Description Pessaries are devices fitted and worn in the vagina to provide support to the pelvic organs. Pessaries are available in various sizes and shapes and are categorized as supportive (eg, ring, lever, Gellhorn, Gehrung, Shaatz) or space occupying (eg, doughnut, cube, inflatable). Indications Pelvic organ prolapse, urinary incontinence, cervical incompetence (lever or ring type), drug delivery. Pessaries are often used as either an alternative to…

Description Cervical conization is a diagnostic or therapeutic procedure that removes a cone-shaped specimen from the uterine cervix. Loop electrocautery excisional procedure (LEEP, also known as large loop excision of the transformation zone [LLETZ]) uses electrosurgical energy instead of a knife to remove the diseased cervical tissue. Indications Histologically verified advanced epithelial atypia (for diagnosis or therapy) or inability to adequately evaluate the cervix through colposcopy.…

Description Removal of an intrauterine contraceptive device (IUD). Indications Elective, desiring a return to fertility or to replace a device after its approved lifespan. IUDs should also be removed in the face of active pelvic inflammatory disease, unrelenting side effects, or an intrauterine pregnancy (if possible). The IUD does not have to be removed from an asymptomatic patient in whom actinomycosis is found on cervical cytology.…

Description Placement of an intrauterine contraceptive device (IUD). Indications Elective, desiring contraception. The IUD is associated with an efficacy rate that is comparable to sterilization and oral contraceptives and may be a particularly good choice for women with diabetes, thromboembolism, menorrhagia, or dysmenorrhea. The copper IUD may be preferable for those breastfeeding or with breast cancer or liver disease. The copper IUD may be placed up…

Description Operative hysteroscopy enables the visual inspection and treatment of intracavitary and submucosal myometrial leiomyomata, which incorporates the use of mechanical or electrosurgical instruments. Indications Known or suspected endometrial polyp(s) or symptomatic intracavitary, submucosal, or intramural leiomyomata where there is a significant proportion of the lesion that protrudes into the uterine cavity. Contraindications Patients who are medically unstable, viable (desired) pregnancy, known cervical or uterine cancer,…

Description Diagnostic hysteroscopy describes a number of techniques that allow the direct inspection of the endometrial cavity, endocervix, and fallopian tube ostia. Indications Dysfunctional uterine bleeding, postmenopausal bleeding, menorrhagia, abnormal endometrial thickening documented by ultrasonography, retained intrauterine contraceptives or other foreign bodies, infertility (eg, suspected Müllerian anomalies), endometrial or pelvic infections (eg, tuberculosis), surveillance of (treated) endometrial cancer or other situations in which a visual or…

Description Forceps-aided birth is a method of assisting or expediting vaginal vertex birth through the application of obstetric forceps. Operative vaginal birth can be faster and safer than cesarean birth in many cases. There is a greater chance of success in delivering the fetus vaginally with forceps-assisted techniques that with vacuum methods. Discussion here is limited to low or outlet forceps with the fetus presenting within…

Description External cephalic version is the process used to move a malpositioned fetus into the vertex position by external means. This is performed on the nonlaboring patient near term (≥37 0/7 weeks) to improve the chance of vaginal delivery. Indications Fetal malposition, oblique or most often breech. Contraindications External cephalic version is contraindicated anytime vaginal delivery is not clinically appropriate. Additional contraindications include nonreassuring fetal heart…

Description Endometrial biopsy is an office technique used for obtaining tissue samples from the lining of the uterus. In-office techniques have largely replaced traditional dilatation and curettage. Indications Dysfunctional uterine bleeding, postmenopausal bleeding, menorrhagia, infertility (selected cases), endometrial or pelvic infections (eg, tuberculosis), or other situations in which a tissue diagnosis is indicated. Because it is associated with some discomfort and a small but not insignificant…

Description Dilation and curettage (D&C) is the dilation of the uterine cervix with the removal (by scraping) of a portion of the uterine lining or uterine contents. (The same term may be applied to any setting in which a cavity is curetted after gaining entrance through dilation, such as endocervical curettage of a cervical stump.) The procedure may be combined with other diagnostic procedures such as…

Description Diaphragms (rubber or latex domes with a springy ring) are designed to provide a physical barrier between the sperm and egg in conjunction with contraceptive jelly or creams to provide contraception by both barrier and spermicidal actions. Contraceptive diaphragm use is associated with a 12% typical use failure rate and a 6% perfect use rate. Indications Elective. (Approximately 2% or less of women using contraception…

Description Cystourethroscopy (commonly referred to as cystoscopy) is a technique for visualizing the interior of the urethra or bladder. This may also serve as a portal for other diagnostic or therapeutic measures. Indications To diagnose urinary tract disorders such as bleeding, pain, or dysfunction (eg, interstitial cystitis). Cystourethroscopy can be a part of the evaluation of abnormal symptoms, signs, or laboratory findings; intraoperatively during gynecologic or…

Description Cervical cryocautery is the use of cold to produce a “frost bite” as an ablative therapy for cervical abnormalities. Loop electrocautery excisional procedures (LEEP, also known as large loop excision of the transformation zone [LLETZ]) have largely replaced cervical cryosurgery. Indications Histologically verified advanced epithelial atypia. Because this is an ablative technology, a histologic diagnosis must be established before instituting this therapy. Contraindications Undiagnosed cervical…

Description Colposcopy is a diagnostic technique that allows the clinician to identify normal landmarks, find changes suggestive of underlying abnormality, and select sites for biopsy that will yield the greatest information. It may be used to support other procedures such as conization. Colposcopy is based on a simple stereoscopic operating microscope with magnifications of 4–40 times. Although most often used to examine the uterine cervix, colposcopy…

Description Male circumcision is the removal of some or the entire foreskin of the phallus. Indications Parental or religious preference (not a medically indicated procedure). Circumcision of newborns should be performed only on healthy and stable infants. Contraindications Age greater than 6–8 weeks (relative), age less than 12 hours, ambiguous genitalia, hypospadias, illness, less than 1 hour postprandial, possibility of blood dyscrasia, prematurity, undescended testicles (relative).…

Description A technique for obtaining fetal chorionic villus cells for cytogenetic or other testing, chorionic villus sampling (CVS) is usually performed between 10 and 13 weeks gestation and involves the aspiration of the placental tissue using either percutaneous transabdominal or transcervical approaches. Transabdominal CVS can be performed at more than 13 weeks gestation. A transvaginal approach similar to the transabdominal method also has been used for…

Description Cesarean birth (or cesarean section) is the delivery of the fetus through surgical incisions in the mother’s abdomen and uterus. The rate of cesarean birth varies from 10% to 35% around the world, influenced by cultural factors and the availability of surgical care. In the United States, the rate of cesarean births increased by 5-fold for a 20-year period that ended in the early 1990s.…

Description Cervical polypectomy is the removal of cervical or visible endocervical polyps; it is generally a simple, painless office procedure. Indications Cervical or visible endocervical polyp. Some authors have questioned the need to treat asymptomatic polyps. Contraindications Known or suspected allergy to the agents used, coagulopathy. Relative: pregnancy. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership…

Description Cervical conization is a diagnostic or therapeutic procedure that removes a cone-shaped specimen from the uterine cervix. Cold knife cone biopsy used to be the preferred treatment for removing abnormal cells, but now most cone biopsies are performed using the wire loop and electrosurgical energy (loop electrosurgical excision procedure [LEEP]/large loop excision of the transformation zone [LLETZ] cone). Cold knife cone biopsy is generally used…

Description Cervical cerclage is the placement of a suture or tape to support and partially occlude the uterine cervix to reduce the risk for preterm delivery in the face of cervical insufficiency. A number of procedures have been described, but the most common and simplest is the McDonald cerclage, which is described here. Cervical cerclage also may be accomplished by placing the suture via an abdominal…