Perioperative management - Anesthesia examination, Pap smear, LEEP conization, cystoscopy, hysteroscopy, fractional curettage, rectoscopy

• Gynecological history (cycle history, bleeding disorders, postmenopausal bleeding)
• Family history (cancers in the family, especially gynecological malignancies)
• Previous gynecological procedures and findings (e.g., abnormal PAP smears, HPV status, biopsies)
• General medical history (cardiovascular, pulmonary, metabolic diseases)
• Medication history (anticoagulants, antidiabetics, immunosuppressants)
• Allergies and intolerances
• Nicotine, alcohol, and drug use

• General status (vital signs, cardiovascular system, pulmonary examination)
• Gynecological examination (speculum setting, bimanual examination, colposcopy)
• Transvaginal sonography (endometrial thickness, myometrium, ovaries)
• Palpation of lymph nodes (inguinal, supraclavicular)
• Rectovaginal examination in case of suspected infiltration

Laboratory:

• Complete blood count
• Coagulation (INR, PTT)
• Liver and kidney function tests (Creatinine, Urea, ALT, AST, GGT, Bilirubin)
• Tumor markers (if indicated, e.g., CA-125, SCC, CEA)

Imaging:

• MRI pelvis for unclear findings
• CT abdomen/thorax if tumor is suspected

ECG for patients at risk

Preoperative Information

• Information about the surgical goal, procedure, risks (e.g., bleeding, infection, organ injury)
• Alternatives to surgery, postoperative management
• Consent form (written and verbal)

Nutrition and Bowel Preparation

• 6 hours of preoperative fasting, clear fluids allowed up to 2 hours before
• Bowel preparation: Depending on the extent of surgery, possibly an enema the day before

Antibiotic Prophylaxis

Single dose of Cefuroxime/ Metronidazole

• Vital parameters: Blood pressure, heart rate, SpO2, temperature, level of consciousness
• Bleeding control: Inspection of vaginal tampons, drains
• Pain management: Analgesics according to WHO step scheme (e.g., paracetamol, NSAIDs, opioids as needed)
• Early mobilization: Prevention of thrombosis and pneumonia
• Fluid management: Adjustment of infusion therapy
• Bladder function: Observation for urinary retention after cystoscopy or conization

Postoperative Follow-up

• Gynecological examination after 2–6 weeks
• Discussion of histological findings
• If necessary, initiation of further diagnostics/therapy in case of malignancy detection

Behavioral Recommendations

• Physical rest for 1–2 weeks
• Avoidance of sexual intercourse, tampons, and full baths for approximately 4 weeks
• Thrombosis prophylaxis for patients at risk
• If necessary, antibiotic therapy in case of signs of infection
• In case of postoperative complications (fever, heavy bleeding, severe pain), presentation in the clinic