Glossary

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
  • Ectopic or tubal pregnancy Ectopic or Tubal Pregnanacy

    (Fallopian tube distended with an ectopic pregnancy. Dark blood is seen within the cavity.)

    • This is a pregnancy which develops in the fallopian tube instead of the uterus.
    • Condition is usually diagnosed in the first trimester, and the patient usually presents with vaginal bleeding and abdominal pain.
    • This condition affects one to two percent of pregnancies.
    • Can cause life threatening bleeding if the pregnancy were to rupture the tube. Patients suspected of having an ectopic pregnancy should undergo immediate evaluation. If this occurs after clinic hours, the patient should go to the emergency room.
    • Historically was treated surgically. Some patients are now eligible for medical therapy with methotrexate.
  • Emergency contraception
    • Emergency contraception or the “morning-after pill” is a controversial treatment to prevent pregnancy after unprotected sex.
    • Up to 72 hours after sexual contact, this therapy is taken to prevent pregnancy. The sooner after sexual contact this is given, the better the result.
    • No specific mechanism of action has been identified.
    • Numerous products or protocols are useful for emergency contraception.
      • Plan B: contains two pills; second pill is ingested 12 hours after the first.
      • Yuzpe protocol utilizing any of a number of products.
        • Preven: 0.25 levonorgestrel + 0.05 mg ethinyl estradiol—take 2 pills, then repeat in 12 hours.
        • Ovral: 0.5mg norgestrel + 0.05mg ethinylestradiol—take 2 pills, then repeat in 12 hours.
        • Alesse or Levlite: take 5 pills, then repeat in 12 hours.
        • Nordette, Levlen or Loovral: take 4 pills, then repeat in 12 hours.
        • Triphasil or Trilevelen: take first 4 pills in pack, then repeat in 12 hours with last 4 in the pack.
    • Emergency contraception is considered controversial because some consider it an abortifacient.
    • Efficacy is hard to determine, but it is likely 70-74 percent.
    • There are no known teratogenic effects to a baby if the therapy is unsuccessful and a pregnancy results.
    • There are numerous side effects to the therapy:
      • Nausea affects 30-66 percent of patients who use combined contraceptive pills.
      • Emesis or vomiting affects 12-22 percent.
      • Breast tenderness affects 1-47 percent.
  • Endometrial ablation
    • A procedure done to treat abnormal uterine bleeding.
    • Procedure done through a hysteroscope in the operating room as an outpatient. Thus, the procedure is done from a vaginal approach. Patients go home afterward and may typically return to work in 3-5 days.
    • Involves treating the lining of the uterus with energy. There are a variety of commercially accepted devices.
    • The better devices promise upwards of 90 percent satisfaction with the procedure. Up to 40 percent of patients achieve amenorrhea (no further bleeding). Approximately 20 percent of patients will desire another procedure in the future to treat their abnormal bleeding.
    • After the procedure, most patients will complain of some menstrual-type cramps. They will also likely have some spotting from the cervical dilation.
    • The risks of the procedure are the same as the risks for hysteroscopy. There are the general risks of anesthesia and surgery: risk of infection and bleeding. As with any uterine surgery, there is a small risk the device will put a hole in the uterus. This is rare and treated with observation in most cases.
    • This procedure should not be done in patients who desire future fertility. Unfortunately, it is not a reliable sterilization procedure, and patients will need to continue birth control strategies or seek sterilization for themselves or preferably their spouses as applicable.
  • Endometrial biopsy Endometrial Biopsy
    • A procedure typically done in the office.
    • Indicated in patients with abnormal uterine bleeding, especially patients over 30-35 years old.
    • Low-risk procedure.
    • Urine pregnancy test will commonly be done beforehand.
    • A speculum is placed and a small, straw-like device is introduced into the uterus. Getting through the cervix can sometimes be the most difficult part, and a local block will sometimes be necessary. A small sample of tissue is obtained. Once the device is in the uterus, the procedure lasts less than a minute. It does cause significant cramping. This is well-tolerated by most patients, though some consider the cramping intolerable and in-office attempts will be abandoned on rare occasion.
    • It is very helpful to take a nonsteroidal anti-inflammatory agent, such as ibuprofen, before the procedure if these medicines are tolerated by the patient.
    • Results of the biopsy are typically available in two weeks.
  • Endometriosis Endometriosis
    • A condition characterized by the presence of tissue resembling uterine lining or endometrium, outside the uterine cavity.
    • These ectopic implants are commonly in the pelvis around the ovaries and uterus.
    • Thought to affect 2-5 percent of women.
    • Affects upwards 87 percent of patients with chronic pelvic pain.
    • Suspected in women with chronic pelvic pain, painful menstruation, painful intercourse and even infertility.
    • See also: EndoFacts
    • Source: Hesla JS, Rock JA. “Endometriosis”. Telinde’s Operative Gynecology. Lippincott-Raven Publisher. 8th ed. 1997. p 585.
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