Chapter 35 Emergency gynaecology
History includes last normal menstrual period (LMP), past pregnancy history, sexual activity, contraception, pregnancy signs and symptoms, preventative health strategies (PAP smear, breast examination) as well as characteristics of presenting symptoms (commonly pain, abnormal vaginal bleeding plus or minus pregnancy, vaginal discharge, fever).
Investigations often will involve ultrasound and serum beta human chorionic gonadotrophin (bhCG) estimation (see Table 35.1).
Reference intervals | ||
Serum hCG (U/L) | ||
Females | < 2.0 | Pre-menopausal |
< 10 | Post-menopausal | |
Males | < 2.0 | |
Pregnancy test | ||
Serum hCG (U/L) | Interpretation | |
< 2 | Negative (if taken after first missed period) | |
2–25 | Borderline result (suggest repeat in 48 hours) | |
> 25 | Consistent with pregnancy | |
Pregnancy staging | ||
Weeks since LMP | Approximate hCG range (U/L) | Comment |
3–4 | 0–130 | Week prior to first missed period |
4–5 | 75–2600 | Week after first missed period |
5–6 | 850–20,800 | |
6–7 | 4000–200,000 | |
7–12 | 11,500–289,000 | |
12–16 | 18,300–137,000 | |
16–29 | 1400–53,000 | Second trimester |
29–41 | 940–60,000 | Third trimester |
LMP, last normal menstrual period
COMMON PRESENTATIONS
Pain
Ruptured ectopic pregnancy
Diagnosis made by positive bhCG (see Table 35.1), and ultrasound (US) negative for intrauterine pregnancy. (Heterotopic pregnancy—an ectopic pregnancy together with an intrauterine pregnancy—occurs in approx 1 in 30,000 pregnancies.)
Acute salpingitis (PID)
(See also the section ‘Pelvic inflammatory disease’ in Chapter 41, ‘Infectious diseases’.)