OB/GYN Emergencies

Pregnancy & Gynecologic Emergencies

Types of Pregnancy Loss (10-15% of Pregnancies)

• Threatened: Light, painless spotting with possible cramping. Cervix remains closed. Advise rest for 24-48 hours.
• Inevitable: Increased cramping and bleeding, cervix dilated >3 cm.
  • Management: D&C, Rhogam if indicated.
• Incomplete: Severe cramping, heavy bleeding, open cervix, passage of tissue.
  • Management: D&C, Pitocin, Rhogam.
• Septic: Persistent pain, foul-smelling discharge.
  • Management: D&C, monitor for toxic shock.

Emergency contraception should be given alongside an antiemetic prescription.
“Date rape” drugs metabolize quickly—collect samples early.

Hypertensive Disorders of Pregnancy

Preeclampsia:

• Hypertension + proteinuria
• Decreased urine output
• Swelling in hands/face
• HELLP Syndrome: Hemolysis, elevated liver enzymes, low platelets
• Neurologic Signs: Headache, hyperactive reflexes
  • Treatment: Hydralazine or Labetalol for BP; Magnesium sulfate to prevent seizures

Eclampsia:

Preeclampsia + Seizures + Fetal distress

• Treatment: Secure airway, oxygen therapy, left lateral positioning, prepare for C-section if needed.

Placental Disorders

Placenta Previa (Painless Bleeding)

Placenta covers cervical opening (partial/complete).

• Signs: Bright red bleeding (oxygenated placental blood)
• Treatment: Left lateral recumbent position, fetal monitoring.

Placental Abruption (Painful Bleeding)

Premature placental separation.

• Signs: Dark red bleeding (if visible), severe back or abdominal pain, fetal distress.
• Treatment: Monitor fundal height and oxygenation.

Gestational Trophoblastic Disease

Molar Pregnancy (Hydatidiform Mole)

Benign overgrowth of trophoblastic tissue.

• Signs:
  • Grape-like vesicles in uterus
  • Persistent vaginal discharge (red/brown)
  • Elevated HCG
  • Ultrasound: “Snowstorm” pattern
  • Severe nausea/vomiting (hyperemesis)

Choriocarcinoma

Malignant trophoblastic tumor (can develop after molar pregnancy or retained placenta).

Ectopic Pregnancy (Emergency)

• Signs: Pelvic pain, vaginal bleeding, cervical motion tenderness.
• Rupture Signs: Syncope, hemorrhagic shock.

Ovarian Cysts

• Usually asymptomatic.
• Rupture → Intraperitoneal bleeding (not vaginal).

Pelvic Inflammatory Disease (PID)

Causes: Gonorrhea, chlamydia, multiple sexual partners, IUD use.

• Signs:
  • Cervical motion tenderness
  • Adnexal tenderness → Possible tubo-ovarian abscess
• Treatment: Ceftriaxone (Rocephin) + Metronidazole (Flagyl) + Doxycycline.

Toxic Shock Syndrome (TSS)

Caused by Staphylococcus aureus.

• Early Signs: Fever, sore throat, muscle pain, headache.
• Skin Findings: Widespread rash, blanching erythema, swelling.

Infections Affecting the External Genitalia

• Vulvovaginitis Causes: Scabies, abscesses, Bartholin’s cyst, genital warts (condyloma), herpes simplex.
• Discharge Characteristics:
  • Candida albicans: White, thick.
  • Bacterial vaginosis: Gray, fishy odor.
  • Trichomonas vaginalis: Yellow-green, frothy.
  • Gonorrhea: Thick, green/yellow.
  • Chlamydia: Yellowish with strong odor, may cause burning during urination or intercourse.

Herbal & Alternative Remedies to Know

Black Cohosh

• Common Use: Menopausal symptom relief.
• Caution: Not recommended for those with a history of breast or endometrial cancer.

Isoflavones

• Common Use: Menopause management, benign prostatic hyperplasia (BPH).
• Caution: Avoid in cases of soy allergies, breast cancer, or bladder cancer.

Guidelines for Breast Milk Storage

• Room Temperature: 4-8 hours.
• Refrigerated: Up to 8 hours.
• Frozen: Safe for 8 months.
• After Partial Use: Consume within 2 hours or refrigerate immediately.

Infertility Considerations

• Timeline for Testing: Evaluation typically begins after 12 months of unsuccessful attempts to conceive.
• Initial Assessments: Semen analysis, estrogen levels, and FSH testing.