A stamped case of PID with hydrosalphinxwith with adenomosis & bulky uterus too + Cevicitis. So I think she is multi with completion of child bearing . So in such case Hysterectomy with bilateral tubectomy will be ideal(can go for oophrectomy as well if 42+) Tt is totally going to differ if she is young.
31yrs old with adenomyosis nd cervicitis with pain lower abdomen nd white discharge.Give her antibiotic course of Ciprofloxacin nd Metrogyl for 2wks.Candid CL vag tab for 6days.Treat her husband simultaneously.Rpt scan after 1month.Do papsmear on D7/8 of next cycle aftet treating infection.Do endometrial biopsy..For adenomyosis if she has menstrual problem or dysmenorrhea give her T.Norethisterone 5mg b.d for 21days from D5 for 6 cycles.Rpt scan after 6months.If no improvement nd she has completed her family adv.hysterectomy.
Patient is having pain abdomen and vaginal discharge.Take detail history regarding UTI also.Ask if any history of menorrhagia n sv. dysmenorrhea as usg shows adenomyosis.Do gynaec check up,ps,pv examination.see for vaginitis and Abnormal discharge, see size of uterus n tenderness in fornices in case of PID. Get CBC, urine exam, pelvic scan. We will gv treatment of PID as said and follow up the patient. If menstrual problems are there ,pain persists and family is complete,then only we go for TAH .
Age of patient ? Its a typical PID case.do ps take cervical swab for C/S, pap's smear. Start cap Doy 100mg bdx 14days, NSAID, SERRATID, Tab meterogyl 4oomtds for 5 days. Inj placentrex im od x 14 days.vaginal pessary x 7 days. Review after two wks if not not relieved completely, Tab Azithromycin 500mg od x 5days may be repeated. If age about forty & family is completed hysterectomy may be advised.
IV antibiotics, antispasmodics+ analgesics for pain relief(mostly due to hydrosalpinx), high vaginal & cervical swab, oral doxy , vaginal tablets for cervicitis,hysterectomy should be the last line of trt 'cos even afterwards she would have lower abdominal pain.
There is no mention of menstrual history and PS/ PV findings. Pap smear to be done. Management will depend upon menstrual history and Pap smear findings. If required, cervical biopsy should be taken. At the age of 31 years, decision about hysterectomy has to be taken in extreme circumstances.
This is a case of adenomyosis n endometriosis... For white discharge given Clingen forte vag supp...manage further according to symptoms dysmenorrhea, infertility
age is 31 so if family complete then t/t is hysterectomy with b/l tubectomy +/- b/l oophorectomy (decide on table, depending on ovary status)
I agree with Dr.Y Verma.
This is a case of PID with cervicitis with adenomyosis.Rx-doxycycline +flagyl .vaginal swab&pap smear to be taken.
Cases that would interest you
- Login to View the image
F.24. Married for 4yrs. No issue. Cycle regular and average flow. HSG.Dr. Syam Sundar Patro1 Like24 Answers
- Login to View the image
Friends today I am discussing about Female Infertility . Female Infertility is a condition that affects approximately 1 out of every 6 couples. An infertility diagnosis is given to a couple that has been unsuccessful in efforts to conceive over the course of one full year. When the cause of infertility exists within the female partner, it is referred to as female infertility. Female infertility factors contribute to approximately 50% of all infertility cases, and female infertility alone accounts for approximately one-third of all infertility cases. Causes of female infertility The most common causes of female infertility include problems with ovulation, damage to fallopian tubes or uterus, or problems with the cervix. Age can contribute to infertility because as a woman ages, her fertility naturally tends to decrease. Ovulation problems may be caused by one or more of the following: A hormone imbalance A tumor or cyst Eating disorders such as anorexia or bulimia Alcohol or drug use Thyroid gland problems Excess weight Stress Intense exercise that causes a significant loss of body fat Extremely brief menstrual cycles Damage to the fallopian tubes or uterus can be caused by one or more of the following: Pelvic inflammatory disease A previous infection Polyps in the uterus Endometriosis or fibroids Scar tissue or adhesions Chronic medical illness A previous ectopic (tubal) pregnancy A birth defect DES syndrome (The medication DES, given to women to prevent miscarriage or premature birth can result in fertility problems for their children.) Abnormal cervical mucus can also cause infertility. Abnormal cervical mucus can prevent the sperm from reaching the egg or make it more difficult for the sperm to penetrate the egg. How is female infertility diagnosed Potential female infertility is assessed as part of a thorough physical exam. The exam will include a medical history regarding potential factors that could contribute to infertility. Healthcare providers may use one or more of the following tests/exams to evaluate fertility: A urine or blood test to check for infections or a hormone problem, including thyroid function Pelvic exam and breast exam A sample of cervical mucus and tissue to determine if ovulation is occurring Laparoscope inserted into the abdomen to view the condition of organs and to look for blockage, adhesions or scar tissue. HSG, which is an x-ray used in conjunction with a colored liquid inserted into the fallopian tubes making it easier for the technician to check for blockage. Hysteroscopy uses a tiny telescope with a fiber light to look for uterine abnormalities. Ultrasound to look at the uterus and ovaries. May be done vaginally or abdominally. Sonohystogram combines an ultrasound and saline injected into the uterus to look for abnormalities or problems. Tracking your ovulation through fertility awareness will also help your healthcare provider assess your fertility status. Female infertility treatment Female infertility is most often treated by one or more of the following methods: Taking hormones to address a hormone imbalance, endometriosis, or a short menstrual cycle Taking medications to stimulate ovulation Using supplements to enhance fertility – shop supplements Taking antibiotics to remove an infection Having minor surgery to remove blockage or scar tissues from the fallopian tubes, uterus, or pelvic area. There is usually nothing that can be done to prevent female infertility caused by genetic problems or illness. However, there are several things that women can do to decrease the possibility of infertility: Take steps to prevent sexually transmitted diseases Avoid illicit drugs Avoid heavy or frequent alcohol use Adopt good personal hygiene and health practices Have annual check-ups with your GYN once you are sexually active When should I contact my healthcare provider? It is important to contact your healthcare provider if you experience any of the following symptoms: Abnormal bleeding Abdominal pain Fever Unusual discharge Pain or discomfort during intercourse Soreness or itching in the vaginal area Some couples want to explore more traditional or over the counter efforts before exploring infertility procedures. If you are trying to get pregnant and looking for resources to support your efforts, we invite you to check out the fertility product and resource guide provided by our corporate sponsor. Review resource guide here. Homeopathic Treatment for Infertile Women: Homeopathic treatment for infertility of women is safe for the patient as the medicines are non-toxic and naturally extracted. These medicines can be used for a longer period of time. A homeopath practitioner will take a lot of things into account while treating the patient- like her mental and physical constitution. He or she will try to investigate the underlying causes that are leading to the infertility. Here are some common medicines, used for the treatment of infertile women: Medicines for Patients having Acidic Vagina: In some females, the vaginal fluids are extremely acidic in nature. Thus, the sperm fails to stay alive under such conditions and travel further up the reproductive tract for fertilisation with ovum. Therefore, the woman fails to conceive. In such cases, borax and Natrum Phos are prescribed for the patient. While Borax is given to females with vaginal discharge similar to the white portion of an egg, Natrum Phos is for women with creamy and honey-coloured discharge. Medicine to Cure Prolonged Periods or Menorrhagia: When a female suffers from prolonged periods, she might turn infertile. Besides, the patient may also suffer from Leucorrhea, anaemia and fatigue. To cure infertility in such cases, two medicines are used- Calcerea Carb and Aletris Farinosa. Women with extremely longer periods are given Calcerea Carb. Women with early menses can take Aletris Farinosa. Medicines for Women Experiencing Shorter Periods: Infertility is also caused when the monthly period cycle of the patient is irregular. She may be facing extremely shorter and scanty periods. Under such circumstances, Pulsatilla and Sepia are prescribed for the patient. Sepia is for women who feel a bearing down sensation in the uterus. Pulsatilla is given to women who are facing scanty periods ever since their menarche. Medicine for Women with Reduced Sexual Drive: Some women complain of having decreased sexual desire or arousal. Agnus Castus and Sepia are given to such women. Sepia is for female patients who have excessively dry vagina and face pain during intercourse. If you wish to discuss any specific problem, you can consult a homeopathDr. Rajesh Gupta14 Likes27 Answers
- Login to View the image
46yrs female ,P2l2 c/o irregular menses Dysmenorrhea... 2yrs LMP-10/1/17 M/H- 2-3/ 20 to 45 days O/H- p1 &2- female- FTND Not a k/c/o HTN/DM Usg report attached... What's the management?Dr. Poonam Khot2 Likes30 Answers
- Login to View the image
A 30 year old female presented with white discharge from the vagina. It is not related to menstruation cycle. She has this discharge daily. What should be the procedure for this?Dr. Mahima Chaudhary6 Likes26 Answers
- Login to View the image
What is your opinion of doing bilateral salpingo Oophorectomy at the time of hysterectomy. Coz patients are of the opinion that if they undergo Tubectomy,they will land with a BIGGER operation that is hysterectomy.therefore some people come asking to do a hysterectomy after child bearing. If only hysterectomy is done when indicated and later if they require laparotomy for ovarian cyst /tumour,patients question "why you didn't remove these appendages earlier. One patient had hysterectomy,followed by laparotomy again for an ovarian cyst,later another cyst on other side -third surgery .she again developed cystic mass in the pelvis for which she had fourth surgery . Though we leave ovaries ,their function gradually comes down after hysterectomy and they have PMS and osteoporosis. When I have to do a hysterectomy ,I remove the appendages if she is above 40 years and retain them if she is young. What are your opinionsDr. Suvarchala Pratap10 Likes21 Answers