Emergency gynaecology

Published on 14/03/2015 by admin

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Last modified 14/03/2015

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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).

Management includes excluding pregnancy for every female of reproductive age, and early attention to vital signs, anticipating that certain conditions are associated with immediately life-threatening presentations.

Sensitivity and attention to patient comfort mandates conducting gynaecological history and pelvic examinations in a private area (when the patient’s condition is stable), using a warmed speculum, and offering analgesia early.

Investigations often will involve ultrasound and serum beta human chorionic gonadotrophin (bhCG) estimation (see Table 35.1).

Table 35.1 Interpretation of quantitative serum hCG results

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

Acute salpingitis (PID)

(See also the section ‘Pelvic inflammatory disease’ in Chapter 41, ‘Infectious diseases’.)

Diagnosis is made by a combination of clinical findings and some or all of the following: positive microbiology from cervical secretions (swabs taken specifically for gonococcus and Chlamydia), leukocytosis, US documenting inflammatory adnexal mass or retained products.

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