OBGYN Emergencies Flashcards
A 30-year-old female presents with severe lower abdominal pain and vaginal bleeding. She is sexually active and reports a positive pregnancy test. On examination, her vital signs are stable, but her pelvis is tender to palpation. What is the most likely diagnosis, and what steps should be taken?
The most likely diagnosis in this case is an ectopic pregnancy. The immediate steps to be taken include a focused ultrasound examination (transvaginal ultrasound) to confirm the diagnosis and assess the location of the pregnancy. If ectopic pregnancy is confirmed, surgical intervention or medical management may be necessary, depending on the clinical presentation and patient’s stability.
What is the textbook definition of abnormal uterine bleeding?
- > 80mL per menses
- > 7 days
- Clots > 2.5cm
- Changing pad/tampon Q3hr
How can you control abormal uterine bleeding?
What lab must be ordered?
- TXA (all day long!)
- Blood products
- Consider IV conjugated equine estrogen
- NSAIDs are prostoglandin inhibitors and can reduce cramping and bleeding
- Consult OBGYN
Pregnancy test
How are you going to treat heavy menstrual bleeding in the ED?
Estrogen containing OCP 3 pills x 2 days or until bleeding stopped then 2 x 3d
What is the most common etiology of PID?
GC or chlamydia
What is the presentation of PID?
Bilateral lower abdominal pain, discharge, fever, chills, malaise, cervical motion tenderness (chandalier sign), adnexal tenderness
Do mucus membrane abcesses heal faster than skin abcesses?
Yes
What is the treatment for a bartholin cyst?
What kind of gland are the bartholin gland?
Drainage with Word Catheter, painful give meds prior
Mucus gland, located within the labia majora at 4 and 8 o’clock position
Do bartholin cysts typically require antibiotics?
No, because the gland is sterile
What is the presentation of an ectopic pregnancy?
What is the definitive diagnostic test?
- POOP typically 6-8wks after LMP
- Pain typically along one of the lower quadrants
- Vaginal bleeding
- May be in shock
- Syncope
Quantitative hCG
What is Blighted Ovum?
What is the treatment?
Gestational sac but no fetus
Need to remove the sac
What is the treatment for spontaneous abortion?
- If stable, medically manage with Misoprostol and +/- mifepristone
- If heavy bleeding needs a D&C
What is the difference between pre-eclampsia and eclampsia?
Can occur up to how long post-partum?
Seizures
Up to 6 weeks post-op
What is a key physical exam to work-up up eclampsia?
Why?
Reflexes
Treating with magneisum so need to watch for toxicity
What are complications associated with placental abruption?
- Hemorrhage
- DIC
- Hypovolemic shock
- ARDS
- Renal Failure
- Death
