[醫如往常] Senior Clerkship Day 8: Ob/Gyn Hysteroscopy, SILS, 病歷寫作

Hysteroscopy 楊教授

Resectoscope

TCR, Trans Cervical Resection

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Timing: proliferative follicular phase

Contraindication: PID, Pregnancy, cervical cancer

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Pre-TCR

Ultrasonography

Laminaria 海草棒 吸水撐大cervix

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Common

Endometrial polyp, sono hyperechoic

Intrauterine myoma type 0

Submucous myoma type I

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Septate可以用

Bicornuate 不能用

用3D sono看fundus

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Asherman syndrome

Uterine adhesion

Central 比較好

Marginal type 不適合

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Post operation

No need for NPO

Oral antibiotics

Discharge 當天或隔天

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Afternoon Meeting

Single-port laparoscopy(SPL) single-incision laparoscopic surgery (SILS)

• Blood loss
• Diet initiation
• Hospitalization

NTUH用手套改造

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IVF醫學史

成大婦產部 許教授: 2010諾貝爾獎IVF之父 RG Edwards惟一台灣學生

384-322 BC Aristotle:  "Seeds" theory

1578-1657 William Harvey:  "Sperm" theory

Leeuwenhoek: First Sperm study

Dalenpatus: homunculus

1826 Von Bear :Modern father of embryology: Oocytes

1939 Pincus rabbit

1959 張明覺 試管嬰兒之父 rabbit

Polge 冷凍精液大師, 台大鄭登貴指導教授

1967 Patrick Steptoe 腹腔鏡大師

102次失敗

1978 第一成功IVF: Louise Brown華誕

1980 Bourn Hall Clinic

1987 台大首例IVF
 

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鍾醫師 病歷寫作

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General Gynecology

• Introduction:

– This __ year old, GxPx woman is a patient with a

history of A, B, C under __, and D.

• Why is she here?

– She began to have _____ since….

– She experienced _____ for…..

• Course of disease or treatment:

– She went to an LMD and…..

• Echo? CT? Lab?

• Diagnosis?

• Medications given? Surgeries done?• At our hospital:

– Came to our OPD for second opinion?

– Transferred to our ER?

• Echo? CT? Lab?

• Medications given? Surgeries done?

• Impression?

• Plan:

– Therefore, under the impression of _______, she

was admitted for_______.

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General Obstetrics

• Introduction:

– This __ year old, GxPx woman is pregnant for GA __.

– She has a history of A, B, C under __, and D.

• Prenatal care:

– She received prenatal care at ____

– Abnormal or normal results?

• Why is she here?

– APH? Preterm uterine contraction? Previous C/S? Placenta

previa? .....

• Plan:

– Due to labor sign/PROM/Preterm labor/Previous C/S….,

she was admitted for delivery/scheduled C/S, etc.

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GYN oncology

• Introduction:

– This __ year old, GxPx woman is a patient with a history of

A, B, C under __, and D.

• Why is she here?

– Vaginal bleeding? Post-menopausal bleeding? PAP smear

results? Abdominal pain? Accidental findings?

• Course of disease or treatment:

– She went to ____ and did this there.

• Echo? CT? Lab?

• Diagnosis?

• Medications given? Surgeries done?

• Pathology?• At our hospital:

– Came to our OPD for second opinion?

– Transferred to our ER?

• Echo? CT? Lab?

• Medications given? Surgeries done?

• Impression?

• Plan:

– Therefore, under the impression of _______, she

was admitted for_______.

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OBGYN history:

– GxPx, NSD? C/S?

– Menstruation cycle, I/D

– LMP, PMP?

– Past history

– Operations

– PAP smear• Pelvic examination:

– Vagina/vulva: grossly normal

– Cervix(VP): grossly normal, lifting pain?

– Discharge: mild whitish mucoid? Bloody?

– Uterus: Enlarged? About GA ___

– Adnexa: tenderness? Rebounding pain? Mass

noted? (egg size, tennis ball size, etc….)

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Endometrial cancer

Vaginal bleeding stage 1A

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Pubic symphysis week 12

Umbilicus week 20

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Echo trans-Abdominal/Vaginal:

Uterus

Avfl or Rvfl

(A+B)*C*D

EM

LOV

ROV sand like chocolate cyst

CDS: ascites or free