Emergency Medicine > OBGYN Emergencies > Flashcards

OBGYN Emergencies Flashcards

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1
Q

Common causes of premenarcheal abnormal vaginal bleeding

A
  1. Genital Trauma and/or sexual abuse
  2. Vaginitis
  3. Tumors (vaginal, uterine)
  4. FB
  5. Menarche
  6. Precocious puberty
  7. Hematuria
  8. Coagulopathy
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2
Q

common causes of abnml vaginal bleeding of reproductive age

A
  1. Coagulopathy
  2. Anovulatory cycles
  3. Pregnancy (including ectopic, abortion)
  4. Endocrine abnormality
  5. Uterine leiomyomas
  6. Cervical and endometrial polyps
  7. Pelvic infections (salpingitis, cervicitis)
  8. Trauma
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3
Q

common causes of abnml vaginal bleeding during postmenopausal?

A
  1. Exogenous hormones
  2. Atrophic vaginitis
  3. Endometrial lesions (including cervical or uterine cancer/tumors)
  4. Cervical/endometrial polyps
  5. Trauma
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4
Q

w/u to get for abnml vaginal bleeding

A
  1. hcg, CBC, PT/INR, thyroid, STI
  2. US
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5
Q

mgmt for unstable abnml vaginal bleeding

A

resuscitation and GYN consult

  1. Uterine compression
  2. D&C/laparoscopy/laparotomy
  3. IV estrogen
  4. Admission
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6
Q

mgmt for stable abnml vaginal bleeding

A
  1. oral short-term hormonal therapy vs TXA
  2. Discharge and follow up gynecologist
  3. NSAIDs
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7
Q

RF for ectopic pregnancy

A
  1. H/o ectopic pregnancy
  2. h/o fallopian tube, pelvic, or abd surgery
  3. STI
  4. PID
  5. Endometriosis
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8
Q

classic triad presentation of ectopic pregnancy

A

abdominal pain, vaginal bleeding, amenorrhea

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9
Q

w/u for ectopic pregnancy?
what r/o ectopic?

A
  1. HCG, CBC, progesterone, type & screen, CMP
  2. US
    - Transabdominal may be first
    - Transvaginal if transabdominal nondiagnostic
    - Visualization of unequivocal IUP w/o abnormalities excludes ectopic
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10
Q

mgmt for ectopic pregnancy

A
  1. ABC
  2. Bedside urine HCG
  3. Rh immune globulin as needed
  4. OB consult
  5. Expectant tx
  6. Definitive - Surgery, Medication
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11
Q

w/u for vaginal bleeding during early pregnancy

A
  1. quantitative HCG, CBC, STI testing, type & screen, urinalysis
  2. US
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12
Q

mgmt for vaginal bleeding in early pregnancy

A
  1. Unstable: resuscitation and emergent OB consultation
  2. Rh (-): anti-Rho (D) IG
  3. Further tx dependent upon US findings:
    - Expectant management
    - Ectopic pregnancy
    - IUP w/ vaginal bleeding
    - Incomplete abortion
    - Gestational trophoblastic disease
    - Inevitable abortion

DC: instructions and follow up

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13
Q

premature separation of the placenta from the uterine wall

A

placental abruption

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14
Q

the implantation of the placenta over the cervical os

A

placenta previa

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15
Q

what is considered preterm labor?

A

labor < 37 wks

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16
Q

w/u for vaginal bleeding in late pregnancy

A
  1. CBC, type & cross, cervical fluid eval, STI, coags, lytes, DIC profile, UA
  2. US
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17
Q

late pregnancy pt presenting with vaginal bleeding - what should you be cautious about when doing your PE?

A

ddx of placental abruption or placenta previa - don’t want to introduce more risk of infection when doing a pelvic exam so do a sterile speculum test
don’t do a bimanual!

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18
Q

mgmt for vaginal bleeding in late pregnancy?

A
  1. Unstable: ABC, emergent OB consultation
  2. Rh negative: anti-Rho (D) immunoglobulin
  3. Further tx dependent upon US:
    - Placental abruption/placenta previa: emergent c-section
    - OB consultation
    - Maternal and fetal monitoring
    - Tocolysis
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19
Q

rupture of membranes before the onset of labor

A

Premature Rupture of Membranes

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20
Q

classic presentation of premature rupture of membranes?

A
  • rush of fluid or continuous leakage of fluid from vagina
  • Exam: sterile speculum with STI testing
  • Dx: pool of fluid in posterior fornix
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21
Q

mgmt for premature rupture of membranes

A

multifactorial, may need antibiotics/steroids, OB consultation/admission

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22
Q

what is a threatened abortion?

A

vaginal bleeding in < 20 wks of pregnancy with a closed cervical os, benign exam, and no passage of tissue

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23
Q

vaginal bleeding with open cervical os

what type of sponaneous abortion?

A

inevitable

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24
Q

partial passage of the conceptus, more likely between 6 and 14 weeks

what type of spontaneous abortion?

A

incomplete

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25
what is a complete abortion?
passage of all fetal tissue < 20 wks gestation
26
what is a missed abortion?
fetal death < 20 wks w/o passage of any fetal tissue for 4 wks after fetal death
27
w/u for spontaneous abortion
1. CBC, type & cross, quantitative HCG, UA - if concern for septic abortion: blood/urine cx, BMP/LFTs, PT/PTT 2. US
28
mgmt for Threatened/Inevitable/Complete Abortion
DC, OB f/u
29
mgmt for Incomplete/Missed abortion
OB consultation, D&C
30
mgmt for Septic Abortion
1. OB consultation 1. admit (consider ICU) 1. unaysn/clinda + gentamicin
31
pregnancy complications of chronic HTN
abruption, preeclampsia, low birth weight, cesarean delivery, premature birth, and fetal demise
32
what is Gestational HTN? Criteria?
>140/90 after 20 wks or in immediate postpartum period w/o proteinuria Criteria: SBP >= 140 or DBP >= 90 on two occasions at least 4 hrs apart
33
RF for gestational HTN
**first-time mothers**, FHx PIH, women carrying multiples, < 20 or >40 y/o, HTN or kidney disease prior to pregnancy
34
mgmt for gestational HTN
1. rest/lying on left side 1. more prenatal checkups 1. less salt 1. drink 8 glasses of water a day 1. meds
35
what is preeclampsia?
> 140/90 on two occasions at least 4 hrs apart + **proteinuria >= 300** in 24 hrs at 20 wks’ gestation
36
alt criteria for preeclampsia?
(HTN w/o proteinuria): 1. thrombocytopenia 1. elevation LFTs 1. new renal insufficiency 1. pulmonary edema 1. new-onset mental status/visual disturbance
37
s/s of preeclampsia
* HA, visual disturbances, edema or abd pain * Severe Preeclampsia: end-organ involvement; >160/110
38
difference between preeclampsia vs eclampsia
Eclampsia is preeclampsia with **seizures**
39
what is HELLP Syndrome?
* Clinical variant of preeclampsia * Criteria: Hemolysis, Elevated Liver enzymes, Low Platelets *Caveat: May only complain of abd pain and NOT have elevated BP*
40
w/u for preeclampsia
1. CBC, **CMP**, LDH, peripheral smear, UA, PT/PTT 1. Imaging: focused US or a CT _abdomen_
41
mgmt for preeclampsia
1. Severe preeclampsia or eclampsia - **Mg Sulfate** 1. Severe HTN - **labetalol**, hydralazine; _dec BP slowly_ 1. Emergent OB consult, admit 1. **definitive tx: deliver baby**
42
pelvic pain MC from gynecologic pathology therefore you should always r/o ?
pregnancy!
43
what is primary dysmenorrhea?
cramping pelvic pain that comes before or during a period
44
what is Mittelschmerz
benign pelvic pain that occurs midcycle (during or after ovulation)
45
pelvic pain that may be one-sided, self-limiting (minutes to hours), range from mild to severe pain, MC 2 weeks before period dx?
Mittelschmerz
46
crampy, lower abdominal/pelvic pain; may be associated with nausea/vomiting, back pain, headache and irritability dx?
Primary Dysmenorrhea
47
sacs, usually filled with fluid, in/on an ovary
Ovarian Cysts
48
presentation of ovarian cyst
sudden-onset unilateral pain pain caused by stretching of the capsule
49
concerning features of an ovarian cyst
* >8cm * multiloculated * solid
50
complication of ovarian cyst
bleeding from cyst wall or cyst rupture *hemorrhagic may be more concernign*
51
sudden onset of unilateral, severe adnexal pain; may have N/V and low-grade fever may have h/o ovarian cyst, pregnancy, or chemical induction of ovulation
ovarian torsion
52
Endometriosis s/s
**recurrent** pelvic pain associated with menstrual cycles, dyspareunia, and infertility
53
benign smooth muscle tumors, usually in the uterus or GI tract
Leiomyomas (uterine fibroids)
54
s/s of Leiomyomas (uterine fibroids)
abnormal vaginal bleeding, dysmenorrhea, bloating, backache, urinary sx, enlarged uterus, and dyspareunia
55
RF for PID
1. < 25y 1. multiple sexual partners 1. a new sexual partner (last 30 days) 1. presence of other STI 1. recent intrauterine device insertion or procedure (< 3 wks)
56
s/s of PID
lower abd pain, vaginal discharge, vaginal bleeding, urinary discomfort, fever, N/V
57
dx criteria for PID
* Group 1 (min criteria): uterine or adnexal tenderness and cervical motion tenderness * Group 2 (improves specificity): F, vaginal/cervical secretions, inc ESR/CRP, (+) pelvic cx * Group 3 (procedure-based): laparoscopy, pelvic US (or MRI), endometrial bx
58
w/u for pelvic pain
* HCG, CBC, UA, ESR/CRP, cervical swabs for **GC/Chlamydia** * transvaginal US (or MRI)
59
general mgmt for nonemergent pelvic pain
1. reassurance 1. NSAIDs 1. abx/preventative counseling (if indicated) 1. gynecology referral
60
indications to admit pelvic pain
* Failed outpatient treatment * Tubo-ovarian abscess * Toxic appearance * Inability to tolerate oral medication
61
parental tx options for admitted PID
1. Cefotetan/cefoxitin + Doxy 1. Clinda + gentamicin 1. unaysn + doxy
62
outpatient tx for PID
* Rocephin/cefotxitin + probenecid * other 3rd gen cephalo + doxy +/- flagyl
63
alt outpatient tx for PID
*if parenteral cephalo not feasible and community prevalence for FQ resistance is low: Levofloxacin/ofloxacin +/- flagyl
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