Gynaecological emergencies

🚨 Ectopic Pregnancy

• Clinical Presentation:
  • ⚡ Sudden, severe lower abdominal or pelvic pain.
  • 🩸 Vaginal bleeding, often light but persistent.
  • Signs of rupture → hypotension, tachycardia, shoulder-tip pain (diaphragmatic irritation).
  • History: missed period, positive pregnancy test, risk factors (PID, tubal surgery, IVF, smoking).
• Diagnostic Tests:
  • 🧪 β-hCG: Low or plateauing levels (normally double every 48h in early pregnancy).
  • 🔎 Transvaginal ultrasound → absence of intrauterine sac + adnexal mass or free fluid.
  • 💉 Culdocentesis or FAST scan may reveal intraperitoneal blood if ruptured.
• Treatment:
  • 💊 Methotrexate (single dose) for stable, early, unruptured ectopics.
  • 🔪 Laparoscopy/laparotomy for ruptured ectopic or contraindication to methotrexate.
  • 🩸 IV fluids + blood transfusion in shock; Anti-D for Rhesus-negative women.

⚡ Ovarian Torsion

• Clinical Presentation:
  • Acute, severe unilateral pelvic pain (often intermittent early on).
  • 🤢 Nausea, vomiting.
  • May occur on background of ovarian cyst/dermoid; adnexal mass may be palpable.
• Diagnostic Tests:
  • Ultrasound with Doppler → ↓/absent blood flow (though normal flow doesn’t rule out torsion).
  • CT/MRI if ultrasound inconclusive.
• Treatment:
  • Urgent laparoscopy → detorsion and ovarian salvage (time critical to preserve fertility).
  • Oophorectomy if ovary non-viable/necrotic.
  • Ovarian fixation (oophoropexy) sometimes considered to reduce recurrence.

💥 Ruptured Ovarian Cyst

• Clinical Presentation:
  • ⚡ Sudden, sharp pelvic pain (often mid-cycle, "mittelschmerz").
  • Abdominal bloating or tenderness.
  • Severe cases → dizziness, hypotension if haemoperitoneum.
• Diagnostic Tests:
  • Pelvic US → collapsed cyst + free pelvic fluid.
  • CBC for haemoglobin drop.
• Treatment:
  • Stable → observation, analgesia, fluids.
  • Unstable → surgical exploration, cystectomy, control of bleeding.

🦠 Pelvic Inflammatory Disease (PID)

• Clinical Presentation:
  • Lower abdominal/pelvic pain, cervical motion tenderness (Chandelier sign 🕯️).
  • Fever, abnormal vaginal discharge, dyspareunia.
  • May complicate to tubo-ovarian abscess.
• Diagnostic Tests:
  • Endocervical swabs → gonorrhoea, chlamydia PCR.
  • Ultrasound → exclude abscess or hydrosalpinx.
  • Urinalysis → rule out UTI.
• Treatment:
  • Antibiotics: Ceftriaxone IM + Doxycycline PO ± Metronidazole.
  • Hospitalise if severe/septic, or abscess → may need drainage.
  • Partner notification & treatment; STI education.

☠️ Septic Abortion

• Clinical Presentation:
  • Fever, chills, rigors, pelvic pain.
  • Foul-smelling vaginal discharge 🦠.
  • Signs of sepsis → tachycardia, hypotension, confusion.
• Diagnostic Tests:
  • CBC, blood cultures.
  • Pelvic US → retained products of conception.
• Treatment:
  • Broad-spectrum IV antibiotics (e.g., gentamicin + clindamycin + ampicillin).
  • Surgical evacuation (D&C or suction curettage).
  • IV fluids, vasopressors if septic shock.

🩸 Acute Uterine Haemorrhage

• Clinical Presentation:
  • Sudden, heavy vaginal bleeding ± clots.
  • Lightheadedness, syncope; hypovolemic shock in severe cases.
• Diagnostic Tests:
  • Pelvic US → fibroids, polyps, retained tissue.
  • CBC, coagulation screen.
• Treatment:
  • Resuscitation: IV fluids, blood products.
  • Medical: Tranexamic acid, uterotonics, high-dose estrogen/progestins.
  • Surgical: D&C, uterine artery embolisation, hysterectomy (if refractory).

🧫 Pelvic Abscess

• Clinical Presentation:
  • Pelvic pain, fever, palpable mass.
  • History: PID, postpartum infection, recent pelvic surgery.
  • Systemic features: tachycardia, ↑WCC, sepsis signs.
• Diagnostic Tests:
  • Pelvic US/CT → abscess confirmation, localisation.
  • CBC + blood cultures.
• Treatment:
  • IV broad-spectrum antibiotics (covering anaerobes, Gram negs, streptococci).
  • Drainage: percutaneous or surgical if no improvement.
  • Supportive care: IV fluids, analgesia, sepsis management.