Emergency Obstertrics & Gynecology
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Emergency Obstertrics & Gynecology

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Emergency Obstertrics & Gynecology Presentation Transcript

  • 1. Obstetrics and Gynecology Emergency
  • 2. Gynecologic Emergency
    • Women Acute Problems
      • Abnormal vagina bleeding
      • Acute Abdominal pain
  • 3. Women Acute Problems
    • Approach to the problem
    • History taking
    • Physical Examination
      • General Physical Examination
      • Pelvic Examination
    • Laboratory test
  • 4. 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
  • 5. The Physician Role
    • The physician is
      • A good listener
      • Empathic
      • Honest
      • Genuine
  • 6. The Physician Role
    • The physician use
      • Understandable language
      • Appropriate body language
      • A collaborative approach
      • Open dialogue
      • Appropriate emotional content
      • Humor and warmth
  • 7. The Physician Role
    • The physician is not
      • Confrontation
      • Combative
      • Condescending
      • Overbearing
      • Judgmental
  • 8. 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
  • 9. Women Acute Problems
    • Physical examination
    • General physical examination
    • Abdominal examination
      • Bowel sound
      • Mass
    • Point of tenderness or Ascites
    • Guarding & Rebound tenderness
  • 10. 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
  • 11. 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
  • 12. Urine pregnancy test
    • Any adolescent with abnormal bleeding should undergo sensitive pregnancy testing, regardless of whether she states that she has had intercourse.
  • 13. Abnormal (vaginal) bleeding
    • Introituses
    • Vagina
    • Cervix
    • Uterus
  • 14. Introituses
    • Infection
    • Trauma
    • Sexual Abuse
  • 15. Vagina
    • Congenital
    • Trauma (sexual abuse)
    • Infection
    • Tumor
  • 16. Cervix
    • Congenital
    • Trauma (sexual abuse)
    • Tumor
    • Infection
  • 17. Abnormal Uterine Bleeding
    • Metrorhagia
    • Menorrhea
    • Hyper menorrhea
    • (Hypo menorrhea)
  • 18. Abnormal uterine Bleeding
    • Extreme age
      • Prepubertal
      • Adolescent
      • Perimenopause
      • Postmenopause
    • Reproductive
  • 19. Abnormal Uterine Bleeding
    • Reproductive age
      • Pregnancy complication
      • Not pregnancy condition
  • 20. Abnormal Uterine Bleeding
    • Reproductive age
    • Pregnancy complication
      • Abortion: Threaten, inevitable, complete, incomplete
      • Molar pregnancy
      • Ectopic pregnancy
  • 21. Abnormal Uterine Bleeding
    • Reproductive age
    • Not pregnancy condition
      • Congenital Anomaly
      • Trauma
      • Tumor: Benign or Malignant
      • Infection
      • Other medical disease
      • Exogenous hormonal or drug used
  • 22. Abnormal Uterine Bleeding
    • Extreme age
      • Children and Early adolescent
      • Menopause
  • 23. 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
  • 24. Abnormal Uterine Bleeding
    • Extreme age: Menopause
      • Peri-menopausal bleeding
      • Post-menopause bleeding
        • Organic disease
        • Functional condition
  • 25. Abnormal Uterine Bleeding
    • Peri-menopause:
    • Organic disease
        • Myoma uteri
        • Cervical or endometrial polyp
        • Endometrial hyperplasia
        • Endometrial carcinoma
  • 26. Abnormal Uterine Bleeding
    • Peri-menopause:
    • Function condition (dysfunctional uterine bleeding, DUB)
    • Anovulatory bleeding
    • Hormonal effect: HRT, Other hormone
  • 27. Abnormal Uterine Bleeding
    • Post-menopausal bleeding
    • Causes are the same as peri-menopause bleeding
    • but malignant tumor is more likely
  • 28. Abnormal Uterine Bleeding
    • In peri and post menopausal women, malignant tumor must be rule out before dysfunctional uterine bleeding (DUB) is diagnosed and treatment.
  • 29. Acute pelvic pain
    • Gynecologic disease or dysfunction
    • Recurrent pelvic pain .
    • Gastrointestinal
    • Genitourinary
    • Musculoskeletal
    • Others
  • 30. Acute Pelvic Pain
    • Gynecologic disease or dysfunction
      • Complication of pregnancy
      • Acute infection .
      • Adnexal disorder .
  • 31. Acute Pelvic Pain
    • Complication of pregnancy
      • Ruptured ectopic pregnancy
      • Abortion: threaten or incomplete
      • Degeneration of liomyoma
  • 32. Ectopic pregnancy Triad
    • Missed period
    • Abdominal or pelvic pain
    • Adnexal mass .
  • 33. Acute Pelvic Pain
    • Acute infection
      • Endometritis
      • Pelvic inflammatory disease
      • Tubo-ovarian abscess
  • 34. PID
    • Minimum criteria
      • 1 . Lower abdominal tenderness,
      • 2. Adnexa tenderness
      • 3. Cervical motion tenderness
  • 35. 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
  • 36. 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
  • 37. 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 .
  • 38. Acute Pelvic Pain
    • Adnexal disorders
      • Hemorrhagic function ovarian cyst
      • Torsion of adnexa
      • Twisted par ovarian cyst
      • Ruptured of functional or neoplastic ovarian cyst .
  • 39. Recurrent pelvic pain
    • Mittelschmerz (midcycle pain)
    • Primary dysmenorrhea
    • Secondary dysmenorhea
  • 40. Recurrent pelvic pain
    • Gastrointestinal
      • Appendicitis
      • Bowel obstruction
      • Diverticulitis
      • Inflammatory bowel disease
      • Irritable bowel syndrome
  • 41. Recurrent pelvic pain
    • Genitourinary
      • Cystitis
      • Pyelonephritis
      • Ureteral lithiasis
  • 42. Recurrent pelvic pain
    • Musculoskelital
    • Others
      • Acute Porphyria
      • Pelvic thrombophebitis
      • Aneurysm
      • Abdominal angina
  • 43. 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
  • 44. Obstetrics Emergency
    • Antepartum hemorrhage
    • Acute complication of preeclamsia
    • Postpartum hemorrhage
    • Acute abdomen during pregnancy
    • Abdominal trauma during pregnancy
    • Cardiac arrest during pregnancy
  • 45. Antepartum Hemorrhage
    • Abortion
    • Abnormal Placentation
      • Placenta previa
      • Placenta abruption
  • 46. Antepartum Hemorrhage
    • Placenta previa
      • Painless bleeding
      • Ultra sonography
      • Maternal bleeding may be severe
      • Termination of pregnancy
  • 47. Antepartum Hemorrhage
    • Placenta abruption
      • Painful vagina bleeding
      • Fetus in jeopardy
  • 48. Acute complication of preeclampsia
    • Seizer
      • MgSo 4 is appropriate than diazepam or phenetoin
    • Hypertension
      • More than 160/110 mmHg
      • Hydralazine
      • Nifedipine
      • Sodium nitroprusside
  • 49. Postpartum Hemorrhage
    • Immediate PPH
    • Delayed PPH
      • Infection
      • Retain piece of conceptive product
      • Uterine atony
  • 50. Acute Abdomen during Pregnancy
    • Acute appendicitis
    • Renal stone
    • Acute cholecystitis
  • 51. Abdominal Trauma during Pregnancy
    • Blunt or sharp
    • Fetal viability
    • Maternal condition
    • Fetal well being
  • 52. Abdominal Trauma during Pregnancy
    • Physical abuse
    • Sexaul Assault
    • Automobile accidents
    • Fetal injury and death
    • Placenta abruption
    • Uterine rupture
  • 53. 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
  • 54. Cardiac Arrest during Pregnancy
    • Basic life support (BLS)
    • Advance cardiac life support (ACLS)
    • Pregnancy physiologic change
    • Post mortem cesarean section
  • 55.