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Emergency Obstertrics & Gynecology
 

Emergency Obstertrics & Gynecology

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    Emergency Obstertrics & Gynecology Emergency Obstertrics & Gynecology Presentation Transcript

    • Obstetrics and Gynecology Emergency
    • Gynecologic Emergency
      • Women Acute Problems
        • Abnormal vagina bleeding
        • Acute Abdominal pain
    • Women Acute Problems
      • Approach to the problem
      • History taking
      • Physical Examination
        • General Physical Examination
        • Pelvic Examination
      • Laboratory test
    • Women Acute Problems
      • History takin g
      • Chief complain
      • Present illness
      • Past history
        • PMP (past normal menstruation period)
        • LMP (last normal menstruation perio d )
        • Gravida & parity
        • Abortion
        • Sexual intercourse
        • Contraception
        • Pregnancy & Delivery
    • The Physician Role
      • The physician is
        • A good listener
        • Empathic
        • Honest
        • Genuine
    • The Physician Role
      • The physician use
        • Understandable language
        • Appropriate body language
        • A collaborative approach
        • Open dialogue
        • Appropriate emotional content
        • Humor and warmth
    • The Physician Role
      • The physician is not
        • Confrontation
        • Combative
        • Condescending
        • Overbearing
        • Judgmental
    • Normal menstruation
      • Beyond the first 1 to 2 years after menarche menstrual cycle conform to a cycle length of 21 to 35 days with a duration of less than 7 days
      • Recurrent amount more than 80 cc/cycle cause anemia
    • Women Acute Problems
      • Physical examination
      • General physical examination
      • Abdominal examination
        • Bowel sound
        • Mass
      • Point of tenderness or Ascites
      • Guarding & Rebound tenderness
    • Women Acute Problems
      • Pelvic examination
      • M/N IUB: Discharge, appearance
      • Vagina: Mucosa & Discharge
      • Cervix: Discharge, Erosion, Os status, Excitation pain
      • Uterus: Size, Shape, Position
      • Adnexae: Mass, Tenderness
      • Caldesac: Bulging, Mass, Tenderness
    • Women Acute Problems
      • OPD laboratory
      • Wet smear
        • NSS
        • KOH
      • Gram stain
      • Complete blood count
      • Urine examination
      • Urine pregnancy test
      • Option: Culture & sensitivity
        • Endometrial aspiration
        • Tissue Biopsy, PAP
    • Urine pregnancy test
      • Any adolescent with abnormal bleeding should undergo sensitive pregnancy testing, regardless of whether she states that she has had intercourse.
    • Abnormal (vaginal) bleeding
      • Introituses
      • Vagina
      • Cervix
      • Uterus
    • Introituses
      • Infection
      • Trauma
      • Sexual Abuse
    • Vagina
      • Congenital
      • Trauma (sexual abuse)
      • Infection
      • Tumor
    • Cervix
      • Congenital
      • Trauma (sexual abuse)
      • Tumor
      • Infection
    • Abnormal Uterine Bleeding
      • Metrorhagia
      • Menorrhea
      • Hyper menorrhea
      • (Hypo menorrhea)
    • Abnormal uterine Bleeding
      • Extreme age
        • Prepubertal
        • Adolescent
        • Perimenopause
        • Postmenopause
      • Reproductive
    • Abnormal Uterine Bleeding
      • Reproductive age
        • Pregnancy complication
        • Not pregnancy condition
    • Abnormal Uterine Bleeding
      • Reproductive age
      • Pregnancy complication
        • Abortion: Threaten, inevitable, complete, incomplete
        • Molar pregnancy
        • Ectopic pregnancy
    • Abnormal Uterine Bleeding
      • Reproductive age
      • Not pregnancy condition
        • Congenital Anomaly
        • Trauma
        • Tumor: Benign or Malignant
        • Infection
        • Other medical disease
        • Exogenous hormonal or drug used
    • Abnormal Uterine Bleeding
      • Extreme age
        • Children and Early adolescent
        • Menopause
    • Abnormal Uterine Bleeding
      • Extreme age: Children and Early adolescent
      • Organic disease
        • Congenital anomaly
        • Trauma: foreign body, sexual abuse
        • Tumor: benign or malignant
        • Infection: sexual abuse
      • Functional condition: Anovulation
    • Abnormal Uterine Bleeding
      • Extreme age: Menopause
        • Peri-menopausal bleeding
        • Post-menopause bleeding
          • Organic disease
          • Functional condition
    • Abnormal Uterine Bleeding
      • Peri-menopause:
      • Organic disease
          • Myoma uteri
          • Cervical or endometrial polyp
          • Endometrial hyperplasia
          • Endometrial carcinoma
    • Abnormal Uterine Bleeding
      • Peri-menopause:
      • Function condition (dysfunctional uterine bleeding, DUB)
      • Anovulatory bleeding
      • Hormonal effect: HRT, Other hormone
    • Abnormal Uterine Bleeding
      • Post-menopausal bleeding
      • Causes are the same as peri-menopause bleeding
      • but malignant tumor is more likely
    • Abnormal Uterine Bleeding
      • In peri and post menopausal women, malignant tumor must be rule out before dysfunctional uterine bleeding (DUB) is diagnosed and treatment.
    • Acute pelvic pain
      • Gynecologic disease or dysfunction
      • Recurrent pelvic pain .
      • Gastrointestinal
      • Genitourinary
      • Musculoskeletal
      • Others
    • Acute Pelvic Pain
      • Gynecologic disease or dysfunction
        • Complication of pregnancy
        • Acute infection .
        • Adnexal disorder .
    • Acute Pelvic Pain
      • Complication of pregnancy
        • Ruptured ectopic pregnancy
        • Abortion: threaten or incomplete
        • Degeneration of liomyoma
    • Ectopic pregnancy Triad
      • Missed period
      • Abdominal or pelvic pain
      • Adnexal mass .
    • Acute Pelvic Pain
      • Acute infection
        • Endometritis
        • Pelvic inflammatory disease
        • Tubo-ovarian abscess
    • PID
      • Minimum criteria
        • 1 . Lower abdominal tenderness,
        • 2. Adnexa tenderness
        • 3. Cervical motion tenderness
    • PID
      • Additional Criteria
        • 1. Oral temperature > 101 F (>38.3 C)
        • 2. Abnormal cervical or vaginal discharge
        • 3. Elevated erythrocyte sedimentation rate
        • 4. Elevated C-reactive protein
        • 5. Laboratory documentation of cervical infection with N. gonorrhea or C. trachomatis
    • PID: Admitted criteria
      • 1. Surgical emergencies such as appendicitis cannot be excluded.
      • 2. The patient is pregnant.
      • 3. The patient does not respond clinically to oral antimicrobial therapy.
      • 4. The patient is unable to follow or tolerate an outpatient oral regimen
    • PID: Admitted criteria
      • 5.The patient has severe illness, nausea and vomiting, or high fever.
      • 6.The patient has a tubo-ovarian abscess.
      • 7.The patient is immunodeficiency (i.e., has HIV infection with low CD4 counts, is taking immunosuppressive therapy, or has another disease).
      • 8. The patient is adolescent .
    • Acute Pelvic Pain
      • Adnexal disorders
        • Hemorrhagic function ovarian cyst
        • Torsion of adnexa
        • Twisted par ovarian cyst
        • Ruptured of functional or neoplastic ovarian cyst .
    • Recurrent pelvic pain
      • Mittelschmerz (midcycle pain)
      • Primary dysmenorrhea
      • Secondary dysmenorhea
    • Recurrent pelvic pain
      • Gastrointestinal
        • Appendicitis
        • Bowel obstruction
        • Diverticulitis
        • Inflammatory bowel disease
        • Irritable bowel syndrome
    • Recurrent pelvic pain
      • Genitourinary
        • Cystitis
        • Pyelonephritis
        • Ureteral lithiasis
    • Recurrent pelvic pain
      • Musculoskelital
      • Others
        • Acute Porphyria
        • Pelvic thrombophebitis
        • Aneurysm
        • Abdominal angina
    • Recurrent pelvic pain
      • Primary dysmenorrhea
      • Secondary dysmenorrhea
        • Imperforated hymen
        • Transverse vaginal septum
        • Cervical stenosis
        • Uterine anomaly
        • Intrauterine synergia
        • Endometrial polyps
        • Uterine liomyoma
        • Adenomyosis
        • Pelvic congestion syndrome
        • Endometriosis
    • Obstetrics Emergency
      • Antepartum hemorrhage
      • Acute complication of preeclamsia
      • Postpartum hemorrhage
      • Acute abdomen during pregnancy
      • Abdominal trauma during pregnancy
      • Cardiac arrest during pregnancy
    • Antepartum Hemorrhage
      • Abortion
      • Abnormal Placentation
        • Placenta previa
        • Placenta abruption
    • Antepartum Hemorrhage
      • Placenta previa
        • Painless bleeding
        • Ultra sonography
        • Maternal bleeding may be severe
        • Termination of pregnancy
    • Antepartum Hemorrhage
      • Placenta abruption
        • Painful vagina bleeding
        • Fetus in jeopardy
    • Acute complication of preeclampsia
      • Seizer
        • MgSo 4 is appropriate than diazepam or phenetoin
      • Hypertension
        • More than 160/110 mmHg
        • Hydralazine
        • Nifedipine
        • Sodium nitroprusside
    • Postpartum Hemorrhage
      • Immediate PPH
      • Delayed PPH
        • Infection
        • Retain piece of conceptive product
        • Uterine atony
    • Acute Abdomen during Pregnancy
      • Acute appendicitis
      • Renal stone
      • Acute cholecystitis
    • Abdominal Trauma during Pregnancy
      • Blunt or sharp
      • Fetal viability
      • Maternal condition
      • Fetal well being
    • Abdominal Trauma during Pregnancy
      • Physical abuse
      • Sexaul Assault
      • Automobile accidents
      • Fetal injury and death
      • Placenta abruption
      • Uterine rupture
    • Abdominal Trauma during Pregnancy
      • As in none pregnant women
      • Evaluate and stabilization maternal injuries
      • Fetal assessment may divert from life threatening maternal injuries
      • Repositioning the large uterus away from the great vessel
    • Cardiac Arrest during Pregnancy
      • Basic life support (BLS)
      • Advance cardiac life support (ACLS)
      • Pregnancy physiologic change
      • Post mortem cesarean section
    •