Podcast
Questions and Answers
What is the primary origin of most hematomas described in the content?
What is the primary origin of most hematomas described in the content?
Which grade of placental abruption is associated with disseminated intravascular coagulation (DIC)?
Which grade of placental abruption is associated with disseminated intravascular coagulation (DIC)?
What is the most common cause of ectopic pregnancy?
What is the most common cause of ectopic pregnancy?
What is the recommended treatment for vulvar and vaginal hematomas that exceed 10 cm in diameter?
What is the recommended treatment for vulvar and vaginal hematomas that exceed 10 cm in diameter?
Signup and view all the answers
Which condition is not considered a risk factor for umbilical cord prolapse?
Which condition is not considered a risk factor for umbilical cord prolapse?
Signup and view all the answers
Which diagnostic tool is considered invaluable for early pregnancy complaints?
Which diagnostic tool is considered invaluable for early pregnancy complaints?
Signup and view all the answers
Which of the following is NOT a symptom of ectopic pregnancy?
Which of the following is NOT a symptom of ectopic pregnancy?
Signup and view all the answers
What is a common outcome for infants who survive severe placental abruption, according to the content?
What is a common outcome for infants who survive severe placental abruption, according to the content?
Signup and view all the answers
If a hemodynamically unstable patient is suspected of having an ectopic pregnancy, what is the most appropriate initial step?
If a hemodynamically unstable patient is suspected of having an ectopic pregnancy, what is the most appropriate initial step?
Signup and view all the answers
What percentage of normal pregnancies typically show a beta-hCG increase of 66% or more within 48 hours?
What percentage of normal pregnancies typically show a beta-hCG increase of 66% or more within 48 hours?
Signup and view all the answers
Which of the following conditions should be included in the differential diagnosis for ectopic pregnancy?
Which of the following conditions should be included in the differential diagnosis for ectopic pregnancy?
Signup and view all the answers
What laboratory test is typically repeated after 48 hours if the ectopic pregnancy diagnosis remains unclear?
What laboratory test is typically repeated after 48 hours if the ectopic pregnancy diagnosis remains unclear?
Signup and view all the answers
Which of these symptoms is indicative of a hemorrhagic ovarian cyst?
Which of these symptoms is indicative of a hemorrhagic ovarian cyst?
Signup and view all the answers
What is a common sign indicating the need for immediate operative intervention in suspected ovarian pathology?
What is a common sign indicating the need for immediate operative intervention in suspected ovarian pathology?
Signup and view all the answers
What could be a potential cause of abnormal uterine bleeding (AUB) in a patient with anovulatory patterns?
What could be a potential cause of abnormal uterine bleeding (AUB) in a patient with anovulatory patterns?
Signup and view all the answers
Which diagnostic tool is most effective for evaluating suspected ectopic pregnancy?
Which diagnostic tool is most effective for evaluating suspected ectopic pregnancy?
Signup and view all the answers
What is a characteristic symptom of menorrhagia?
What is a characteristic symptom of menorrhagia?
Signup and view all the answers
In cases of gynecologic hemorrhage linked to endometrial cancer, what is the recommended procedure?
In cases of gynecologic hemorrhage linked to endometrial cancer, what is the recommended procedure?
Signup and view all the answers
Which would be a significant finding in a CBC of a patient experiencing menorrhagia?
Which would be a significant finding in a CBC of a patient experiencing menorrhagia?
Signup and view all the answers
What is the range of the cutoff quantitative b-hCG value for visualizing an intrauterine pregnancy on transvaginal ultrasound?
What is the range of the cutoff quantitative b-hCG value for visualizing an intrauterine pregnancy on transvaginal ultrasound?
Signup and view all the answers
What is the primary etiology for vulvar and vaginal hematomas?
What is the primary etiology for vulvar and vaginal hematomas?
Signup and view all the answers
Which surgical approach is most appropriate for hemodynamically unstable patients with tubal ectopic pregnancies?
Which surgical approach is most appropriate for hemodynamically unstable patients with tubal ectopic pregnancies?
Signup and view all the answers
What could indicate the presence of a ruptured endometrioma?
What could indicate the presence of a ruptured endometrioma?
Signup and view all the answers
What type of ovarian mass is almost always associated with adnexal torsion?
What type of ovarian mass is almost always associated with adnexal torsion?
Signup and view all the answers
Which laboratory test is not typically included in the initial assessment for abnormal uterine bleeding?
Which laboratory test is not typically included in the initial assessment for abnormal uterine bleeding?
Signup and view all the answers
Which condition is NOT a differential diagnosis for patients with adnexal torsion?
Which condition is NOT a differential diagnosis for patients with adnexal torsion?
Signup and view all the answers
What is an important consideration when evaluating pediatric trauma with hymenal tearing?
What is an important consideration when evaluating pediatric trauma with hymenal tearing?
Signup and view all the answers
What is a common symptom experienced by 70% of patients with adnexal torsion?
What is a common symptom experienced by 70% of patients with adnexal torsion?
Signup and view all the answers
What has been a successful medical treatment for ectopic pregnancies while preserving tubular architecture?
What has been a successful medical treatment for ectopic pregnancies while preserving tubular architecture?
Signup and view all the answers
Which of the following is a common associated symptom of adnexal torsion?
Which of the following is a common associated symptom of adnexal torsion?
Signup and view all the answers
What is often necessary to confirm the diagnosis of adnexal torsion?
What is often necessary to confirm the diagnosis of adnexal torsion?
Signup and view all the answers
What is NOT an indication for methotrexate use in managing ectopic pregnancies?
What is NOT an indication for methotrexate use in managing ectopic pregnancies?
Signup and view all the answers
What is the percentage of ovarian tumors involved in cases of adnexal torsion?
What is the percentage of ovarian tumors involved in cases of adnexal torsion?
Signup and view all the answers
What is primarily indicated for patients who have a tubo-ovarian abscess?
What is primarily indicated for patients who have a tubo-ovarian abscess?
Signup and view all the answers
What are the most common bacteria associated with pelvic inflammatory disease?
What are the most common bacteria associated with pelvic inflammatory disease?
Signup and view all the answers
What symptom do 90% of patients with pelvic inflammatory disease typically present with?
What symptom do 90% of patients with pelvic inflammatory disease typically present with?
Signup and view all the answers
In cases of life-threatening infections, what initial surgical intervention is often necessary?
In cases of life-threatening infections, what initial surgical intervention is often necessary?
Signup and view all the answers
Which condition may mimic the presentation of pelvic inflammatory disease in patients?
Which condition may mimic the presentation of pelvic inflammatory disease in patients?
Signup and view all the answers
What treatment should be considered if a patient does not improve on broad-spectrum antibiotics?
What treatment should be considered if a patient does not improve on broad-spectrum antibiotics?
Signup and view all the answers
Which imaging modality is commonly used to diagnose pelvic inflammatory disease?
Which imaging modality is commonly used to diagnose pelvic inflammatory disease?
Signup and view all the answers
What is the typical WBC count observation related to pelvic inflammatory disease?
What is the typical WBC count observation related to pelvic inflammatory disease?
Signup and view all the answers
Which surgical procedure is recommended instead of performing a salpingo-oophorectomy in certain cases?
Which surgical procedure is recommended instead of performing a salpingo-oophorectomy in certain cases?
Signup and view all the answers
What must be considered for patients with an adnexal mass and acute abdomen in the context of PID?
What must be considered for patients with an adnexal mass and acute abdomen in the context of PID?
Signup and view all the answers
Study Notes
Gynecologic and Obstetric Emergencies
-
Learning Objectives cover symptoms and signs of gynecologic emergencies, diagnostic approaches to gynecologic emergencies, differential diagnosis, surgical diseases causing gynecologic acute abdomen, symptoms and signs of obstetric emergencies, and management of DIC.
-
Key gynecologic emergencies include ectopic pregnancies, adnexal torsion, tubo-ovarian abscess, hemorrhagic ovarian cysts, gynecologic hemorrhage (specifically abnormal uterine bleeding), and vulvar and vaginal trauma.
-
Ectopic pregnancy differential diagnosis includes appendicitis, ruptured hemorrhagic ovarian tumors, adnexal torsion, and endometriosis.
-
The most common cause of ectopic pregnancy is salpingitis.
-
Almost 50% of patients undergoing salpingectomy for an ectopic pregnancy had a clinical history or histopathologic findings consistent with acute salpingitis.
-
Altered ciliary motility from hormonal imbalances or tobacco abuse can cause ectopic pregnancy.
-
Pelvic masses, tubal adhesions from prior surgeries, and abnormal embryonic development are also contributing factors to ectopic pregnancy.
-
Relative risk for ectopic pregnancy increases significantly with pelvic infection, multiple induced abortions, and prior pelvic surgery.
-
Signs and Symptoms of ectopic pregnancy include abdominal pain, amenorrhea, irregular vaginal bleeding, adnexal tenderness, abdominal tenderness, and adnexal mass.
-
A high percentage of patients with ectopic pregnancies presenting with symptoms exhibit abdominal pain, amenorrhea, and vaginal bleeding.
-
Diagnosis involves physical examination, laboratory assessment, and transvaginal ultrasound. If acute bleeding occurs, the patient's hemoglobin level may not drop, prompting a suspicion of hemodynamic instability and warranting surgical diagnosis. Serial labs and physical exams track the patient's status until confirmed diagnosis.
-
Complete blood count (CBC), quantitative beta-hCG, and blood type are initial laboratory tests. Levels should be repeated in 48 hours.
-
85% of normal pregnancies show a 66% or greater increase in b-hCG levels within 48 hours, but only 13% of ectopic pregnancies show increases exceeding 66%.
-
Transvaginal ultrasound assists in assessing early pregnancy complaints, including vaginal bleeding and pelvic pain.
-
Pseudosacs, adnexal mass, pelvic fluid, and intra-abdominal hemorrhage can be visualized.
-
Treatment traditionally is surgical, but methotrexate alternatives are available for some patients.
-
Laparoscopy, instead of laparotomy, is often appropriate for hemodynamically stable patients; laparotomy is often necessary for unstable ones.
-
Indications for methotrexate, a medical alternative, are unruptured pregnancies, ectopic mass less than 3.5 cm, and no fetal cardiac activity with a lower hCG level.
-
Contraindications are abnormal renal function (CrCl < 60), hepatic dysfunction (liver function tests > 2.5 times the upper limit of normal), absolute neutrophil count less than 1500, platelets less than 100, active pulmonary diseases, peptic ulcer disease, and breastfeeding.
Adnexal torsion
-
Patients with adnexal torsion typically experience intermittent acute abdominal pain.
-
Differential diagnoses include ruptured corpus luteum, adnexal abscess, acute appendicitis, ectopic pregnancy, and bowel obstruction.
-
Adnexal torsion is almost always associated with an enlarged ovarian mass.
-
In vitro fertilization may increase adnexal torsion due to hyperstimulation.
-
Pregnancy can also increase predisposition to adnexal torsion.
-
Ovarian tumors cause 50-60% of torsion cases, with mature cystic teratomas (dermoid tumors) being most frequent.
-
Signs and symptoms often include acute, intermittent, unilateral pelvic pain that may be worsened by positional shifts. 70% of patients have associated gastrointestinal complaints. A tender, unilateral adnexal mass is present in approximately 70% of patients
Tubo-ovarian abscess
-
Pelvic inflammatory disease (PID) results in significant morbidity, affecting not only the initial presentation but also long-term sequelae. Infections of the upper genital tract present similarly to ectopic pregnancy, hemorrhagic corpus luteal cyst, appendicitis, or endometriosis/endometrioma.
-
PID diagnosis requires direct abdominal tenderness, cervical motion tenderness, and adnexal tenderness. Additional potential criteria include temperature greater than 38°C, leukocytosis over 10,500, erythrocyte sedimentation rate greater than 15 mm/h, positive Gram stain (Gram-negative intracellular diplococci in endocervix), and/or positive culture for Chlamydia trachomatis or Neisseria gonorrhoeae. Mucopurulent material from the cervix or peritoneal cavity (culdocentesis or laparoscopy).
-
Treatment is frequently outpatient, but hospitalization may be required in certain situations such as an adnexal mass and acute abdomen in PID, where possible tubo-ovarian abscess is a concern.
-
Indications for hospitalization are the presence of a tubo-ovarian complex or abscess, pregnancy, adolescents (difficult to manage), immunodeficiency, uncertain diagnosis or surgical emergencies, gastrointestinal symptoms, operative or diagnostic procedure history, inadequate response to outpatient treatment, upper quadrant peritonitis, and intrauterine device presence.
-
Etiology is polymicrobial organisms, and the most common bacteria are Neisseria gonorrhoeae and Chlamydia trachomatis, which often coexist.
-
The most common complications are acute abdominal pain in 90% of patients and elevated white blood cell counts in 75% of patients.
Hemorrhagic ovarian cysts
-
Patients with hemorrhagic ovarian cysts typically present with acute abdomen.
-
Differential diagnoses can include acute appendicitis, ectopic pregnancy, ruptured endometrioma, and ovarian torsion.
-
Approximately 2-4 days after ovulation, blood from the vascular theca zone often fills the cyst cavity.
-
History should include the patient's last menstrual period.
-
Patients usually experience unilateral tenderness in the lower abdomen or pelvic region.
-
Clinical diagnosis frequently involves transvaginal ultrasound to identify adnexal masses, a CBC to assess current blood counts, and abdominal/pelvic CTs with contrast to aid in evaluation of other causes involving acute abdomen.
Gynecologic hemorrhage
-
Abnormal uterine bleeding (AUB) has two main categories: organic (structural or systemic) causes and non-organic, usually related to patterns observed within an individual's ovulatory cycles.
-
AUB can manifest as menorrhagia or in irregular intervals.
-
Women experiencing monthly blood loss exceeding 80 mL are likely to have lower hemoglobin, hematocrit, and iron levels.
-
Diagnosis includes various blood tests (CBC, coagulation profile, liver function tests, thyroid-stimulating hormone, pregnancy test), pap smear, gonorrhea/chlamydia culture, and endometrial biopsy.
-
20% of adolescent females hospitalized for AUB have coagulation defects. Risk factors are systemic or reproductive tract disorders, accidents of pregnancy, bleeding/coagulation disorders, hypothyroidism, cirrhosis, malignancies, or foreign bodies.
-
Medical treatment uses a medication regimen for stabilization of AUB, such as 25 mg IV Premarin every 4 hours, until the bleeding stops. For oral Premarin, 2.5 mg tablets are used, three times per day for 7 days, and then daily dosage. Oral contraceptive pills (OCPs) are used three times per day for seven days, and then daily dosage, once per week, for three weeks.
Vulvar and vaginal trauma
-
Hematomas are usually secondary to blunt trauma.
-
Sexual abuse is a concern, especially in pediatric or adolescent patients experiencing hymenal or labial tearing.
-
Venous hematomas are self-limiting and more difficult to control surgically than arterial hematomas.
-
Management is generally conservative, unless the hematoma is more than 10cm in diameter or rapidly expanding. If necessary, interventional radiology can perform embolization. Resolution of most hematomas requires several weeks.
-
Diagnosis involves close observation of hematoma size, location, and rate of expansion
True Obstetric Emergencies
-
These include Vasa previa, placental abruption, uterine rupture, amniotic fluid embolism, DIC, prolapsed cord, and precipitous delivery.
-
Note: Some pages contain images and/or descriptions that cannot be captured in study notes.
Placenta Previa
-
Poor implantation site, potentially complete, partial, or marginal.
-
Vasa Previa is a dangerous developmental disorder where umbilical vessels run from the umbilical cord to the placenta between the amnion and chorion.
-
It's associated with earlier placenta previa and a higher implantation site.
-
Occurrence is relatively rare (1 out of 3000 births). Increased risk is associated with low-lying placenta, smoking history, history of prior C-sections, multiple pregnancies, and assisted conceptions. Mother is not at risk. Fetal mortality can be 33-100%.
Abruptio Placentae
-
Definition: premature separation of the placenta from the uterus.
-
Typically develops after week 20 of pregnancy and is a leading cause of neonatal death.
-
Severity is classified as Grade 0 to Grade 3 (increasing in degree of detachment and bleeding).
-
Half of abruptions are mild (grade 0 or 1), with a minor detachment part of the placenta, corresponding to a mild or lacking symptom manifestation. Severe abruptions (grade 3) involved more than half the placenta and often trigger DIC (Disseminated Intravascular Coagulation).
-
Possible causes include hypertension, placental necrosis, ruptured spiral arterioles, smoking, blunt force trauma, history of previous abruption, multiple pregnancies, and preexisting medical conditions.
-
Symptoms often include vaginal bleeding, hard or rigid uterine tone, uterine, abdominal or back pain, silent bleeding signs (shock, oliguria), non-reassuring fetal heart rate (FHR), and high-frequency low-amplitude contractions.
-
Lab findings are decreased hemoglobin and hematocrit (H&H), decreased clotting factors, and fetal-maternal bleeding.
Uterine Rupture
-
Complete separation of the uterine myometrium, releasing the fetus into the peritoneal cavity via rupture of the membranes.
-
A partial separation is referred to as a uterine dehiscence where the membranes remain intact.
-
Common risk factors include prior uterine surgery, hyperstimulation of the uterus, and trauma.
-
Typical manifestations include sudden fetal distress, abdominal pain, syncope, pallor, vomiting, shock, maternal tachycardia, vaginal bleeding, and presenting part ascent.
Amniotic Fluid Embolus (AFE)
-
Amniotic fluid enters the mother's venous circulation.
-
Prerequisites include ruptured membranes, ruptured uterine/cervical veins, and a pressure gradient from uterus to veins.
-
AFE is a leading cause of maternal mortality and usually causes brain damage in surviving mothers and 100% DIC (disseminated intravascular coagulation).
Prolapsed Cord
-
Umbilical cord lies beside or below the presenting part of the fetus.
-
Diagnosed through observing variable decelerations during uterine contractions, fetal bradycardia, and the umbilical cord protruding from the vagina
-
The cord should not be handled, and the expectant mother is prepared for rapid delivery by placing the mother on her right side(s) and delivering the baby via C-section.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Related Documents
Description
Test your knowledge on obstetrics and gynecology with this quiz. It covers topics such as hematomas, placental abruption, ectopic pregnancy, and treatment options for vaginal conditions. Perfect for those studying maternal health and female reproductive issues.
