A 35-year-old female, gravida 1, para 0, presents to the clinic for her anatomy ultrasound at 20 weeks’ gestation. She denies any complaints and has not yet begun feeling fetal movements. Her prenatal course thus far has been unremarkable. She declined aneuploidy screening earlier in her pregnancy. Her past medical history is significant for chronic hypertension, which has been controlled with labetalol. She has no other relevant past medical or surgical history. She has no known allergies.

A 42-year-old nullipara presents with abdominopelvic and bladder pressure, low back pain, and heavy menstrual periods. Menses are regular, lasting five to seven days with heavy flow and no intermenstrual bleeding. She does not desire future childbearing and would like definitive management but is worried about missing work. She has no past medical or surgical history. She is not taking medications and has no known drug allergies.

A 40-year-old female, gravida 2, para 2, presents to the office for preoperative consultation regarding endometrial ablation for heavy menstrual bleeding. Her last menstrual period was two weeks ago.

A 26-year-old nulligravid woman presents with concerns of heavy menses and pelvic pain. Her last menstrual period was one week ago. She describes a long history of cyclic heavy menses which were initially improved on combination oral contraceptive pills but have worsened in the last two years. On her heaviest days, she soaks through a tampon in 1 hour and has soiled her clothes. She notes worsening pelvic pain which was previously limited to her menses but now feels like a constant fullness in her lower abdomen. She reports urinary frequency and denies dysuria or malodorous urine. She is not sexually active and denies a history of pelvic infections. She had a negative Pap test last year. She has a history of anemia, but no other medical problems. She has never had surgery. She desires future childbearing. She takes no medications other than her contraceptive pills.

A 35-year-old multiparous woman is taken to the operating room after appropriate counseling and consent for surgical sterilization via bilateral salpingectomy. Her medical history is significant for class II obesity. Her past surgical history is significant for two cesarean sections. She is not taking any medications and has no allegies. A 5 mm trocar was placed using direct entry via an optical trocar in the umbilicus. Two additional laparoscopic trocars were placed in bilateral lower quadrants under direct visualization. Standard abdominal survey was performed and within normal limits. The left tube was resected and removed through the trocar. Attention was turned to the right tube and approximately 250 mL of blood was noted in the right lower quadrant. Suction irrigation was used to remove the blood from the right lower quadrant. There was no further bleeding. The right salpingectomy was completed, and the specimen removed. Intra-abdominal pressure was decreased and an abdominal survey was repeated. All surgical sites were noted to be hemostatic; however, when the right trocar was removed, bleeding from the right trocar site was identified.

A 40-year-old nulligravid woman last menstrual period 15 weeks ago presents with irregular menstrual bleeding. Upon questioning, she has had irregular cycles for the last 20 years. She has never taken any hormonal medication to regulate her bleeding. She has never been pregnant despite not using contraception since age 21. You perform an endometrial biopsy and the pathologic diagnosis is endometrial intraepithelial neoplasia (EIN). She does not desire future fertility. Her past medical history is significant for hypertension and morbid obesity. She was recently diagnosed with diabetes and has adjusted her diet to try and control her blood sugar. She requests to have a hysterectomy for treatment of her irregular menses. She denies any significant family history of breast, ovarian, or colon cancer. She has no past surgical history. She is currently taking hydrochlorothiazide 25 mg PO daily and has no known drug allergies.

A 40-year-old gravida 1, para 1001 presents with worsening pelvic pain. Her symptoms have been present for over 15 years and are progressing. Most recently, she has daily symptoms described as sharp, stabbing, intermittent pelvic pain. Her menstrual cycle exacerbates the pain. In addition to dysmenorrhea, she reports deep dyspareunia and a history of infertility. She denies any bowel or bladder dysfunction. Menarche was early at age 10. Menses occur every 25 days, with an 8- to 10-day duration with heavy bleeding and dysmenorrhea. Past treatments include combined oral contraceptive pills, gonadotropin-releasing hormone (GnRH) agonist following laparoscopy-proven endometriosis, and she is currently in her fourth year of a levonorgestrel-containing intrauterine device (IUD). She has no significant past medical history. Her past surgical history is significant for operative laparoscopy 12 years ago with excision of endometriosis (pathology confirmed) and adhesiolysis to improve fertility. She is not taking any medications and is allergic to sulfa (rash). She is a non-smoker, drinks alcohol socially. She is happily married and works for a non-profit organization. Her daughter is 10 years old and healthy. Due to her increasing pelvic pain she now requests hysterectomy.

A 44-year-old gravida 2, para 2 presents for evaluation of a four-month history of intermenstrual bleeding. Menses occur at regular, 28-day intervals, and last 4–5 days with recently heavy flow. For the past four months she has had painless intermenstrual bleeding at unpredictable times throughout her cycle. Intermenstrual bleeding ranges from spotting to moderate flow and lasts one to two days. Her last menstrual period was three weeks ago. She is up to date on cervical cancer screening and routine gynecologic care. Medical history is significant for hypothyroidism, two prior cesarean deliveries, and bilateral tubal ligation. She is on levothyroxine and denies any medications allergy. She is sexually active with one male partner and denies any history of sexually transmitted infections or recent exposures.

A 25-year-old female, gravida 0, with chronic pelvic pain presents for a scheduled diagnostic laparoscopy. Her medical and surgical history is otherwise unremarkable. She relies on depot medroxyprogesterone acetate for contraception and has no known drug allergies. Anesthetic induction and intubation proceeded without complication. Laparoscopic entry is attempted using the Veress needle. Following two unsuccessful attempts at sub-umbilical insufflation, insertion of the Veress is attempted at Palmer’s point, 3 cm below the costal margin in the left midclavicular line. Opening pressure at Palmer’s point is 14 mmHg. The needle is retracted slightly, the pressure decreases appropriately to 5 mmHg, and abdominal insufflation proceeds. Upon placement of the initial trocar and visualization of the abdominal cavity with the laparoscope, a 2.5 cm laceration is noted along the inferior border of the left hepatic lobe. Bleeding is minimal and pressure is applied. Approximately 2 minutes later, the anesthesiologist alerts the surgeon of acute-onset tachycardia, hypotension, and hypoxia.

A 32-year-old female, gravida 2, para 1, presents to the emergency department for evaluation of acute-onset low abdominal pain that began several hours ago. Her last menstrual period was approximately six weeks ago and her urine pregnancy test in the emergency department is positive. She denies gastrointestinal symptoms, dizziness, or fever. Her past obstetric history is significant for one uncomplicated normal spontaneous vaginal delivery three years ago. Her past medical history is significant for chlamydia diagnosed and treated in the last year and endometriosis. Her past surgical history is significant for diagnostic laparoscopy.

A 32-year-old para 0 presents with persistent pain after laparoscopic assisted vaginal hysterectomy/bilateral salpingo-oophorectomy (LAVH/BSO) for endometriosis. Her surgery was notable for bilateral endometriomas with scarring of the ovaries to each respective ovarian fossa and adhesions of the rectosigmoid colon to the left ovary. She had an uneventful recovery from surgery and was started on estrogen-only therapy for skeletal and cardiovascular protection. Three months following surgery, she reports the onset of an intense intermittent left lower quadrant pain. This began cyclically though it has progressed to pain for at least two weeks of each month. She has no past medical history. Her past surgical history is significant for three laparoscopic endometriosis surgeries, LAVH/BSO. She is taking estradiol (Estrace) 1 mg PO daily. She has no allegies.

A 34-year-old gravida 2, para 2 woman presents to the gynecology clinic for increasingly heavy menstrual bleeding over the past year. Periods occur every 28–29 days and are predictable. Bleeding lasts for seven days with the heaviest bleeding occurring on days 2 and 3. On those days, she uses super tampons and maxi pads, changing them every 2 hours, and at night is using night-time pads. She has to leave long meetings at work to change protection and has menstrual accidents. She passes large clots and describes “gushing” type bleeding when on the toilet. She has tried non-steroidal anti-inflammatory drugs and tranexamic acid for bleeding with only slight improvement in heaviness; oral contraceptive pills have not worked in the past and she is not using them now. She has no relevant past medical or surgical history and denies any drug allergy.

A 45-year-old female, gravida 3, para 3, presents to the office for a postoperative visit complaining of watery vaginal discharge. She underwent a hysterectomy six weeks ago for abnormal uterine bleeding. Two weeks ago, she first noticed intermittent watery vaginal discharge, which has become persistent. She describes the discharge as yellow and sometimes blood tinged. She also reports pain in her vagina and an abnormal urinary stream. She denies dysuria, fevers, chills, nausea, or vomiting. She has regular bowel movements and denies hematochezia. She underwent a laparoscopic assisted vaginal hysterectomy with bilateral salpingectomy. The procedure was difficult due to dense adhesive disease in the vesicouterine space. She has not resumed sexual activity and plans on returning to work next week.

A 33-year-old female, gravida 2, para 2, presents with irregular intermenstrual bleeding occurring each month since undergoing her second cesarean delivery 15 months ago. Since finishing breastfeeding, she has experienced light intermenstrual bleeding episodes following menses. She denies any change in bowel or bladder symptoms. She is sexually active with one partner using condoms and denies pain or bleeding with intercourse. She denies any history of sexually transmitted diseases or abnormal Pap test that required treatment. Her past medical and surgical histories are non-contributory. She is not taking any medications and denies medication allergy.

A 45-year-old woman, gravida 4, para 4, is postoperative day 1 from a robotic-assisted total laparoscopic hysterectomy. By 02:00, she had produced only 10 mL of urine output over the prior 2 hours and a total of 50 mL over the past 7 hours. The surgery began at 15:00 and required 4.5 hours, the majority of which was spent dissecting the bladder free of the uterus and cervix. There was difficulty with the left uterine artery, leading to an estimated blood loss of 1500 mL. The patient was briefly hypotensive and responded to a large fluid bolus. At the end of the surgery, the operative field was dry and cystoscopy revealed vigorous jets from both ureters. Her starting hemoglobin was 11.2 g/dL. A repeat hemoglobin was planned for 02:30. Her urine has been blood tinged since the surgery. The patient has no medical problems and has had four previous cesarean deliveries. She takes no medications.

A 71-year-old gravida 2, para 2 woman presents with vaginal bleeding for one week. The bleeding has been light and dark red in color. She has not been on hormone replacement therapy. She denies pelvic pain, or changes in bowel or bladder function. Her medical and surgical history are non-contributory. There is no family history of breast, uterus, ovarian, or colon cancers. She is not taking medications and has no history of drug allergy.

A 42-year-old woman, gravida 2, para 2, last menstrual period three weeks ago, presents for surgical consultation secondary to heavy menstrual bleeding. She reports persistent, regular monthly bleeding with passage of clots. She was admitted to the hospital for a blood transfusion secondary to anemia, dizziness, and fatigue. She was discharged on a progestational agent and reports initial improvement in her bleeding and symptoms. The heavy vaginal bleeding has recurred and is now associated with constant pelvic pain and cramping. She is sexually active with her husband. She is requesting a hysterectomy. She has no relevant past medical or surgical history. She is currently taking medroxyprogesterone (Provera) 20 mg PO three times daily and has no known drug allergies.

A 38-year-old para 2 presents for scheduled total laparoscopic hysterectomy for heavy menstrual bleeding. She has no past medical history. Her past surgical history is significant for two low transverse cesarean sections. She is not taking any medications and she has no known drug allergies. Laparoscopic entry is started with a Veress needle inserted through a small incision in the skin of the umbilicus until two popping sounds are heard. Aspiration in the space is negative. A hanging drop test is slow but the saline flows in. The gas source is connected and the pressure at the tip of the Veress needle reads 10 mmHg. Insufflation is begun at 1 L/min and a sharp trocar is inserted once the pressure becomes 20 mmHg. Upon entry of the laparoscope, distended fat is visualized instead of intraperitoneal contents.

A 24-year-old woman presents to the office with complaint of bumps on her vulva. She first noticed them several months ago and feels they have grown since then. She currently feels the lesions are the size of grapes and bumpy in texture. The site is not painful, but there is discomfort and irritation when the lesions rub against her clothing. Recently, she has been avoiding intercourse because of the bumps. She has been sexually active with a new partner in the last year and they do not consistently use condoms. Her gynecologic history is significant for regular withdrawal bleeding on oral contraceptive pills with good compliance. She has seasonal allergic rhinitis and exercise-induced asthma but otherwise denies medical or surgical history. She denies medication allergies and has no contributory family history.