1. The general gynecology examination must incorporate
the whole physical examination to adequately diagnosis and treat
2. Gynecologic causes of acute abdomen include: pelvic inflammatory
disease and tubo-ovarian abscess, ovarian torsion, ruptured ectopic
pregnancy, and septic abortion. Pregnancy must be ruled out early in
assessment of reproductive age patients presenting with abdominal
or pelvic pain.
3. Pregnancy confers important changes to both the cardiovascular
system and the coagulation cascade. Trauma in pregnancy must be
managed with these changes in mind.
4. Pelvic floor dysfunction (pelvic organ prolapse, urinary and
fecal incontinence) is common; 11% of women will undergo
a reconstructive surgical procedure at some point in their lives.
5. It is critical that abnormal lesions of vulva, vagina, and cervix
are biopsied for diagnosis before any treatment is planned; postmenopausal
bleeding should always be investigated to rule out malignancy. Early-stage
cervical cancer is managed surgically whereas chemoradiation is
preferred for stages IB and above.
6. Risk-reducing salpingo-oophorectomy should be considered in women
with BRCA1 or BRCA2 mutations;
risk-reducing salpingo-oophorectomy and complete hysterectomy should
be considered in women with hereditary nonpolyposis coli cancer.
7. Complete debulking for epithelial ovarian cancer is a critical
element in patient response and survival. The preferred primary
therapy for optimally debulked advanced-stage ovarian epithelial
ovarian cancer in women without significant intra-abdominal adhesions
is intraperitoneal chemotherapy.
The female reproductive tract is a unique component of the body with
a multitude of tightly regulated functions. Many of the activities
normally ongoing, such as angiogenesis and physiologic invasion,
are necessary for the reproductive organs to fulfill their purpose,
and are usurped in disease. Immune surveillance is modified by multiple
mechanisms under investigation, regulated in a different fashion,
to allow implantation, placentation, and development of the fetus.
How this potential disruption of the normal immune barriers is involved
in pathologic events is incompletely understood. The ongoing rupture,
healing, angiogenesis, and regrowth of the ovarian capsule and endometrium
during the menstrual cycle uses the same series of biologic and
biochemical events that are also active in pathologic events such
as endometriosis and endometriomas, mature teratomas, dysgerminomas,
and progression to malignancy. Genetic abnormalities, both germline
and somatic, that may cause competence and/or promote disease
are now being uncovered, especially in the progression to malignancy, in
pharmacogenomics, and in surgical risks such as bleeding and clotting.
Incorporation of genetic and genomic information in disease diagnosis
and assessment is a wave for the near future and may alter how we
consider who is at risk, how diseases are diagnosed and followed,
and even what drugs or therapies we use for an individual patient.
These points will be incorporated with surgical approaches into
discussions of anatomy, diagnostic work-up, infection, surgical
and medical aspects of the obstetric patient, pelvic floor dysfunction,
The outlet of the bony pelvis is defined by the ischiopubic ramus anteriorly