Emergency Obstertrics & Gynecology
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Transcript of Emergency Obstertrics & Gynecology
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Obstetrics and GynecologyEmergency
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Gynecologic Emergency
Women Acute Problems Abnormal vagina bleeding Acute Abdominal pain
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Women Acute Problems
Approach to the problem History taking Physical Examination
General Physical Examination Pelvic Examination
Laboratory test
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Women Acute Problems History taking Chief complain Present illness Past history
PMP (past normal menstruation period) LMP (last normal menstruation period) Gravida & parity Abortion Sexual intercourse Contraception Pregnancy & Delivery
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The Physician Role
The physician is A good listener Empathic Honest Genuine
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The Physician Role
The physician use Understandable language Appropriate body language A collaborative approach Open dialogue Appropriate emotional content Humor and warmth
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The Physician Role
The physician is not Confrontation Combative Condescending Overbearing Judgmental
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Normal menstruation
Beyond the first 1 to 2 years after menarche menstrual cycle conform to a cycle length of 21 to 35 days with a duration of less than 7 days
Recurrent amount more than 80 cc/cycle cause anemia
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Women Acute Problems
Physical examination General physical examination Abdominal examination
Bowel sound Mass
Point of tenderness or Ascites Guarding & Rebound tenderness
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Women Acute Problems Pelvic examination M/N IUB: Discharge, appearance Vagina: Mucosa & Discharge Cervix: Discharge, Erosion, Os
status, Excitation pain Uterus: Size, Shape, Position Adnexae: Mass, Tenderness Caldesac: Bulging, Mass,
Tenderness
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Women Acute Problems OPD laboratory Wet smear
NSS KOH
Gram stain Complete blood count Urine examination Urine pregnancy test Option: Culture & sensitivity
Endometrial aspiration Tissue Biopsy, PAP
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Urine pregnancy test
Any adolescent with abnormal bleeding should undergo sensitive pregnancy testing, regardless of whether she states that she has had intercourse.
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Abnormal (vaginal) bleeding
Introituses Vagina Cervix Uterus
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Introituses
Infection Trauma Sexual Abuse
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Vagina
Congenital Trauma (sexual abuse) Infection Tumor
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Cervix
Congenital Trauma (sexual abuse) Tumor Infection
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Abnormal Uterine Bleeding
Metrorhagia Menorrhea Hyper menorrhea (Hypo menorrhea)
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Abnormal uterine Bleeding
Extreme age Prepubertal Adolescent Perimenopause Postmenopause
Reproductive
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Abnormal Uterine Bleeding
Reproductive age
Pregnancy complication Not pregnancy condition
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Abnormal Uterine Bleeding
Reproductive age Pregnancy complication
Abortion: Threaten, inevitable, complete, incomplete
Molar pregnancy Ectopic pregnancy
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Abnormal Uterine Bleeding
Reproductive age Not pregnancy condition
Congenital Anomaly Trauma Tumor: Benign or Malignant Infection Other medical disease Exogenous hormonal or drug used
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Abnormal Uterine Bleeding
Extreme age
Children and Early adolescent Menopause
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Abnormal Uterine Bleeding
Extreme age: Children and Early adolescent
Organic disease Congenital anomaly Trauma: foreign body, sexual abuse Tumor: benign or malignant Infection: sexual abuse
Functional condition: Anovulation
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Abnormal Uterine Bleeding
Extreme age: Menopause
Peri-menopausal bleeding Post-menopause bleeding
Organic disease Functional condition
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Abnormal Uterine Bleeding
Peri-menopause: Organic disease
Myoma uteri Cervical or endometrial polyp Endometrial hyperplasia Endometrial carcinoma
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Abnormal Uterine Bleeding
Peri-menopause: Function condition (dysfunctional
uterine bleeding, DUB) Anovulatory bleeding Hormonal effect: HRT, Other
hormone
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Abnormal Uterine Bleeding
Post-menopausal bleeding Causes are the same as peri-
menopause bleeding but malignant tumor is more
likely
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Abnormal Uterine Bleeding
In peri and post menopausal women, malignant tumor must be rule out before dysfunctional uterine bleeding (DUB) is diagnosed and treatment.
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Acute pelvic pain
Gynecologic disease or dysfunction
Recurrent pelvic pain. Gastrointestinal Genitourinary Musculoskeletal Others
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Acute Pelvic Pain
Gynecologic disease or dysfunction
Complication of pregnancy Acute infection. Adnexal disorder.
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Acute Pelvic Pain
Complication of pregnancy Ruptured ectopic pregnancy Abortion: threaten or incomplete Degeneration of liomyoma
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Ectopic pregnancy Triad
Missed period Abdominal or pelvic pain Adnexal mass.
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Acute Pelvic Pain
Acute infection Endometritis Pelvic inflammatory disease Tubo-ovarian abscess
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PID
Minimum criteria 1. Lower abdominal tenderness, 2. Adnexa tenderness 3. Cervical motion tenderness
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PID Additional Criteria
1. Oral temperature > 101 F (>38.3 C) 2. Abnormal cervical or vaginal discharge 3. Elevated erythrocyte sedimentation rate 4. Elevated C-reactive protein 5. Laboratory documentation of cervical
infection with N. gonorrhea or C. trachomatis
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PID: Admitted criteria 1. Surgical emergencies such as
appendicitis cannot be excluded. 2. The patient is pregnant. 3. The patient does not respond
clinically to oral antimicrobial therapy.
4. The patient is unable to follow or tolerate an outpatient oral regimen
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PID: Admitted criteria 5.The patient has severe illness,
nausea and vomiting, or high fever. 6.The patient has a tubo-ovarian
abscess. 7.The patient is immunodeficiency
(i.e., has HIV infection with low CD4 counts, is taking immunosuppressive therapy, or has another disease).
8. The patient is adolescent.
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Acute Pelvic Pain
Adnexal disorders Hemorrhagic function ovarian cyst Torsion of adnexa Twisted par ovarian cyst Ruptured of functional or neoplastic
ovarian cyst.
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Recurrent pelvic pain
Mittelschmerz (midcycle pain) Primary dysmenorrhea Secondary dysmenorhea
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Recurrent pelvic pain
Gastrointestinal Appendicitis Bowel obstruction Diverticulitis Inflammatory bowel disease Irritable bowel syndrome
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Recurrent pelvic pain
Genitourinary Cystitis Pyelonephritis Ureteral lithiasis
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Recurrent pelvic pain
Musculoskelital Others
Acute Porphyria Pelvic thrombophebitis Aneurysm Abdominal angina
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Recurrent pelvic pain Primary dysmenorrhea Secondary dysmenorrhea
Imperforated hymen Transverse vaginal septum Cervical stenosis Uterine anomaly Intrauterine synergia Endometrial polyps Uterine liomyoma Adenomyosis Pelvic congestion syndrome Endometriosis
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Obstetrics Emergency
Antepartum hemorrhage Acute complication of
preeclamsia Postpartum hemorrhage Acute abdomen during pregnancy Abdominal trauma during
pregnancy Cardiac arrest during pregnancy
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Antepartum Hemorrhage
Abortion Abnormal Placentation
Placenta previa Placenta abruption
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Antepartum Hemorrhage
Placenta previa Painless bleeding Ultra sonography Maternal bleeding may be severe Termination of pregnancy
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Antepartum Hemorrhage
Placenta abruption Painful vagina bleeding Fetus in jeopardy
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Acute complication of preeclampsia
Seizer MgSo4 is appropriate than diazepam or
phenetoin Hypertension
More than 160/110 mmHg Hydralazine Nifedipine Sodium nitroprusside
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Postpartum Hemorrhage
Immediate PPH Delayed PPH
Infection Retain piece of conceptive product Uterine atony
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Acute Abdomen during Pregnancy
Acute appendicitis Renal stone Acute cholecystitis
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Abdominal Trauma during Pregnancy
Blunt or sharp Fetal viability Maternal condition Fetal well being
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Abdominal Trauma during Pregnancy
Physical abuse Sexaul Assault Automobile accidents Fetal injury and death Placenta abruption Uterine rupture
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Abdominal Trauma during Pregnancy
As in none pregnant women Evaluate and stabilization maternal
injuries Fetal assessment may divert from life
threatening maternal injuries Repositioning the large uterus away
from the great vessel
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Cardiac Arrest during Pregnancy
Basic life support (BLS) Advance cardiac life support
(ACLS) Pregnancy physiologic change Post mortem cesarean section
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