Main gynecological diseases

Inflammatory diseases and infections

Inflammatory processes of the female genital tract are classified by their clinical course and localization. Infection may affect the lower genital tract (bacterial vaginosis, vaginal candidiasis, trichomonal vaginitis) or internal organs (pelvic inflammatory disease — PID, including involvement of the uterus and appendages).

A separate group consists of specific sexually transmitted infections, such as gonorrhea and genital chlamydia. To understand pathogenesis, it is important to consider the pathways of pathogen spread in the body and local defense factors that prevent the generalization of the process.

"Acute abdomen" syndrome

"Acute abdomen" is a collective term for acute intra-abdominal pathologies requiring emergency hospitalization and urgent care.

The clinical picture includes:

• Sudden pain syndrome starting in the lower abdomen and intensifying to the point of fainting (patients often remember the exact hour the pain started).
• Dyspeptic disorders (nausea, vomiting).
• Impaired bowel transit (delay of stool and gas, diarrhea is more common in children).
• Signs of peritoneal irritation.

Etiologically, three groups of causes are distinguished:

1. Intra-abdominal hemorrhage: ovarian apoplexy and ruptured ectopic pregnancy (the frequency of the latter has increased 2–3 times over the past decade).
2. Circulatory disorders: torsion of the pedicle of an ovarian mass or torsion with necrosis of a myomatous node.
3. Acute inflammation: processes involving the peritoneum (peritonitis).

Uterine myoma in pregnancy

Pregnancy frequently occurs against the background of gynecological pathologies, among which developmental anomalies, cervical tumors, ovarian masses, and uterine myoma (a benign tumor of muscle and fibrous elements) are common. Depending on the predominance of cells, myoma, fibroma, and fibromyoma are distinguished. Coexistence with pregnancy occurs in 0.5–2.5% of cases.

Most often in pregnant women, nodes are located between muscle fibers (interstitial) or beneath the serous membrane (subserous). Submucosal nodes are rare because they usually lead to infertility or early miscarriages. In the first 8 weeks of pregnancy, myoma can grow due to cell hyperplasia and hypertrophy, while in later terms it increases (by an average of 12%) due to edema, hemodynamic disturbances, and degenerative changes.

The main danger is circulatory disturbance and node necrosis. In addition, myoma increases the risk of pregnancy termination (especially with cervical-isthmic localization leading to isthmic-cervical incompetence), placental insufficiency, fetal growth restriction, fetal malpresentation, and premature placental abruption. The primary diagnostic method is ultrasound examination.

Uterine displacement anomalies

Normally, the uterus has a specific angle of inclination, but sometimes pathological flexions occur:

• Hyperanteflexion is an acute anterior angle (less than 70°) between the body and cervix of the uterus. Most often associated with sexual infantilism or previous inflammation. It manifests as scanty, painful menstruations (hypomenstrual syndrome, algomenorrhea) and primary infertility. Vaginal examination reveals a small uterus sharply deviated anteriorly, a long conical cervix, a narrow vagina, and shallow fornices. Treatment involves addressing the cause and symptomatic therapy 2–3 days before menstruation (spasmolytics, analgesics, antiprostaglandin drugs).
• Retroflexion — deviation of the uterine body backward and the cervix forward. In this case, the bladder remains uncovered, and the intestine constantly presses on the uterus, which over time contributes to pelvic organ prolapse or descent. The mobile form occurs due to decreased ligamentous tone (in asthenia, weight loss, birth trauma) and is easily repositioned manually during a bimanual examination. The fixed form is the result of adhesions following inflammation or endometriosis; bringing the uterus into a normal position is impossible. The pathology may be asymptomatic or cause dragging pain, adjacent organ dysfunction, and menstrual cycle irregularities (algomenorrhea, menometrorrhagia).

Class and exam questions

What else to study on this topic

• Etiology and pathogenesis of pelvic inflammatory disease (PID)
• Clinical presentation and diagnosis of ruptured ectopic pregnancy
• Specific infections: gonorrhea and genital chlamydia
• Lower genital tract infections: bacterial vaginosis, candidiasis, trichomoniasis
• Ultrasonic diagnosis and management tactics of pregnancy in uterine myoma

Other topics in the "Gynecology" section

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