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In Office Procedures

Woman getting ultrasounds

Colposcopy

Colposcopy (kol-POS-kuh-pee) is a procedure to closely examine your cervix, vagina and vulva for signs of disease. During colposcopy, your doctor uses a special instrument called a colposcope.

Your doctor may recommend colposcopy if your Pap test has shown abnormal results. If your doctor finds an unusual area of cells during colposcopy, a sample of tissue can be collected for laboratory testing (biopsy).

Many women experience anxiety before their colposcopy exams. Knowing what to expect during your colposcopy may help you feel more comfortable.

LEEP

LEEP uses a thin wire loop electrode which is attached to an electrosurgical generator. The generator transmits a painless electrical current that quickly cuts away the affected cervical tissue in the immediate area of the loop wire. This causes the abnormal cells to rapidly heat and burst, and separates the tissue as the loop wire moves through the cervix.

This technique allows your physician to send the excised tissue to the lab for further evaluation which insures that the lesion was completely removed, as well as allowing for a more accurate assessment of the abnormal area.

You may want to ask your doctor if it's OK to take an over-the-counter pain reliever such as ibuprofen before your procedure to help minimize any pain. Never take any drug before any medical procedure without explicitly asking your doctor about it. Always follow your doctors instructions for preparation for the LEEP.

Are there any complications associated with the LEEP?

Complications are usually mild but can include:

  • mild pain or discomfort
  • bleeding

You should call your physician if you experience bleeding that is heavier than a normal period, or if pain is severe. Other symptoms that should be reported to your physician include any heavy vaginal discharge or strong vaginal odor.

After the LEEP you should not:

  • Have sexual intercourse for as long as recommended by your physician
  • Lift heavy objects
  • Use tampons
  • Douche
  • Take tub baths--take showers only to prevent infection

What happens during the LEEP procedure?

The LEEP procedure takes about 20-30 minutes and is usually performed in your physician's office. In some ways it may seem much like a normal pelvic exam because you will lie on the exam table with your feet in the stirrups. A colposcope will be used to guide your doctor to the abnormal area. Unlike a normal colposcopy, a tube will be attached to the speculum to remove the small amount of smoke caused by the procedure.

An electrosurgical dispersive pad will be placed on your thigh. The pad is a gel-covered adhesive electrode which provides a safe return path for the electrosurgical current. A single-use, disposable loop electrode will be attached to the generator hand piece by your physician. Your cervix will be prepared with acetic acid and iodine solutions that enable your physician to more easily see the extent of the abnormal area. Next a local anesthetic will be injected into the cervix; the electroloop will be generated and the wire loop will pass through the surface of your cervix.

After the lesion is removed your physician will use a ball electrode to stop any bleeding that occurs; he may also use a topical solution to prevent further bleeding. You can leave your physician's office soon after the procedure.

Important!

It's important for you to remember that having cervical dysplasia does not mean that you have cervical cancer. However, treatment of the abnormal area is imperative to prevent abnormal cervical cells from developing into cervical cancer

After the LEEP procedure, make sure to follow your doctor's instructions precisely. Your doctor will tell you when to return for follow up Pap smears, and / or colposcopies. Keeping these follow up appointments is necessary to verify that all of the abnormal cervical tissues have been removed, as well as to make sure that if abnormal cervical cells redevelop they are caught early and treated appropriately.

Ultrasound

Our practice offers our patients the convenience of in-office ultrasounds for both obstetrics and gynecology. We perform ultrasounds for early pregnancy diagnosis, late pregnancy follow-up, evaluation of pregnancy-related complaints and complications, as well as gynecological ultrasound for evaluation of the uterus, ovaries, and to assist in diagnosis of gynecologic complaints. Same day ultrasounds are often available for emergencies.


Hysteroscopy

A hysteroscopy is a way for your doctor to look at the lining of your uterus. He or she uses a thin viewing tool called a hysteroscope. The tip of the hysteroscope is put into your vagina and gently moved through the cervix into the uterus. The hysteroscope has a light and camera hooked to it so your doctor can see the lining (endometrium) on a video screen.

A hysteroscopy may be done to find the cause of abnormal bleeding or bleeding that occurs after a woman has passed menopause. It also may be done to see if a problem in your uterus is preventing you from becoming pregnant (infertility). A hysteroscopy can be used to remove growths in the uterus, such as fibroids or polyps.

Your doctor may take a small sample of tissue (biopsy). The sample is looked at under a microscope for problems. Another surgery, called a laparoscopy, may also be done at the same time as a hysteroscopy if infertility is a problem.

It is best to have a hysteroscopy done when you are not having your menstrual period. If there is a chance that you could become pregnant, the hysteroscopy should be done before you are ovulating so your doctor is sure you are not pregnant.

Do not douche, use tampons, or use vaginal medicines for 24 hours before the hysteroscopy.

You may be given a medicine (sedative) to relax you for the test, or general, regional, or local anesthesia can be used. Your doctor will discuss this with you.

Why It Is Done?

A hysteroscopy may be done to:

  • Find the cause of severe cramping or abnormal bleeding. Your doctor can pass heated tools through the hysteroscope to stop the bleeding.
  • See whether a problem in the shape or size of the uterus or if scar tissue in the uterus is the cause of infertility.
  • Look at the uterine openings to the fallopian tubes. If the tubes are blocked, your doctor may be able to open the tubes with special tools passed through the hysteroscope.
  • Find the possible cause of repeated miscarriages. Other tests may also be done.
  • Find and reposition a misplaced intrauterine device (IUD).
  • Find and remove small fibroids or polyps.
  • Check for endometrial cancer.
  • Use heated tools to remove problem areas in the lining of the uterus (endometrial ablation).
  • Place a contraceptive implant (Essure) into the opening of the fallopian tubes as a method of permanent sterilization.

How To Prepare?

Tell your doctor if you:

  • Are or might be pregnant.
  • Are taking any medicines.
  • Are allergic to any medicines.
  • Have had bleeding problems or take blood-thinners, such as aspirin or warfarin (Coumadin).
  • Have been treated for a vaginal, cervical, or pelvic infection in the past 6 weeks.
  • Have any heart or lung problems.

IUD

IUD insertion and removal

An IUD is a small, T-shaped plastic device that is wrapped in copper or contains hormones. The IUD is inserted into your uterus by your doctor. A plastic string tied to the end of the IUD hangs down through the cervix into the vagina. You can check that the IUD is in place by feeling for this string. The string is also used by your doctor to remove the IUD.

Insertion

You can have an IUD inserted at any time, as long as you are not pregnant. An IUD is inserted into your uterus by your doctor. The insertion procedure takes only a few minutes and can be done in a doctor's office. Sometimes a local anesthetic is injected into the area around the cervix, but this is not always needed. Your doctor may have you feel for the IUD string right after insertion, to be sure you know what it feels like. You may be given antibiotics to prevent infection

*IUD insertion is easiest in women who have had a vaginal childbirth in the past.

Your doctor may have you feel for the IUD string right after insertion, to be sure you know what it feels like. You may be given antibiotics to prevent infection.

Type of IUDs

  • Hormonal IUD. The hormonal IUD, such as Mirena, releases levonorgestrel, which is a form of the hormone progestin. The hormonal IUD appears to be slightly more effective at preventing pregnancy than the copper IUD. The hormonal IUD is effective for at least 5 years.
  • Copper IUD. The most commonly used IUD is the copper IUD (such as Paragard). Copper wire is wound around the stem of the T-shaped IUD. The copper IUD can stay in place for at least 10 years and is a highly effective form of contraception.

How it works

Both types of IUD prevent fertilization of the egg by damaging or killing sperm. The IUD also affects the uterine lining (where a fertilized egg would implant and grow).

  • Hormonal IUD - This IUD prevents fertilization by damaging or killing sperm and making the mucus in the cervix thick and sticky, so sperm can't get through to the uterus. It also keeps the lining of the uterus (endometrium) from growing very thick. This makes the lining a poor place for a fertilized egg to implant and grow. The hormones in this IUD also reduce menstrual bleeding and cramping.
  • Copper IUD - Copper IUD. Copper is toxic to sperm. It makes the uterus and fallopian tubes produce fluid that kills sperm. This fluid contains white blood cells, copper ions, enzymes, and prostaglandins.

What To Expect After Treatment

You may want to have someone drive you home after the insertion procedure. You may experience some mild cramping and light bleeding (spotting) for 1 or 2 days.

Why It Is Done

You may be a good candidate for an IUD if you:

  • Do not have a pelvic infection at the time of IUD insertion.
  • Have only one sex partner who does not have other sex partners and who is infection-free. This means you are not at high risk for sexually transmitted infections (STIs) or pelvic inflammatory disease (PID), or you and your partner are willing to also use condoms.
  • Want an effective, long-acting method of birth control that requires little effort and is easily reversible.
  • Cannot or do not want to use birth control pills or other hormonal birth control methods.
  • Are breast-feeding.

The copper IUD is recommended for emergency contraception if you have had unprotected sex in the past few days and need to avoid pregnancy and you plan to continue using the IUD for birth control. As a short-term type of emergency contraception, the copper IUD is more expensive than emergency contraception with hormone pills.

Follow-up

Your doctor may want to see you 4 to 6 weeks after the IUD insertion, to make sure it is in place.

Be sure to check the string of your IUD after every period. To do this, insert a finger into your vagina and feel for the cervix, which is at the top of the vagina and feels harder than the rest of your vagina (some women say it feels like the tip of your nose). You should be able to feel the thin, plastic string coming out of the opening of your cervix. It may coil around the cervix, which can make it difficult to find. Call your doctor if you cannot feel the string or the rigid end of the IUD.

If you cannot feel the string, it doesn't necessarily mean that the IUD has been expelled. Sometimes the string is just difficult to feel or has been pulled up into the cervical canal (which will not harm you). An exam and sometimes an ultrasound will show whether the IUD is still in place. Use another form of birth control until your doctor makes sure that the IUD is still in place.

If you have no problems, check the string after each period and return to your doctor once a year for a checkup.

  • The copper IUD is approved for use for up to 10 years.
  • The hormonal IUD is approved for use for up to 5 years.

How Well It Works

The IUD is a highly effective method of birth control.

  • When using the hormonal IUD, about 2 out of 1,000 women become pregnant in the first year.
  • When using the copper IUD, about 6 out of 1,000 women become pregnant in the first year.
  • Most pregnancies that occur with IUD use happen because the IUD is pushed out of (expelled from) the uterus unnoticed. IUDs are most likely to come out in the first few months of IUD use, after being inserted just after childbirth, or in women who have not had a baby.

Advantages of IUDs include cost-effectiveness over time, ease of use, lower risk of ectopic pregnancy, and no interruption of foreplay or intercourse.

Other advantages of the hormonal IUD

Also, the hormonal IUD:

  • Reduces heavy menstrual bleeding by an average of 90% after the first few months of use.
  • Reduces menstrual bleeding and cramps and, in many women, eventually causes menstrual periods to stop altogether. In this case, not menstruating is not harmful.
  • May prevent endometrial hyperplasia or endometrial cancer.
  • May effectively relieve endometriosis and is less likely to cause side effects than high-dose progestin.
  • Reduces the risk of ectopic pregnancy.
  • Does not cause weight gain.

Advantages of IUDs include cost-effectiveness over time, ease of use, lower risk of ectopic pregnancy, and no interruption of foreplay or intercourse.

Risks

Risks of using an intrauterine device (IUD) include:

  • Menstrual problems. The copper IUD may increase menstrual bleeding or cramps. Women may also experience spotting between periods. The hormonal IUD may reduce menstrual cramps and bleeding.
  • Perforation. In 1 out of 1,000 women, the IUD will get stuck in or puncture (perforate) the uterus.1 Although perforation is rare, it almost always occurs during insertion. The IUD should be removed if the uterus has been perforated.
  • Expulsion. About 2 to 10 out of 100 IUDs are pushed out (expelled) from the uterus into the vagina during the first year. This usually happens in the first few months of use. Expulsion is more likely when the IUD is inserted right after childbirth or in a woman who has not carried a pregnancy. When an IUD has been expelled, you are no longer protected against pregnancy.

Disadvantages of IUDs include the high cost of insertion, no protection against STDs, and the need to be removed by a doctor.

Disadvantages of the hormonal IUD

The hormonal IUD may cause noncancerous (benign) growths called ovarian cysts, which usually go away on their own.

The hormonal IUD can cause hormonal side effects similar to those caused by oral contraceptives, such as breast tenderness, mood swings, headaches, and acne. This is rare. When side effects do happen, they usually go away after the first few months.

Pregnancy with an IUD

If you become pregnant with an IUD in place, your doctor will recommend that the IUD be removed. This is because the IUD can cause miscarriage or preterm birth (the IUD will not cause birth defects).

When to call your doctor

When using an IUD, be aware of warning signs of a more serious problem related to the IUD.

Call your doctor now or seek immediate medical care if:

  • You have severe pain in your belly or pelvis.
  • You have severe vaginal bleeding.
  • You are passing clots of blood and soaking through your usual pads or tampons each hour for 2 or more hours.
  • You have vaginal discharge that smells bad. You have a fever and chills.
  • You think you might be pregnant.

Watch closely for changes in your health, and be sure to contact your doctor if:

  • You cannot find the string of your IUD, or the string is shorter or longer than normal.
  • You have any problems with your birth control method.
  • You think you may have been exposed to or have a sexually transmitted infection.

IUD use and medical conditions

An IUD can be a safe birth control choice for women who:

  • Have a history of ectopic pregnancy. Both the copper IUD and hormonal IUD are appropriate.
  • Have a history of irregular menstrual bleeding and pain. The hormonal IUD may be appropriate for these women and for women who have a bleeding disorder or those who take blood thinners (anticoagulants).
  • At risk for bacterial endocarditis. Antibiotics would be used at the time of insertion and removal to prevent infection.
  • Have diabetes.
  • Are breast-feeding.
  • Have a history of endometriosis. The hormonal IUD is a good choice for women who have endometriosis.

What To Think About

The IUD is most likely to work well for women who have been pregnant before. Women who have never been pregnant are more likely to have pain and cramping after the IUD is inserted. They are also more likely to expel the IUD. But they can still use the IUD.

Pelvic inflammatory disease (PID) concerns have been linked to the IUD for years. But it is now known that the IUD itself does not cause PID. Instead, if you have a genital infection when an IUD is inserted, the infection can be carried into your uterus and fallopian tubes. If you are at risk for a sexually transmitted infection (STI), your doctor will test you and treat you if necessary, before you get an IUD.

Intrauterine devices reduce the risk of all pregnancies, including ectopic (tubal) pregnancy. But if a pregnancy does occur while an IUD is in place, it is a little more likely that the pregnancy will be ectopic. Ectopic pregnancies require medicine or surgery to remove the pregnancy. Sometimes the fallopian tube on that side must be removed as well.

Considerations

IUDs may not be a good choice if you:

  • Have a sexually transmitted infection (STI) currently or had one within the past 3 months.
  • Are not willing to use condoms to protect yourself from sexually transmitted infections.
  • Have an active infection of your vagina or cervix.
  • Have pelvic inflammatory disease (PID) or have a recent history of PID.
  • Have a bleeding disorder or take blood-thinners (anticoagulants). Your doctor may not recommend a copper IUD, but you may be able to use a hormonal IUD.
  • Have a history of problems with IUDs.
  • Have never been pregnant (you are more likely to have pain with an IUD and are more likely to have the IUD come out after it is inserted).
  • Have abnormalities of your uterus.
  • Have a uterine infection after childbirth or a septic abortion.
  • Have uterine bleeding of unknown origin.
  • Have an allergy to copper, so the copper IUD would not be an option.

If you have one of the older, all-plastic IUDs, such as the Lippes Loop, ask your doctor at your next checkup about replacing this IUD with a more effective copper or hormonal one.

Fetal Monitoring

Electronic fetal heart monitoring is commonly used for tracking how well the baby is doing within the contracting uterus and for detecting signs of fetal distress.

External fetal heart monitoring is performed by attaching external transducers to the mother's abdomen with elastic straps. The transducers use Doppler ultrasound to detect fetal heart motion, and the information is sent to the fetal heart monitor which calculates and records the fetal heart rate on a continuous strip of paper. More modern fetal heart monitors have incorporated microprocessors and mathematical procedures to improve the fetal heart rate signal and the accuracy of the recording.

During fetal monitoring, a nurse will evaluate the strip for continuity and adequacy for interpretation, identify the baseline fetal heart rate and presence of variability, determine whether there are accelerations or decelerations from the baseline, identify patterns of uterine contraction, and correlate accelerations and decelerations with the uterine contractions. This will allow the nurse to determine whether the fetal heart rate recording is reassuring, nonreassuring, or ominous. A plan can then be developed for the situation to help deliver the baby in the best possible manner.

Reading The Fetal Monitor Strip

The typical fetal monitor strip consists of two rows of graphs; the upper graph charting the fetal heart rate (in beats per minute) and the lower graph charting the mother's contractions (in mm of Hg). The normal fetal heart rate range is between 120 and 160 beats per minute. The small up and down fluctuations in the fetal heart rate are called "variability", and a long term deviation in the fetal heart trate that lasts more than 15 minutes is considered a change in baseline.

Just above the lower graph are notations to the time that corresponds with the progression of the strip. Each small square of the charts represents a span of 10 seconds, equaling 1 minute for every 6 small squares across. Since 2 squares are 1 cm wide, the strip progresses out of the machine at a rate of 3 cm/min. There are usually also numbers just below the upper chart which count an increasing number of panels that have been displayed and a decreasing number of panels left until the roll of paper containing the strip comes to an end.

The electronic fetal heart monitor is primarily used to detect fetal hypoxia (lack of sufficient oxygenation) in hopes of catching it early enough to prevent neurological damage in the unborn baby. Indications of fetal hypoxia are represented by prolonged deviations from a normal baseline pattern of the fetal heart rate. The fetal heart rate is controlled by the autonomic nervous system, with an inhibitory influence coming from the vagus nerve, and an excitatory influence coming from the sympathetic nervous system. Stimulation of the peripheral nerves of the fetus by its own activity (such as movement) or by uterine contractions causes acceleration (rise) of the fetal heart rate. A deceleration (drop) of the fetal heart rate usually indicates that the fetus is under some sort of stress, which may be a good healthy sign if it corresponds with movement or uterine contractions, but may be a bad sign if it happens apart from movement of uterine contractions.

Normal and Reassuring Patterns

The normal fetal heart rate range is between 120 and 160 beats per minute. A constant variation from the baseline (variability) reflects a healthy nervous system, chemoreceptors, baroreceptors and cardiac responsiveness. Beat-to-beat, or short-term, variability is an important indicator of fetal trouble. Loss of this variability may indicate an ominous condition, but it can also indicate healthy rest-activity in the fetus or depression of the central nervous system due to medication. An increase in variability may indicate acute hypoxia or mechanical compression of the umbilical cord.

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We deliver your family, from our skilled hands to your loving arms. Sharing the joy of new life is our job. Our practice is dedicated to the Healthcare of Women and provides complete Obstetrical and Gynecologic services.

With Dr. Starikov’s easy-going personality and genuine listening skills, he immediately puts patients at ease. Dr. Starikov is also dedicated to providing patients with the highest standard of OB/GYN care in a friendly and caring office environment.
Dr. Albert Starikov

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