A spontaneous vaginal delivery (SVD) occurs when a pregnant woman goes into labor with or without use of drugs or techniques to induce labor, and delivers her baby in the normal manner, without forceps, vacuum extraction, or a cesarean section. Assisted vaginal delivery (AVD) occurs when a pregnant woman goes into labor with or without the use of drugs or techniques to induce labor, and requires the use of special instruments such as forceps or a vacuum extractor to deliver her baby vaginally.

At one time, women who had delivered by cesarean section in the past would usually have another cesarean section for any future pregnancies. The rationale was that if allowed to labor, many of these women with a scar in their uterus would rupture the uterus along the weakness of the old scar. Over time, a number of observations have become apparent: Most women with a previous cesarean section can labor and deliver vaginally without rupturing their uterus. Some women who try this will, in fact, rupture their uterus. When the uterus ruptures, the rupture may have consequences ranging from near trivial to disastrous. It can be very difficult to diagnose a uterine rupture prior to observing fetal effects (eg, bradycardia). Once fetal effects are demonstrated, even a very fast reaction and nearly immediate delivery may not lead to a good outcome. The more cesarean sections the patient has, the greater the risk of subsequent rupture during labor. The greatest risk occurs following a “classical” cesarean section (in which the uterine incision extends up into the fundus.) The least risk of rupture is among women who had a low cervical transverse incision. Low vertical incisions probably increase the risk of rupture some, but usually not as much as a classical incision. Many studies have found the use of oxytocin to be associated with an increased risk of rupture, either because of the oxytocin itself, or perhaps because of the clinical circumstances under which it would be contemplated. Pain medication, including epidural anesthetic, has not resulted greater adverse outcome because of the theoretical risk of decreasing the attendant’s ability to detect rupture early. The greatest risk of rupture occurs during labor, but some of the ruptures occur prior to the onset of labor. This is particularly true of the classical incisions. Overall successful vaginal delivery rates following previous cesarean section are in the neighborhood of 70 This means that about 30of women undergoing a vaginal trial of labor will end up requiring a cesarean section. Those who undergo cesarean section (failed VBAC) after a lengthy labor will frequently have a longer recovery and greater risk of infection than had they undergone a scheduled cesarean section without labor. Women whose first cesarean was for failure to progress in labor are only somewhat less likely to be succesful in their quest for a VBAC than those with presumably non-recurring reasons for cesarean section. For these reasons, women with a prior cesarean section are counseled about their options for delivery with a subsequent pregnancy: Repeat Cesarean Section, or Vaginal Trial of Labor. They are usually advised of the approximate 70successful VBAC rate (modified for individual risk factors). They are counseled about the risk of uterine rupture (approximately 1in most series), and that while the majority of those ruptures do not lead to bad outcome, some of them do, including fetal brain damage and death, and maternal loss of future childbearing. They are advised of the usual surgical risks of infection, bleeding, anesthesia complications and surgical injury to adjacent structures. After counseling, many obstetricians leave the decision for a repeat cesarean or VBAC to the patient. Both approaches have risks and benefits, but they are different risks and different benefits. Fortunately, most repeat cesarean sections and most vaginal trials of labor go well, without any serious complications. For those choosing a trial of labor, close monitoring of mother and baby, with early detection of labor abnormalities and preparation for

Macrobiopsy of breast lesions is a complicated procedure when performed with vacuum assisted biopsy tools. The Spirotome is a hand-held needle set that doesn’t need capital investment, is ready to use and provides tissue samples of high quality in substantial amounts. In this way quantitative molecular biology is possible with one tissue sample. The Coramate is an automated version of this direct and frontal technology

A video showing breast examination after breast implants

A report of Female Genital Mutilationn FGM (female circucision) in Menya In Egypt تقرير من مدينة المنيا في صعيد مصر عن ختان لاناث

Imperforate Hymen

急性坏疽性阑尾炎并穿孔de 腹腔镜手术治疗

Women Health Tips: Importance of getting a pap smear, breast exam, and mammogram

Misgav Ladach - Joel Cohen approach for breech presentation

Stop suffering alone and get relief from vaginal atrophy symptoms

Typically, breast reconstruction takes place during or soon after mastectomy, and in some cases, lumpectomy. Breast reconstruction also can be done many months or even years after mastectomy or lumpectomy. During reconstruction, a plastic surgeon creates a breast shape using an artificial implant (implant reconstruction), a flap of tissue from another place on your body (autologous reconstruction), or both.

Parkinson disease (PD) is a common neurodegenerative condition. Typically beginning in the sixth or seventh decade of life, it is characterized by the unilateral onset of resting tremor in combination with varying degrees of rigidity and bradykinesia. PD was originally described by James Parkinson (1755-1824), a man of many talents and interests. Parkinson published works on chemistry, paleontology, and other diverse topics. Early in his career he was a social activist championing the rights of the disenfranchised and poor. His efforts in this area were enough to result in his arrest and appearance before the Privy Council in London on at least one occasion. In collaboration with his son, who was a surgeon, he also offered the first description in the English language of a ruptured appendix. His small but famous publication, "Essay on the Shaking Palsy," was published in 1817, seven years before his death. The clinical descriptions of 6 cases was remarkable in part because he never actually examined the people he described. Instead, he had simply observed these people on the streets of London.

Fifth disease is a mild rash illness caused by parvovirus B19. This disease, also called erythema infectiosum, got its name because it was fifth in a list of historical classifications of common skin rash illnesses in children. It is more common in children than adults. A person usually gets sick with fifth disease within 4 to 14 days after getting infected with parvovirus B19.

Brown-Séquard syndrome is an incomplete spinal cord lesion characterized by a clinical picture reflecting hemisection injury of the spinal cord, often in the cervical cord region. (See Presentation.) Patients with Brown-Séquard syndrome suffer from ipsilateral upper motor neuron paralysis and loss of proprioception, as well as contralateral loss of pain and temperature sensation. A zone of partial preservation or segmental ipsilateral lower motor neuron weakness and analgesia may be noted. Loss of ipsilateral autonomic function can result in Horner syndrome. (See Etiology, Presentation, and Workup.) As an incomplete spinal cord syndrome, the clinical presentation of Brown-Séquard syndrome may range from mild to severe neurologic deficit. (See Presentation.) Brown-Séquard–plus syndrome The pure Brown-Séquard syndrome reflecting hemisection of the cord is not often observed. A clinical picture composed of fragments of the syndrome or of the hemisection syndrome plus additional symptoms and signs is more common. These less-pure forms of the disorder are often referred to as Brown-Séquard–plus syndrome.[1] Interruption of the lateral corticospinal tracts, the lateral spinal thalamic tract, and at times the posterior columns produces a picture of a spastic, weak leg with brisk reflexes and a strong leg with loss of pain and temperature sensation. Note that spasticity and hyperactive reflexes may not be present with an acute lesion.

Hypertensive emergencies encompass a spectrum of clinical presentations in which uncontrolled blood pressures lead to progressive or impending end-organ dysfunction. In these conditions, the BP should be lowered aggressively over minutes to hours. Neurologic end-organ damage due to uncontrolled BP may include hypertensive encephalopathy, cerebral vascular accident/cerebral infarction, subarachnoid hemorrhage, and/or intracranial hemorrhage.[1] Cardiovascular end-organ damage may include myocardial ischemia/infarction, acute left ventricular dysfunction, acute pulmonary edema, and/or aortic dissection. Other organ systems may also be affected by uncontrolled hypertension, which may lead to acute renal failure/insufficiency, retinopathy, eclampsia, or microangiopathic hemolytic anemia.[1] With the advent of antihypertensives, the incidence of hypertensive emergencies has declined from 7% to approximately 1% of patients with hypertension.[2] In addition, the 1-year survival rate associated with this condition has increased from only 20% (prior to 1950) to a survival rate of more than 90% with appropriate medical treatment

A sleep disorder, or somnipathy, is a medical disorder of the sleep patterns of a person or animal. Some sleep disorders are serious enough to interfere with normal physical, mental, social and emotional functioning. Polysomnography and actigraphy are tests commonly ordered for some sleep disorders.

Genital warts are one of the most common types of sexually transmitted infections. At least half of all sexually active people will become infected with human papillomavirus (HPV), the virus that causes genital warts, at some point during their lives. Women are somewhat more likely than men to develop genital warts. As the name suggests, genital warts affect the moist tissues of the genital area. Genital warts may look like small, flesh-colored bumps or have a cauliflower-like appearance. In many cases, the warts are too small to be visible. Like warts that appear elsewhere on your body, genital warts are caused by the human papillomavirus (HPV). Some strains of genital HPV can cause genital warts, while others can cause cancer. Vaccines can help protect against certain strains of genital HPV

Uterine rupture is usually when the scar from your previous caesarean section tears open. Though it's uncommon, you should be aware of this risk, particularly if you're thinking about giving birth vaginally next time. It's possible for your scar to gape slightly while you're pregnant (scar dehiscence).

A surgeon begins the PPH stapled hemorrhoidectomy by inserting a circular anal dilator and obturator into the anal canal and then securing the dilator in place with four sutures. The surgeon then inserts a PPH anoscope into the obturator. Next, he places a circumferential purse-string suture of 2-0 Monocryl on a UR-6 needle 4 cm proximal to the dentate line. The surgeon opens a PPH stapler and places its anvil across the purse string. The stapler is then closed and fired; it is held closed for two minutes to improve hemostasis. Prior to firing the stapler in a female patient, the surgeon places a gloved finger in the vagina to ensure the vaginal mucosa and rectal-vaginal septum are not trapped within the jaws of the closed stapler. The surgeon then opens and removes the stapler.

Gynecological Examination