FLOW CHARTS FOR GYNAECOLOGICAL CONDITIONS---DIAGNOSIS & MANAGEMENT

Prof. M.C. Bansal. MBBS. MS . MICOG. FICOG.Founder Principal & Controller ;Jhalwar Medical College And Hospital Jhalawar.Ex . Principal & Controller ; Mahatma Gandhi Medical College And Hospital , Sitapura; Jaipur.

Pain full Vulva--1

Pain Full Vulva

Oogenesis /spermatogenesis From stem cells e.g, primary germ cell present in primordial Gonads

Normal work up Plan For Infertile couple

INVESTIGATION Plan For Infertile Couple

Investigation For Anovulation

Treatment Plan For infertile couple

Sexual Motivation

Sexuual Arousal disorders

Sexual Asualt—Case Management Plan

Steroidogenesis----Flow Chart

Pathway of Testosterone synthesis

Androgen Production In Adrenals &ovary

Flow Chart For Management Ambeguous sex of child

Investigation plan for sexual development

Investigation Plan For girl with No Development of secondary sex characters

Flow chart of cloting

DUB: Classification, Pathophysiology And Endometrial Changes

OVULATORY

Idiopathic Ovulatory Menorrhag

ia

Corpus Luteum

insufficiency

Normal Progestero

ne

Altered PG E : PG F

Menorrhagia

Secretory Endometrium

Reduced Progesterone

Reduced PG F2

Premenstrual Spotting

(Polymenorrhoea)

Irregular ripening

ANOVULATORY

Metropathica Haemorrhagica

Prolonged Oestrogen

No Progesterone

Reduced PG F2

Amenorrhoea followed by

bleeding

Hyperplastic Endometrium

Threshold Bleeding

Low Oestrogen

No Progesterone

Reduced PG F2

Polymenorrhoea/

Polymenorrhagia

Proliferative Endometrium

Management of Abnormal Uterine Bleeding of Endometrial cause

Management of Abnormal Uterine Bleeding of Endometrial cause---2

DUB management in Reproductive Age Group Abnormal bleeding Clinical Evaluation Normal AbnormalMedical Rx USGResponse No Response Rx AccordinglyCont. For USG3-6 months/ Polyp

NormalLNG –IUS Response

No Response

Hysterectomy

hysteroscopic polypoidecto

myEndo . Ablation

LNG -IUS= Levonorgstrel intra uterine system

DUB Management in Perimenopausal age group

Abnormal Uterine Bleeding

clinical Evaluation

Risk Factors for Hyperplasia , carcinoma , irregular acyclic Bleeding

NO

Yes

Low Dose OCS

USG, Fractional Curretage, endometrial HP examination

Atypical Hyperplasia

Simple Hyperplasia

Hysterectomy

Low Dose Ocs / cyclical

Progesterone

Pathogenesis Of PMS

Changes in Ovarian steroids

Alteration In Neurotransmiters ( adrenergic, steroidogenic opoids , GABAergic)

Genetic Socio

Predisposition PMS/PMDD culturalFactor

PreMenstrual Syndrome

Treatment Of Chronic Pelvic Pain

Treatment Of Chronic Pelvic Pain --2

Interpretation of Cervcal Cytology -1

Interpretation Of Cervical Cytology --2

Management Of Recurrence of Ca Cervix

Flow chart for Management of High Risk Case of Endometrial Cancer--2

Differentiation Pathway of Germ Cell Tumors

Treatment Plan For Ca Ovary

Symptoms Of suspecious of

Management of Hyper prolactnemia