Obstetrics and Gynecology

The Obstetrics and Gynecology Department in MediClinic takes care of all age’s women, starting from the beginning of the reproductive years to the menopause. The aim of the department if to provide to all our patients a diagnosis, therapy and correct suggestions to prevent pathologies correlated with developmental age and ageing.

To go beyond the difficult challenges that every woman faces from puberty to menopause, it is essential the support of an integrated and high-level health assistance. For this reason, our gynecologists help our patients to live positively and quietly their femininity. Our specialists collaborate with all the MediClinic’s doctors that have specific competences in the woman wellness care.

Why choose MediClinic?

MediClinic offers to its patients the latest diagnostic devices. Our gynecologists uses the most efficient methods for the diagnosis and treatment of the pathologies, according to the most recent and solid scientific evidences. Moreover, the Gynecology Department can recommend to its patients the best surgical treatments. Most of the surgeries can be performed in MediClinic.

Clinical pathways

The Woman Health Pathways are thought to meet the patient’ needs in a few hours. They consist in diagnostic exams, including the gynecology consult, that allow to obtain the patient’s medical case. In each pathway, the gynecologist is the reference point for all the specialists and for all their consults and possible surgeries. At the end of the pathway, the aim of the gynecologist is to point out a solution for the pathology and an adequate therapy.

• WOMEN’S PATHWAY for a complete clinical picture of the patient – gynecologic visit, pelvic ultrasound, colposcopy, pap-test or thin prep, HPV and DNA test for HPV virus, breast evaluation, breast ultrasound and mammography;
• MENOPAUSE PATHWAY for women older than 45 – visits in cooperation with our senologist, cardiologist, rheumatologist and urologist;
• UROGYNECOLOGIC PATHWAY for patients with urinary disorders, incontinence or genital prolapse – urological visits such as uroflowmetry, urodynamics, renal ultrasound, urine culture test and pelvic floor physiotherapy sessions;
• ATYPICAL BLEEDING, PELVIC MASSES AND MENSTRUAL DISORDERS PATHWAY for patients with atypical bleeding, pelvic pain, uterine fibroids, adnexal tumefactions – blood chemistry analyses, tumor markers, complete abdominal ultrasound, diagnostic or operative hysteroscopy and pelvic MRI;
• OBSTETRIC PATHWAY for expecting women – preparation course for childbirth and pelvic floor rehabilitation.

Pelvic floor rehabilitation

The pelvic floor rehabilitation consists in the evaluation and treatment of the dysfunctions of the pelvic area of urological, gynecologic, andrological and colorectal nature, which can be related to an altered functionality of the pelvic floor.

The re-educational path is complicated, it begins with the assessment of the patient’s pelvic floor health, in order to plan a tailor-made therapy. It may consists of a series of non-instrumental techniques, such as physiokinesiotherapy, and instrumental techniques, such as electrostimulation or biofeedback.

The rehabilitation of the pelvic floor is therefore addressed to all those people, men and women, who have an altered pelvic functionality, such as: urine leaking, symptoms of urgency, difficulty/pain/insensitivity during sexual intercourse, pain or sensation of weight, difficulty in holding gas or feces, constipation.

Diagnostic procedures

Pelvic ultrasound (transabdominal and trasvaginal)

The pelvic ultrasound is performed using 2, 3 and 4 size ultrasound scanners. The devices are the most cutting-edge on the marketplace: their precision allow to facilitate the doctor diagnosis. The pelvic ultrasound is a non-invasive exam, that requires a minimal preparation and it does not provoke side effects. It is the best exam to study the uterine morphology and to identify the causes for pain or atypical bleeding. The exam can be performed in two ways: with a transabdominal probe (placed on the patient abdomen) or with a transvaginal probe. To perform the transabdominal ultrasound, the patient must have a full bladder.

The patient can obtain the best diagnostic result with the transvaginal probe, because the doctor can better examine the internal genitals.

Moreover, the pelvic ultrasound enables to locate al the abnormal uterine formations, like fibroids, polyps and synechiae. The probe can deeply examine the most internal genital organs and the uterine appendages, like ovaries, and to identify cysts.

The pelvic ultrasound is essential to diagnoses the pelvic peritonitis and the endometriosis. The ovaries ultrasound allows to count follicles during pregnancy. It is possible to perform it at the beginning of a pregnancy, after performing a pregnancy test: it can be useful to verify a possible intrauterine pregnancy, as it can shows if the pregnancy is located in a tube. In this case, it is necessary to promptly undergo surgery, as this may cause a tube explosion and an important bleeding in the peritoneum (hemoperitoneum). In most cases a pelvic ultrasound can determine the origin of pain and bleeding. In other case, the patient can perform an MRI with or without contrast medium.

Pap smear

The pap smear (called in this way in honor of the doctor that invented the test in 1945, Georgios Papanicolau), is the main method used to diagnose cervical cancers in women. This test should be performed every three years from 25 to 65 ages. The doctor takes a sample of the patient cervical cells. The cells are positioned in a slide, colored and examined by the anatomopathologist, that evaluate if abnormal cells are present.

The aim of the screening is to diagnose the presence of tumoral cells before the cancer develop.

There can be three classes of risk in the observed anomalies and, according to the risk, the doctor decides the necessary diagnostic procedure. The classes of risk all called CIN1, CIN2 and CIN3, where CIN means Cervical Intraepithelial Neoplasia. A neoplasia is the pre-cancerous lesion of cervice.

In CIN1 and CIN2 cases, respectively one third or two thirds of cervical cells are abnormal. For these patients it is recommended to perform regular screenings and, if necessary, a colposcopy. According to the colposcopy results, it can be necessary a cervical biopsy. The results can confirm the diagnosis or evidence a more serious situation. In this second case, it can be necessary to perform a surgery called conization, which consists in the removal a small part of the cervix. The conization is an outpatient procedure. The removed portion of the cervix is analyzed to determine if the risk is low or medium. The conization has no contraindications and does not provoke significant bleedings. Associated with this surgery, usually the patient performs a cervical biopsy, that is that area that extend from the external part of the cervix to the uterine cavity. The biopsy is performed to check that all the abnormal cells were removed.

CN3 patients have a cancer. For those patients, the conization has to be more aggressive: the cervix sample has to be more extended. The operation is performed using a scalpel, as the sample has to be deeper and wider that the tumoral tissue. The exam is associated with a cervical biopsy or, in rarer cases, with and endometrial biopsy.

Colposcopy

The colposcopy is an exam that is used to complete the diagnosis of a cervical pathology. It is usually performed together with the pap smear. The exam allows to the doctor to identify and localize the ill parts of the cervix, that are highlighted by different colors. The doctor positions the colposcope near the vulva. A bright light is shined into the vagina, and the doctor looks through the lens, as if using binoculars. The doctor may apply a solution of vinegar or another type of solution to the area, which helps highlight any areas of suspicious cells. The areas that receive color are sane, the ones that do not react to the substance may be affected by a disease. The images collected by the colposcope can be photographed and they allow to see the pathology in real time. It is different from the cytological exam (that determine the presence of tumor cells) or to the ultrasound (that uses ultrasound and requires to the doctor to interpret the data): with the colposcopy the doctor can see the cervix and evaluate her health condition.

Hysterosalpingography

In MediClinic the patient can perform the hysterosalpingography: this procedure has an essential role in the infertility diagnosis. It is an outpatient and non-invasive procedure, based on an ultrasound, that focuses on the Fallopian tubes. In allows to identify or exclude the Fallopian tubes causes of infertility. It provokes a minimal discomfort, but it eliminates the necessity to use ionizing radiations or ionized contrast mediums (that can provoke allergies) to analyze the tube.

The exam consists in the introduction of a physiologic solution and of a small catheter in the uterus. As the ultrasound detects the passage of water and air, with the catheter it is possible to perform a complete study of the uterus and annexes, with particular interest to the tubes. It is possible to verify if the infertility is caused by pathologies or tubes malformations. The uterine cavity is examined by the ultrasound. The hysterosalpingogram is useful if the patient cannot perform an hysteroscopy.

Diagnostic hysteroscopy

The hysteroscopy is the best method to evaluate the uterine cavity. It requires a simple preparation and it is an outpatient procedure that can be performed without anesthesia. It is performed using the hysteroscope, which is an instrument long 25-30 centimeters, equipped with a camera that allow to the doctor to examine the uterine cavity. There are two types of hysteroscopes: the diagnostic one, that is used to show the uterine cavity and has a diameter of 3 millimeters, and the operative one, that is equipped with a camera and with an electric scalpel. The operative hysteroscope has a diameter of 8 millimeters and it is used to remove the intrauterine formations detected by the diagnostic hysteroscope. The doctor inserts the hysteroscope in the vaginal cavity and, thanks to a flow of water and physiologic solution that distend the cervical canal, evaluate the uterine cavity. The hysteroscope is used identify pathologies shown by an ultrasound. A hysteroscopy can be performed every time that the cause of an abnormal bleeding was not identified, as it enables to examine the uterine cavity and to determine the origin of symptoms.

In few minutes it is possible to perform a complete study, sometimes associated with a biopsy. Once that the exam has finished, the doctor removes the hysteroscope and the patient can leave the facility. It the doctor identifies neoformations like polyps, synechiae, adherences or septum (irregularity of the uterine cavity), the doctor can immediately program the surgical procedure.