Patient training

In our day and age, conceiving a child is often a programmed decision. Many couples decide to attend a preconception consultation, which is useful for early assessment and diagnosis of medical conditions with potential impact on pregnancy.

The patients’ medical histories

The obstetrician seeks to learn:

- Relevant information regarding the medical history of the female patient, such as her age when she started menstruating (her menarche), the regularity of her menstrual cycles, any prior pregnancies, abortions, deliveries, as well as her height, weight, body mass index.
- The history of her gynaecology consultations
- The personal and family medical surgical history

- surgical interventions undergone by the female patient throughout her life, as well as any diagnosed medical conditions, corresponding treatment, medication and doses.
- The family history with all the gynaecological conditions occurring in the patient’s family, any significant medical surgical conditions of the patient’s relatives, as well as any history of children born with genetic syndromes, organic malformations, or deceased within the first year of life.
- The patient’s work environment in order to identify professional risk factors, as well as lifestyle-related aspects such as smoking, the consumption of alcohol and recreational drugs, eating habits, physical activity.

Tests and investigations recommended before conception, depending on the medical history of the female patient
- Complete blood count
- Blood type and Rh factor of both partners
- Viral tests: anti-HBs, anti-HVC, HIV, RPR
- TORCH test
- Evaluation of liver function: AST, ALT, alkaline phosphatase, LDH
- Evaluation of kidney function: Urea, creatinine, uric acid, urinalysis.
- Glycemia, the HOMA index
- Evaluation of thyroid function: - TSH, FT3, FT4, anti-TPO antibodies
- Prolactin
- Vitamin D
- Evaluation of ovarian function: - AMH, FSH, LH, oestradiol, progesterone
- The Papanicolau smear test, the vaginal wet mount, Mycoplasma, Ureaplasma, Chlamydia
- The vaginal ultrasound
- The thrombophilia profile

Recommendations for preconception
- Supplementing the intake of folic acid with 5 mg 1 tablet/day for the prophylaxis of neural tube defects
- Addressing pathological test results in agreement with the members of the multidisciplinary team (gynaecologist, diabetologist, endocrinologist)
- Ensuring a balanced lifestyle with a diversified died as advised by the nutritionist and with regular physical activity to keep the BMI within normal range
- Giving up smoking at least 3 months before conception
- Treating gynaecological conditions diagnosed during the consultation process

The recommendations of the Origyn team
- Bring with your to the preconception consultation all the test results and documents relevant to your medical history
- Be honest and do not given erroneous answers to the doctor’s questions - each question aims to facilitate a complete diagnosis and the answer can influence the doctor’s next steps!
- Collaborate openly with the doctor and ask any questions you may have - you should have no uncertainties or ambiguities when you leave the doctor’s office!

Modern obstetrics seeks to facilitate collaboration between the specialist gynaecologist, the patient, and other types of specialists in order to diagnose and prevent any problem that may affect the foetus, the mother, or the safe delivery of the baby.
Depending on the stage of your pregnancy, several routine blood tests, urine tests, and vaginal smear tests are recommended as part of the adequate monitoring of the pregnancy!

The first trimester of pregnancy - weeks 1-14
- Complete blood count
- Blood type and Rh factor of both partners
- Anti-Rh antibodies in case the mother is Rh negative and the partner is Rh positive
- Viral tests: anti-HBs, anti-HVC, HIV, RPR
- TORCH test, Listeria
- Evaluation of liver function: AST, ALT, alkaline phosphatase, LDH
- Evaluation of kidney function: Urea, creatinine, uric acid, urinalysis, urine culture
- Glycemia
- Evaluation of thyroid function: - TSH, FT3, FT4, anti-TPO antibodies
- Vitamin D
- The Papanicolau smear test, complete vaginal smear test
The most important test during the first trimester - the screening for genetic syndromes
- Double test
- Non-invasive genetic testing - NIPT - as recommended by the attending physician
- Invasive testing - amniocentesis or chorionic villus sampling - as recommended by the attending physician
The routine tests which need to be repeated throughout the pregnancy
- Complete blood count
- Evaluation of liver function: AST, ALT, alkaline phosphatase, LDH
- Evaluation of kidney function: Urea, creatinine, uric acid, urinalysis, urine culture
- Glycemia
- Anti-Rh antibodies in case the mother is Rh negative and the partner is Rh positive

Al doilea trimestru – săptămâna – 15-27
- Complete blood count
- Anti-Rh antibodies in case the mother is Rh negative and the partner is Rh positive
- The elements of the TORCH test to which the patient is not immune must be repeated on week 20 and then on week 28 of gestation
- Evaluation of liver function: AST, ALT, alkaline phosphatase, LDH
- Evaluation of kidney function: Urea, creatinine, uric acid, urinalysis, urine culture
- Glycemia
- The glucose tolerance test - at weeks 24-28 - as recommended by the attending physician
- The complete vaginal smear test

The third trimester - weeks 28-40
- Complete blood count
- Anti-Rh antibodies in case the mother is Rh negative and the partner is Rh positive
- The elements of the TORCH test to which the patient is not immune must be repeated on week 20 and then on week 28 of gestation
- Evaluation of liver function: AST, ALT, alkaline phosphatase, LDH
- Evaluation of kidney function: Urea, creatinine, uric acid, urinalysis, urine culture
- Glycemia
- The complete vaginal smear test

The recommendations of the Origyn team
- Do the tests exactly as recommended by the attending physician.
-Keep a pregnancy file with all the ultrasound scans, test results, and treatment prescriptions received throughout the pregnancy.
-Remember the important diagnoses established by your attending physician and inform other doctors who may examine you, such as in case of an emergency, with regard to these diagnoses.
- Follow the recommendations of your attending physician and undertake any necessary additional investigations which are not included in the set of routine tests.

It is very important to have a specialist in obstetrics and gynaecology monitor the pregnancy in order to give birth to a healthy baby, but this cannot be done without the close collaboration between the mother-to-be and her doctor.
Depending on the stages of the pregnancy, the mother should monitor several aspects of her pregnancy and inform the attending physician with regard to any noticeable changes.

The first trimester of pregnancy - weeks 1-14
- Recording the weight at the start of the pregnancy
- Taking vitamins and supplements as recommended by the attending physician
- Evaluating together with the attending physician the efficacy of the medication and the suitability of the medication in relation to the pregnancy age and the pregnancy itself.
- Presenting at the Emergency Room in case of any of the following manifestations
- Vaginal bleeding
- Significant pain in the lower abdomen
- Having more than 7 bouts of vomiting in one day
- Fever, cough, sore throat, difficulty breathing
- Altered consciousness
- Watery vaginal discharges
- Notifying the doctor in case of any of the following manifestations
- Pink-red vaginal secretion
- Heavy vaginal secretion
- Pain in the lower abdomen
- Nausea and vomiting
- Dizziness and headaches
- Constipation or diarrhoea
- Frequent urination, cloudy urine, or difficult urination

The second trimester of pregnancy - weeks 15-27
- Monitoring weight gain
- Monitoring blood pressure at least twice a week after week 20
- Monitoring active foetal movements that become noticeable starting with weeks 18-20 - active movement should be felt every 2-3 hours
- Monitoring uterine tonicity
- The evaluation of vaginal discharges
- Presenting at the Emergency Room in case of any of the following manifestations
- Vaginal bleeding
- Significant pain in the lower abdomen
- Fever, cough, sore throat, difficulty breathing
- Watery vaginal discharges
- Blood pressure >160/90 mmHg
- Absence of active foetal movements
- Painful uterine contractions
- Notifying the doctor in case of any of the following manifestations
- Pink-red vaginal secretion
- Heavy, smelly vaginal secretion
- Pain in the lower abdomen
- Frequent urination, cloudy urine, or difficult urination
- Itchy palms and soles in the evening
- Blood pressure >140/90 mmHg
- Occurrence of oedema in the lower limbs
- Increase in volume of one lower limb more than the other
- Occurrence or inflammation of varices in the lower limbs
- Oesophageal burning sensation
- Pain in the liver area, in the fundus of the uterus

Al treilea trimestru de sarcină – 15-27 de săptămâni
- Monitoring weight gain
- Monitoring blood pressure at least twice a week after week 20
- Monitoring active foetal movements that become noticeable starting with weeks 18-20 - active movement should be felt every 2-3 hours
- Monitoring uterine tonicity
- The evaluation of vaginal discharges
- Presenting at the Emergency Room in case of any of the following manifestations
- Vaginal bleeding
- Absence of active foetal movements
- Painful uterine contractions
- Watery vaginal discharges
- Blood pressure >160/90 mmHg
- Fever, cough, sore throat, difficulty breathing
- Notifying the doctor in case of any of the following manifestations
- Heavy vaginal secretion
- Pain in the lower abdomen
- Frequent urination, cloudy urine, or difficult urination
- Itchy palms and soles in the evening
- Oesophageal burning sensation
- Pain in the liver area, in the fundus of the uterus
- Blood pressure >140/90 mmHg
- Occurrence of oedema in the lower limbs
- Increase in volume of one lower limb more than the other
- Occurrence or inflammation of varices in the lower limbs

Modern obstetrics seeks to facilitate collaboration between the specialist gynaecologist, the patient, and other types of specialists in order to diagnose and prevent any problem that may affect the foetus, the mother, or the safe delivery of the baby.
Depending on the stage of your pregnancy, several routine blood tests, urine tests, and vaginal smear tests are recommended as part of the adequate monitoring of the pregnancy!

The first trimester of pregnancy - weeks 1-14
The ultrasound confirmation of the pregnancy - weeks 6-7 - vaginal ultrasound
Important features to visualize
- The gestational sac - location, shape, dimensions
- The embryo - dimensions and presence of cardiac activity
- The amniotic sac
- The vitelline vesicle
- Establishing the correct pregnancy diagnosis in case of multiple pregnancies
- The gestational corpus - location and dimensions
- Measuring the length of the cervix
- Detecting areas of trophoblastic scalloping or haematomas

The ultrasound evaluation of the pregnancy - weeks 9-10 - vaginal ultrasound
Important features to visualize
- The embryo with cardiac activity - assessing the exact age of the pregnancy based on the craniocaudal length in the case of spontaneous pregnancies in patients with irregular menstrual cycle.
- Estimating the delivery date
- Visualising the emerging limbs
- Detecting umbilical cord cysts
- 3D ultrasound

First trimester morphology ultrasound - double test
The is most important ultrasound of the first trimester.
By corroborating the ultrasound data (the craniocaudal length, the presence of the nasal bone, the nuchal translucency) with the blood test results (the free β-hCG and PAPP-A levels), it is possible to calculate a diagnosis rate for genetic syndromes such as the trisomy 13, 18, 21.
Important features to visualize
- The embryo with cardiac activity
- The craniocaudal length
- The nuchal translucency
- The presence of the nasal bone
- The cephalic extremity: the cranial contour, the choroid plexuses, the retronasal triangle
- The heart: the cardiac frequency, the blood flow through the tricuspid valve
- The blood flow through the venous duct
- The diaphragm, stomach, kidneys, bladder, insertion of the umbilical cord
- The lower and upper limbs with all 3 corresponding segments
- The location of the placenta
- The amniotic fluid
- The Doppler index of uterine arteries
- The length of the cervix
- 3D ultrasound

The second trimester of pregnancy - weeks 15-27
The ultrasound evaluation of the pregnancy - weeks 16-18
Important features to visualize
- The foetus with present cardiac activity and a growth rate corresponding to the stage of the pregnancy
- Estimated foetal weight based on a formula that requires the measurement of the biparietal diameter, the cranial circumference, the abdominal circumference, the length of the femur.
- The cephalic extremity: the cranial contour, the choroid plexuses, the cerebellum, the lips, the eyeballs, the eye lens.
- The heard: the heart rate, the presence of all 4 chambers
- The diaphragm, stomach, kidneys, bladder
- The lower and upper limbs with all 3 corresponding segments - the measurement of the long bones
- The location of the placenta
- The amniotic fluid
- 3D ultrasound
The second trimester foetal morphology ultrasound - weeks 20-23
This is the most important morphology ultrasound of the entire pregnancy and of the second trimester.
It must be carried out by a doctor competent in maternal and foetal medicine. Important features to visualize
Important features to visualize
- The foetus with present cardiac activity and a growth rate corresponding to the stage of the pregnancy
- Estimated foetal weight
- The morphology of the neurocranium and viscerocranium in order to diagnose any foetal malformation
- The morphology of the heart and large vessels in order to diagnose any foetal malformations
- The morphology of the digestive and excretory system in order to diagnose any foetal malformations
- The morphology of the lower and upper limbs in order to diagnose any foetal malformations
- The foetal Doppler indices
- The diagnosis of placenta anomalies
- The amniotic fluid
- The length of the cervix
- The Doppler index of uterine arteries

The ultrasound evaluation of the pregnancy - weeks 26-28
Important features to visualize
- The foetus with present cardiac activity and a growth rate corresponding to the stage of the pregnancy
- Estimated foetal weight
- The evaluation of pathological or follow up features identified on the foetal morphology ultrasound
- The foetal Doppler indices
- The placenta - location and maturity
- The quantity of amniotic fluid

The third trimester of pregnancy - weeks 28-40
The ultrasound evaluation of the pregnancy - week 32
Important features to visualize
- The foetus with present cardiac activity and a growth rate corresponding to the stage of the pregnancy
- Estimated foetal weight
- The orientation of the foetus
- The evaluation of pathological or follow up features identified on the foetal morphology ultrasound
- The foetal Doppler indices
- The placenta - location and maturity
- The quantity of amniotic fluid
- The length of the cervix

The ultrasound evaluation of the pregnancy - weeks 34-35
- The foetus with present cardiac activity and a growth rate corresponding to the stage of the pregnancy
- Estimated foetal weight
- The orientation of the foetus and the birth prognosis
- The evaluation of pathological or follow up features identified on the foetal morphology ultrasound
- The foetal Doppler indices
- The placenta - location and maturity
- The quantity of amniotic fluid
- The length of the cervix

Pregnancy assessment ultrasound - weeks 37, 38, 39, 40
In its last month, the pregnancy is assessed on a weekly basis by means of ultrasound monitoring and the non-stress test which checks the foetal heart rate and uterine tonicity.
- The foetus with present cardiac activity and a growth rate corresponding to the stage of the pregnancy
- Estimated foetal weight
- The presentation of the foetus
- The detection of pericervical cord entanglement
- The evaluation of pathological or follow up features identified on the foetal morphology ultrasound
- The foetal Doppler indices
- The placenta - location and maturity
- The quantity of amniotic fluid
- The length of the cervix

The recommendations of the Origyn team
- Comply with the ultrasound monitoring of the pregnancy exactly as planned by your attending physician.
-Keep a pregnancy file with all the ultrasound scans, test results, and treatment prescriptions received throughout the pregnancy.
-Remember the important diagnoses established by your attending physician and inform other doctors who may examine you, such as in case of an emergency, with regard to these diagnoses.

Postsurgical wound hygiene

After surgical interventions, while still in hospital, the postsurgical wounds will be cleaned by the attending physician; after discharge, they are typically tended by the patient or the GP.
At home, postsurgical wounds should be cleaned every 2 days, and the dressing should be changed more often than that in case it comes undone or water gets in during daily hygiene.

Why do I need to clean the wound?

At discharge, the attending physician will prescribe the necessary items for cleaning the wounds
- Antiseptic solution - Dermobacter or Betadine
- Sterile pads
- Antibiotic and wound-healing product - Baneocin powder or ointment, Cicatridina spray
- Waterproof plasters

How do I clean the wound correctly?

The person who is going to redress the wound must wash their hands with water and soap.
The existing dressing must be removed without touching the wound with the hands or with another unsterile object.
A sterile pad is then wet with antiseptic solution and used to wipe the wound and existing sutures.
Antibiotic powder or spray is then put on the wound. Any excess solution/powder is removed with a sterile pad so that the new dressing can be applied.
The new dressing is fixed in place with waterproof plasters.
When do I need to worry that my postsurgical wound is not healing properly?

Notify and make an appointment with your doctor in case of any discharges from the wound infiltrating through the dressing, abnormal bleeding or secretions, pain or swelling in the scar area.

How many days after the intervention are the stiches removed?

The attending physician and you decide together when to have the stiches removed. Most often, they are removed 7-11 days after surgery.

How long do I need to keep redressing the wound after the stiches have been removed?

Most often, once the stiches are removed, it is no longer necessary to dress the wound, but if certain areas are incompletely healed, the wound will require redressing until fully closed.

Is it necessary to wear a waist band or girdle after surgical interventions?

After laparoscopic interventions it is not necessary to wear waist girdles or bands.
After conventional surgery, most female patients prefer to benefit from the support provided by a waist girdle in order to move around comfortably, but this is not a requirement.

After the removal of the stiches, wearing a waist girdle is contraindicated.

The journey of the pregnancy is coming to an end, emotions run high, and the final preparations are very stressful!

Below is a packing list of items for the maternity back, including post-delivery essentials which you should not forget to take with you!

Documents necessary on admission
- Identity card
- Referral from the GP
- Health card
- Proof of insurance/Certificate from the employer
- Pregnancy file

For the mothers who give birth by caesarean section - ICU bag
- Waist girdle
- Wet wipes
- Panties
- Absorbent pads for confinement
- Cotton wool pack
- 2-3 litres of table water in 0.5-litre bottles

Products for body hygiene
- Absorbent pads for confinement
- Cotton wool pack
- Soap, deodorant, shampoo
- Wet wipes

Products for breast hygiene
- Manual or electrical breast pump
- Silicone nipples
- Lanolin ointment/cream for nipple sores
- Absorbent breast pads

Water and foods
- Table water in 0.5-1-litre bottles
- Digestive crackers
- Low fat yoghurt
- Low fat cheese
- Soft-boiled egg
- Sieved/cream soup
- Chicken grill
- Coffee

Clothing and accessories for the mother
- Underwear
- Breastfeeding shirt
- Slippers without fluff/fur
- Towel for the face and the body
- Phone charger

Clothing and accessories for the baby
- Clothes for the hospitalization period, only if you wish: body, bonnet, socks
- Diapers
- Wet baby wipes

Discharge checklist
- Discharge set of baby clothes: body, bonnet, socks, trousers, blanket
- Coverall in the cold season
- Baby car seat

If you forgot something or you need anything, do not hesitate to tell your family members, as each hospital has a system for handing our parcels to admitted mothers!

Self-administration of ovarian stimulation medication

In vitro fertilisation entails the administration of ovarian stimulation medication so that the ovaries can produce more follicles as a result of the treatment, compared to the 1 or maximum 2 follicles normally produced each month without medical intervention.
The ovarian stimulation medication is administered via subcutaneous injections in the abdominal area, according to a strict table mentioning precisely the date and time when the injection needs to be given, the exact dose, and the scheduled appointments for the ultrasound scan and other tests.
How can medication be administered subcutaneously?
The first doses of medication and given at the clinic so that the patients may witness the preparation and administration process as it is carried out by qualified staff.
The doses are prepared by the nurse according to the stimulation table.
Prior to this, the medication is stored in the temperature and luminosity conditions recommended by the producer.
The medication is injected subcutaneously in an abdominal fatty fold 2 finger widths to the side of the umbilicus, after disinfecting the skin with alcohol.
Each pharmaceutical product has its own medication formula consisting of powder active substances prepared with saline solution, prefilled syringes or pens similar to those used for administering insulin.
What do I do if I gave myself the wrong dose of medication?
It is important to be careful when self-administering medication and to observe the doses prescribed by your doctor; if you make a mistake, always notify the doctor and discuss how to proceed.
You must not change the time when the medication should be administered and, if you forgot a dose, it is important to notify the doctor in order not to compromise the ovarian response to the treatment.
How do I store the stimulation medication?
It is important to store medication in the temperature, humidity, and light conditions specified by the producer.
How can I dispense of the needles and syringes used for administering the medication?
It is important for used needles to be stored in a secure place and thrown away in special containers for sharply pointed medical waste. These can also be brought to the clinic when you are scheduled to undergo the ultrasound-guided ovarian drilling procedure.

I find that self-administering the medication is too difficult and I need help!
You can request that our nurses administer the medication; all you need to do is to present at our clinic at the designated time according to your protocol and to bring the necessary materials! Check our availability and working hours during weekends and legal holidays.

What is a couple’s infertility consultation with the gynaecologist?

The most important feature of such an infertility consultation is the participation of both partners at the first visit. Infertility is a pathology that affects the couple, which is why both partners need to be present for the consultation to try to find the cause of the infertility and to establish together a comprehensive diagnostic and treatment plan appropriately tailored to individual problems.
When should we make an appointment for an infertility consultation as a couple?
Couple infertility is the failure to obtain a pregnancy naturally after 1 year of consistent and unprotected sexual intercourse, or after 6 months of trying in case the female partner is older than 35. In conclusion, if after 1 year of trying to conceive you are unsuccessful, it would be necessary to make an appointment for an infertility consultation.
The infertility consultation begins with a discussion in which it is important for the gynaecologist to find out:
Information about the female partner
- Height, weight, and body mass index
- The age when the patient first menstruated, the date of the most recent menstruation, the regularity of menstrual cycles, the presence of menstrual pains, the occurrence of amenorrhea (menstrual delays longer than 2 months)
- The gynaecological history of the patients - the number of pregnancies, abortions, natural deliveries or caesarean sections
- The date of the previous gynaecological consultation
- If and when the Papanicolau smear test was last done, and if the results have ever been abnormal
- The history of general and gynaecological surgical interventions
- The patient’s history of medical conditions
- The history of gynaecological conditions in the family
- The history of medical conditions/lost pregnancies/infertility/children with genetic syndromes or deceased during the first year of life at home
- The use of any contraceptive medication
- The work environment and information about lifestyle - diet, smoking, consumption of alcohol, recreational drugs.
- The frequency of sexual relations, the manifestation of pain during sexual intercourse or bleeding afterwards
- Previous infertility tests and investigations, if any

Information about the male partner
- Height, weight, BMI
- The history of surgical interventions on the testicles or prostate
- The history of trauma or accidents in the genital area
- The history of testicular or prostate infections, ureteral discharges or sexually-transmitted infections
- The history of hypospadias, varicocele, undescended testicle at birth
- The history of medical surgical conditions
- The history of administered medication, including any intake of testosterone with the aim of increasing muscle mass
- The work environment and information about lifestyle - diet, smoking, consumption of alcohol, recreational drugs.
- The history of medical conditions/lost pregnancies/infertility/children with genetic syndromes or deceased during the first year of life at home
- If the partner has any children or if he has ever obtained a pregnancy with any of his previous partners
Information about other fertility procedures and treatments undertaken by the couple
- The IUI attempts are noted
- The stimulation protocols and the ovarian response reviewed, including with regard to the embryos obtained as a result of the stimulation cycles
The gynaecological consultation consist in
- The vaginal examination with the use of specula and the collection of biological samples
- The digital vaginal examination
- The vaginal ultrasound
How do I prepare for the infertility consultation?
- I bring with me all my results to previous tests and investigations.
- I bring with me the discharge documents from all my previous surgical interventions
- I bring with me the medical documents of my partner 
Medical recommendations
The infertility consultation ends with the drafting of a complete diagnostic plan and therapeutic solution.
Complementary tests are recommended, including repeat tests if the diagnoses need further clarification.
Additional medical investigations are recommended to both partners depending on their medical records and the results of the ultrasound scan in the case of the female partner.
Female partner
- Blood tests
- AMH, FSH, LH, Progesterone, Oestradiol
- Viral tests
- TORCH test
- TSH, FTS4, FT3, anti-TPO antibodies
- Vitamin D
- Prolactin
- The Papanicolau smear test, the vaginal wet mount, Mycoplasma, Ureaplasma, Chlamydia.
- The assessment of the fallopian tubes via HyCoSy
- Diagnostic/surgical hysteroscopy
- Diagnostic/surgical laparoscopy
- Genetic karyotype
Male partner
- Semen analysis test, semen culture test, Halosperm test
- Viral tests
- Hormone tests - if recommended by the attending physician
- FSH
- LH
- Oestradiol
- Testosterone and free testosterone
- FSH
- Prolactin
- Inhibin B
- Vitamin D
- Urological consultation
- Additional blood tests
- Genetic karyotype
After the recommended tests and investigations are done, a comprehensive diagnosis of the couple’s infertility is achieved and a therapeutic plan can be developed.
Then, it is necessary to schedule an appointment when all the test results can be discussed and the treatment plan can be adapted specifically to each couple and conducted in collaboration with the interdisciplinary team of specialists at the clinic.

What does a gynaecological consultation consist of?
Apart from the recommended annual visits to the gynaecologist, the female patient must open up to her physician about her reasons for presenting, what discomfort she is experiencing, what symptoms, when they started, and if she has taken any medication.
The gynaecological consultation begins with a discussion in which it is important for the gynaecologist to find out:
- The age when the patient first menstruated, the date of the most recent menstruation, the regularity of menstrual cycles, the presence of menstrual pains, the occurrence of amenorrhea (menstrual delays longer than 2 months)
- The gynaecological history of the patients - the number of pregnancies, abortions, natural deliveries or caesarean sections
- The date of the previous gynaecological consultation
- If and when the Papanicolau smear test was last done, and if the results have ever been abnormal
- The use of any contraceptive medication
- The number of sexual partners and the methods of protection used
- The medical surgical and general surgical antecedents
- The work environment and information about lifestyle - diet, smoking, consumption of alcohol, recreational drugs.
The gynaecological consultation consist in
- The seating of the patient in gynaecological position.
- The vaginal examination with the use of bivalve specula, which allow the inspection of the vagina and cervix in order to diagnose a range of pathologies such as polyps, endometriosis, venereal vegetations, the Naboth cysts, malformations of the genital tract etc.
- The collection of samples such as the cervical diagnostic smear for the Papanicolau smear test, the vaginal wet mount, Mycoplasma, Ureaplasma, Chlamydia.
- The evaluation of vaginal discharges
- The digital vaginal examination
- The purpose of the bimanual vaginal examination is to locate painful areas, tumoral masses, and to assess the mobility of the structures comprising the genital apparatus.
- The transvaginal ultrasound
- After lubrication with ultrasound gel, the ultrasound probe is inserted in the vagina.
- The uterus:
- The ultrasound appearance of the cervix, uterine body, and endometrium are inspected, and their dimensions are recorded
- The myometrium is inspected for any uterine fibromas, their location and impact on the uterine cavity, and for endometrial or cervical polyps
- The presence of any uterine malformation anomalies, residual defects of the uterine scar, or uterine synechiae is noted
- The Doppler function is used to highlight the myometrial varices or the vascularisation of fibromas.

- The ovaries:
- The dimensions of the ovaries are recorded
- The reserve of ovarian follicles
- The presence of the dominant follicle/corpus luteum
- The presence of functional or organic cysts - their dimensions, the presence of septa and the Doppler signal
- The presence of paraovarian structures - appearance compatible with hydrosalpinx/extrauterine pregnancy
- The mobility of the ovaries or their abnormal location
- The presence of free fluid in the Douglas pouch
- Pathological elements of neighbouring structures such as the endometriosis of the rectovaginal septum or the uterine cavity
How do I get ready for a gynaecological consultation?
- It is important to avoid scheduling the consultation during the period of menstrual bleeding because the Papanicolau smear test cannot be done.
- Gynaecological consultations can be done in the presence of abnormal genital bleeding, and the gynaecologist will not hesitate to conduct such a consultation on a patient with vaginal bleeding.
- Adequate hygiene before the gynaecological consultation is important.
- Sexual intercourse must be avoided 48 hours before the consultation.
- No vaginal products should be used and the vagina should not be cleansed 48 hours before the collection of vaginal samples.
- The bladder must be empty during the examination.
Can I undertake a gynaecological consultation if I have not yet begun my sexual life?
- Yes! The gynaecological consultation is not addressed only to sexually active female patients. There are numerous gynaecological pathologies that may occur in patients who have not begun to engage in sexual activity.
- You will be invited to answer questions about your physiological and pathological history
- In such cases, the vaginal examination using specula is not done and neither is the digital vaginal examination.
- A rectal examination may be carried out if necessary.
- In this case, a transabdominal ultrasound is performed or, if necessary, a transrectal ultrasound examination with an adequate ultrasound probe.
- The bladder must be full during the transabdominal ultrasound examination.