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Obstetrics and gynecology

Obstetrics and gynaecology

Obstetrics is the surgical medical specialty that deals with the diagnosis, treatment, and, as much as possible, prevention of problems related to foetus development and the mother’s health during pregnancy; the safe term delivery of the baby is also a matter of obstetrics. Gynaecology deals with the diagnosis and treatment of malformations, dysfunctions, and diseases of the female reproductive system regardless of the woman’s age (genital infections, pelvic inflammatory diseases, amenorrhea, dysmenorrhea, genital bleeding, urinary incontinence, genital prolapse, benign and malignant tumours etc.). In practice, the two are often grouped together under the name of “Obstetrics-Gynaecology” or “Obstetrics and Gynaecology”.

The most common surgical treatments administered by our specialist gynaecologists and are:

  • the hysteroscopy (the inspection of the uterine cavity for diagnostic or therapeutic purposes);
  • the laparoscopy (the inspection of an anatomical cavity and the ultrasound-guided execution of surgical manoeuvres through three or more small incisions of only 1.5cm)
  • the cone biopsy (a surgical procedure with both diagnostic and therapeutic purposes, which consists in the extraction of a cone-shaped tissue fragment from the cervix, ensuring the removal of the entire lesion and transformation area together with a section of the endocervical canal)

Dr Radu Maftei, a specialist in Obstetrics-Gynaecology, can tell us more about one of the most common conditions, endometriosis.

“Endometriosis is a benign condition characterised by the presence of endometrial cells outside the uterine cavity. It is a progressive disease which tends to advance from one menstrual cycle to the next, and it affects 10% of the general female population and over 40% of infertile women.

The most frequently seen and best-known location of endometriosis is ovarian, also called endometrioma or endometriotic cyst. The endometriotic cyst may develop on a single ovary or on both ovaries, and its size may vary from several millimetres to several centimetres. Although, most often, the size of the cyst correlates with the patient’s symptoms, this is not always the case. Endometriotic cysts can be asymptomatic even when significant in size, just like it is possible for small endometriotic lesions to cause severe symptoms.

Another common location of endometriosis is in the uterine muscle, in which case the patient is said to be suffering of adenomyosis.

Other possible locations of endometriosis are in the intestines, bladder, ureters, nerves, uterosacral ligaments, peritoneum, and lungs.

The most common signs and symptoms of endometriosis are:

Dysmenorrhea - menstrual pains

Dyspareunia - pain during sexual intercourse

Dysuria - discomfort/pain during urination

Dyschesia - difficulty passing stools. Bowel movement disorders during menstruation or perimenstrually.

Chronic pelvic pain

Increasingly heavier menstrual bleeding

The diagnosis of endometriosis is made based on clinical examination, anamnesis, and paraclinical investigations (vaginal ultrasound, contrast MRI, and the endometriosis protocol) or laparoscopically.

Endometriosis has a negative impact on fertility mainly by causing the ovarian reserve to diminish (either due to the growth of endometriotic cysts or as a result of repeated surgical interventions). Because of the adherences which occur in response to the presence of endometriosis, normal pelvic anatomy is altered, and this makes reproduction more difficult. Patients with endometriosis, especially in the case of ovarian localisation, produce oocytes of poorer quality.

The treatment of endometriosis:

Medication treatment is the most common approach in endometriosis and consists in a combination of oral progestins and contraceptives. It is important to identify and select the patients for whom this type of management would be appropriate.

Surgical treatment - laparoscopy is preferred in such cases because it provides better visibility, and it employs fine instruments that can access pelvic areas otherwise hard to reach.

In the case of patients with endometriosis and infertility, a comprehensive assessment of the couple is important before deciding which assisted human reproduction technique would be optimal.

Endometriosis can become an invalidating illness with a marked negative impact on the patient’s quality of life if it is left undiagnosed while still in its incipient stages or if it is inadequately managed.”