Reproductive Emergencies In Females Flashcards
Evisceration of intrabdominal contents through the vagina and Dehiscence of the vaginal cuff
Is a rare complication of hysterectomy (usually laparoscopy) or other pelvic surgery
- usually occurs within 3 months but can be as long as 5 years out
Risk factors
- post menopausal
- post operative infection
- prior vaginal surgery
- having sex prior to full healing for hysterectomy (laparoscopy or vaginal)
Presents with vaginal bleeding and pain
- can experience post coital bleeding especially if too early altering healing
Patients are always unstable
Treatment:
- ER admittance with safety net
- Give piperacillin-taxobactum IV
- prep for immediate surgery
Ruptured Ectopic pregnancy
Presents usually with suprapubic pain, constant, sharp and stabbing pain
- can have fever, vaginal bleeding/discharge
- can have black/bloody stool or emesis
- can show syncope if hypoperfusion
HCG is always positive and usually >20,000
- HgB is always low also
- pulse is always tachycardia CBC and usually blood in the posterior cul-de-sac
Consult OB/GYN right away!**
Risk factors
- IUD (10% of all ectopic)
- endometriosis
- past surgery in the pelvic cavity
- chronic PID
- maternal age old
- smoking
- prior ectopic
- IVF use to get pregnancy
97% of ectopic = Fallopian tubes
If in the pelvic cavity outside of the reproductive organs = heterotrophs pregnancy
Treatment
- transabdominal or transvaginal ultrasound to confirm. (Must check longitudinal and sagittal
- consult OBGYN immediately for OR and stabilize the patient as best until then
Treatment of complicated vs uncomplicated UTI
Uncomplicated
- healthy young female that is non pregnant and non toxic and has no history of difficult UTIs = 3 days of UTI treatment (based on organism)
Complicated = 7-10 days of treatment required
Why is chlamydia a tricky UTI
Chlamydia can cause UTI symptoms even without a report of sexual contact and also with negative nitrites
- WILL still show positive leukocyte esterase
needs to be considered in any women with a non-specific/non-diagnostic UA or persistent symptoms after appropriate antibiotic treatment
also because of this women <25 and older women at risk for chlamydia should be screened!
Endometritis/ acute PID
Presents with pain that often radiates to the back
- gradual onset but gets worse with time
- fowl smelling discharge is common
- boggy tender uterus with cervix motion tenderness
- **can develop sepsis (if so then will show systemic symptoms with septic signs)
common post pregnancy also!
Need to admit and set up safety net, labs, cultures/lactate levels and antibiotics from cultures
- if septic = fluids and start antibiotics broad spectrum even before cultures (most important first step is antibiotics)
- *if they dont respond within 24-48hrs = MUST get imaging (ultrasound) if you haven’t already**
- in this case it often looks like retained products (phlegmon) in the uterus and thickened myometrium
CT is next if the US of the uterus is normal to check for septic thrombophlebitis, broad ligament masses and thrombosis or appendicitis
Antibiotics = broad spectrum polymicrobial
- usually TMP-SMX or fluowquinolones with ceftriaxone
What must you ask about if a young child comes in with UTI symptoms?
Is anyone touching the child
- you have to rule out sexual assault
Vaginal foreign body (FOB)
VERY common in sexually abused females
- *Most common FOB however is toilet tissue in pre-pubertal girl**
- always have to rule out sexual abuse though
Classic symptoms
- vaginal discharge that is green and fuel
- looks a lot like UTI since pain can or cant be present (varies)
- vaginal bleeding is common and is the most sensitive and specific symptom for a FOB in a pre-pubertal girl
What is the leading cause of maternal mortality?
Postpartum hemorrhages
Is bleeding during pregnancy normal?
It is never normal!
Painless vaginal bleeding after 20 weeks of pregnancy requires what to be your #1 DDX?
Placenta previa
NEVER DO PELVIC EXAM OR TRANSVAGINAL ULTRASOUND
Painful vaginal bleeding after 20 weeks pregnant requires what to be the #1 DDX
Placental abruption
NEVER DO PELVIC EXAM OR TRANSVAGINAL US
What is the lower limit of HCG that usually mean ectopic pregnancy if pelvic pain is also present
> 1500
Pregnant women with new seizure late in pregnancy means what?
Eclampsia
- treat with magnesium sulfate and fix underlying HTN (usually hydralazine)
What is the most common surgical emergency during pregnancy
Appendicitis
Why is ondansetron contraindicated in pregnancy
Associated with fetal cardiac abnormalties, cleft palate
IS a teratogenic medication
use to and still is used for vomiting in pregnancy (morning sickness)
