aging • decreased estrogen • following pelvic surgery • increased abdominal pressure, e.g. obesity, chronic coughing, and constipation • rarely congenital

PROLAPSE

UTERINE PROLAPSE

Symptoms mass or bulge at introitus back pain due to stretching of uterosacral ligaments feeling of heaviness in the pelvis • worse with standing, lifting • relieved by lying down

Classification 0 = No descent 1 = Descent between normal position and ischial spines 2 = Descent between ischial spines and hymen 3 = Descent with hymen 4 = Descent through hymen

Procidentia: failure of genital supports and complete prolapse of uterus

Treatment conservative v a g i n a l p e s s a r y e s t r o g e n t h e r a p y p e l v i c m u s c l e e x e r c i s e s ( K e g e l s ) s u r g i c a l p r o s t h e t i c s l i n g s i n c a s e s a s s o c i a t e d w i t h u r i n a r y i n c o n t i n e n c e v a g i n a l h y s t e r e c t o m y ± a n t e r i o r + p o s t e r i o r r e p a i r

VAULT PROLAPSE

follows hysterectomy, vagina turns inside out

Gynecology 32

MCCQE 2000 Review Notes and Lecture Series

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