Gynaecological emergencies Flashcards
Ectopic pregnancy
An ectopic pregnancy is one that occurs anywhere outside of the uterus - commonly in fallopian tubes
Most common location for ectopic pregnancy?
In one of the fallopian tubes.
Presentation of ectopic pregnancy
Abdominal pain, pelvic pain, amenorrhoea, usually HCG positive and unilateral pain, shoulder tip pain
Investigations for ectopic pregnancy
Urine hCG, serum hCG and abdominal ultrasound
Risk factors for ectopic pregnancy
Previous ectopic Tubal damage- infection, endometriosis, surgery, PID, Intrauterine contraceptive devices Smoking Infertility Infertility treatment Extremes of reproductive age
Management of ectopic pregnancy
Medical management involves the administration of systemic methotrexate, with ongoing monitoring of serum hCG levels.
Surgical management involves the surgical removal of the ectopic pregnancy (most commonly a laparoscopic salpingectomy).
Ovarian torsion
the rotation of the ovary at its pedicle to such a degree as to occlude the ovarian artery and/or vein.
Ovarian torsion symptoms
Sudden onset of sharp and usually unilateral lower abdominal pain, in 70% of cases accompanied by nausea and vomiting.
HCG negative and unilateral
Management of Ovarian torsion
~ Resuscitation ~ Laparoscopy – small incision and ideal ~ Laparotomy – large open incision ~ Detorsion ~ Cystectomy – operation to remove whole bladder ~ Oophorectomy
Ovarian cyst
An ovarian cyst is a fluid-filled sac that forms on or inside an ovary. In some cases, the cyst can break open (rupture).
Presentation of Ovarian cyst
Remember, presentation would be unilateral, HCG negative with signs of infection – like raised WBCs
Pelvic inflammatory disease
An inflammatory condition (often secondary to infection), affecting any part of the higher female reproductive system, e.g; uterus, fallopian tubes, ovaries.
Typically results from an ascending infection from the cervix, and most commonly is a result of the sexually transmitted infections chlamydia, or less so, gonorrhoea.
PID symptoms (lots)
Generalised Abdominal pain, HCG negative
Usually lower region
Can be bilateral or unilateral
If pain is severe, may be associated with nausea and vomiting. If nausea and vomiting are present, this suggests peritonitis.
Dyspareunia
Cervical / vaginal discharge, Often foul smelling
Irregular vaginal bleeding
Heavy blood loss suggests endometritis
Fever (About 1/3 of patients)
Cervicitis
Dyspareunia
pain on sexual intercourse
If nausea and vomiting are present in PID, what does this suggest?
Peritonitis
Investigations in PID
~ FBC, CRP, ?LFT
~ Cervical motion tenderness
~ Genital swabs x2
Management of PID
Some patients may be suitable for oral antibiotics and outpatient treatment
Typical regimen might be single IM dose of ceftriaxone with 14 days doxycycline + metronidazole
Bartholin cyst/abscess
A build-up of mucus secretions can cause the duct of the gland to become blocked, from which a cyst can develop. The cyst itself can become infected, and if untreated, develop into an abscess.
Where are the bartholin glands?
Greater vestibular glands - are located deep to the posterior aspect of the labia majora.
Presentation of small bartholin cysts.
Small Bartholin’s cysts are often asymptomatic.
If they become large, they can cause vulvar pain.
Presentation of bartholin cyst rupture.
The cyst can undergo spontaneous rupture – after which the patient typically experiences a sudden relief of pain.
Bartholin’s abscesses typically present with acute onset of pain, and/or difficulty passing urine.
The morphology of bartholin cyst & abscess
Bartholin’s cyst – typically soft, fluctuant and non-tender
Bartholin’s abscess – typically tense and hard, with surrounding cellulitis
Management of bartholin cyst & abscess
Conservative, Antibiotics- broad spectrum, Incision and drainage
Investigations of bartholin cyst & abscess
Clinical - swabs
