Abdominal pain during pregnancy can have many potential causes and can be difficult to diagnose. A thorough history, physical exam, and consideration of both maternal and fetal well-being is important. Common causes of abdominal pain in pregnancy include appendicitis, urinary tract infections, gallstones, round ligament pain, and obstetric emergencies such as preeclampsia, placental abruption, and ectopic pregnancy. A multidisciplinary approach may be needed and the risks of exploratory surgery must be weighed against risks of delayed diagnosis.
Abdominal pain is a common complaint in pregnancy that can be caused by conditions directly related to pregnancy or unrelated. It can be difficult to determine the cause without investigations. Causes in the first trimester include abortion, molar pregnancy, and ectopic pregnancy. In the second trimester, potential causes are abortion, incarcerated retroverted uterus, complications of amniocentesis, preterm labor, and fibroid degeneration. The third trimester may involve round ligament pain, placental abruption, preeclampsia, and uterine rupture. A careful history, exam, and potential ultrasound or laparoscopy are needed to diagnose the source of abdominal pain in pregnancy.
This document discusses abdominal pain during pregnancy, which can be difficult to distinguish between physiological and pathological causes. A thorough history and examination is most important to determine the cause, which could include issues like miscarriage, ectopic pregnancy, urinary tract infections, appendicitis, or preeclampsia. Treatment depends on the identified cause, and urgent referral is needed if the cause is unclear or if maternal or fetal distress is present. Surgery may be required in some cases but is best performed in the second trimester if possible.
Abdominal pain during pregnancy can have many causes, both pregnancy-related and non-pregnancy related. Pregnancy-related causes include round ligament pain, Braxton Hicks contractions, preterm labor, placental problems, and liver issues related to conditions like preeclampsia. Non-pregnancy related causes include issues like appendicitis, kidney infections, and digestive system problems. A thorough physical exam and testing is needed to determine the cause, and treatment depends on the underlying issue and gestational age of the fetus. The well-being of both the mother and fetus must be closely monitored.
Abdominal pain in pregnancy can have many potential causes including obstetric, gynecological, surgical, and medical issues. A thorough history and physical exam is important to determine the cause, which may include conditions like preterm labor, placental abruption, appendicitis, or ectopic pregnancy. Based on the findings, appropriate investigations like urine tests, ultrasound, and fetal monitoring can help make the diagnosis. Management is tailored to the specific cause but the priority is always the health and safety of the mother and baby.
Information about acute abdomen in pregnancy.
Gastrointestinal surgery in pregnancy.
Presentation on acute abdomen in pregnancy, physiology of pregnancy, upper abdominal pain, lower abdomen pain, diffuse abdominal pain, lonizing radiation etc.
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This document discusses the evaluation and management of acute abdomen during pregnancy. It outlines common etiologies including appendicitis, bowel obstruction, and pregnancy-related causes. The evaluation involves history, physical exam focusing on signs of peritonitis, and lab tests. Imaging options like ultrasound and MRI are discussed. Laparoscopy is generally safe in pregnancy with precautions. Acute appendicitis is the most common non-obstetric surgical emergency. It can be more severe in pregnancy and risks increase with delayed treatment.
This document discusses various obstetric and gynecologic causes of an acute abdomen in pregnant and non-pregnant patients. It describes conditions such as abruptio placentae, ectopic pregnancy, rupture of the uterus, and torsion of the uterus. For each condition, it outlines the clinical features, diagnostic approaches, and principles of treatment. The document provides a comprehensive overview of potential causes of acute abdominal pain in obstetric and gynecologic patients.
Abdominal pain in pregnancy is a very common problem encountered in day to day practice. Although is can be benign at times great care should be exercised to dismiss as nothing significant.
Abdominal pain is a common complaint in pregnancy that can be caused by conditions directly related to pregnancy or unrelated. It can be difficult to determine the cause without investigations. Causes in the first trimester include abortion, molar pregnancy, and ectopic pregnancy. In the second trimester, potential causes are abortion, incarcerated retroverted uterus, complications of amniocentesis, preterm labor, and fibroid degeneration. The third trimester may involve round ligament pain, placental abruption, preeclampsia, and uterine rupture. A careful history, exam, and potential ultrasound or laparoscopy are needed to diagnose the source of abdominal pain in pregnancy.
This document discusses abdominal pain during pregnancy, which can be difficult to distinguish between physiological and pathological causes. A thorough history and examination is most important to determine the cause, which could include issues like miscarriage, ectopic pregnancy, urinary tract infections, appendicitis, or preeclampsia. Treatment depends on the identified cause, and urgent referral is needed if the cause is unclear or if maternal or fetal distress is present. Surgery may be required in some cases but is best performed in the second trimester if possible.
Abdominal pain during pregnancy can have many causes, both pregnancy-related and non-pregnancy related. Pregnancy-related causes include round ligament pain, Braxton Hicks contractions, preterm labor, placental problems, and liver issues related to conditions like preeclampsia. Non-pregnancy related causes include issues like appendicitis, kidney infections, and digestive system problems. A thorough physical exam and testing is needed to determine the cause, and treatment depends on the underlying issue and gestational age of the fetus. The well-being of both the mother and fetus must be closely monitored.
Abdominal pain in pregnancy can have many potential causes including obstetric, gynecological, surgical, and medical issues. A thorough history and physical exam is important to determine the cause, which may include conditions like preterm labor, placental abruption, appendicitis, or ectopic pregnancy. Based on the findings, appropriate investigations like urine tests, ultrasound, and fetal monitoring can help make the diagnosis. Management is tailored to the specific cause but the priority is always the health and safety of the mother and baby.
Information about acute abdomen in pregnancy.
Gastrointestinal surgery in pregnancy.
Presentation on acute abdomen in pregnancy, physiology of pregnancy, upper abdominal pain, lower abdomen pain, diffuse abdominal pain, lonizing radiation etc.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
This document discusses the evaluation and management of acute abdomen during pregnancy. It outlines common etiologies including appendicitis, bowel obstruction, and pregnancy-related causes. The evaluation involves history, physical exam focusing on signs of peritonitis, and lab tests. Imaging options like ultrasound and MRI are discussed. Laparoscopy is generally safe in pregnancy with precautions. Acute appendicitis is the most common non-obstetric surgical emergency. It can be more severe in pregnancy and risks increase with delayed treatment.
This document discusses various obstetric and gynecologic causes of an acute abdomen in pregnant and non-pregnant patients. It describes conditions such as abruptio placentae, ectopic pregnancy, rupture of the uterus, and torsion of the uterus. For each condition, it outlines the clinical features, diagnostic approaches, and principles of treatment. The document provides a comprehensive overview of potential causes of acute abdominal pain in obstetric and gynecologic patients.
Abdominal pain in pregnancy is a very common problem encountered in day to day practice. Although is can be benign at times great care should be exercised to dismiss as nothing significant.
Abdominal pain during pregnancy can have many causes and requires careful diagnosis. A thorough history and physical exam are important to determine the nature, timing, and location of the pain. Common causes include conditions of the reproductive organs like ectopic pregnancy or ovarian cysts. Other medical issues like appendicitis, pancreatitis, or infections must also be considered. The diagnosis and treatment plan aim to address the mother's needs while minimizing risk to the fetus. Proper evaluation and early intervention are important to prevent life-threatening complications for both mother and baby.
Palpate for uterine tenderness and contractions. Check cervix for effacement and dilation. Rule out PPROM by checking for amniotic fluid pooling or leaking. Consider infection/bleeding as potential causes based on history and exam findings.
This document provides information on Pelvic Inflammatory Disease (PID), including its definition, epidemiology, microbiology, pathogenesis, clinical presentation, diagnosis, differential diagnosis, staging, and management. PID is an inflammatory condition of the female upper genital tract that is usually caused by sexually transmitted pathogens like Neisseria gonorrhoeae and Chlamydia trachomatis. It is commonly associated with sexually transmitted infections and can lead to long-term complications if not properly treated. Diagnosis is based on clinical criteria established by the CDC and may involve imaging and laboratory tests. Treatment involves antibiotics according to CDC guidelines.
Preterm labor is defined as the onset of labor between 20 weeks of gestation and 37 weeks. Risk factors include a previous preterm birth, low socioeconomic status, infections, and short cervical length. Diagnosis involves assessing for contractions and cervical changes. Treatment aims to delay delivery through tocolysis, corticosteroids to aid lung maturation, antibiotics for infections, and magnesium sulfate for neuroprotection. Progesterone supplementation and cerclage placement can help prevent preterm birth in high risk women. The goal is to prolong pregnancy and improve neonatal outcomes.
Hyperemesis Gravidarum is a severe form of nausea and vomiting during pregnancy that results in dehydration, weight loss and electrolyte imbalance. It affects 0.3-3% of pregnancies. Risk factors include multiple gestation, family history and nulliparity. Nausea is caused by hormonal changes that relax the gastrointestinal tract. Treatment ranges from dietary changes for mild cases to intravenous hydration and antiemetics for severe cases. Corticosteroids may help refractory nausea and vomiting.
This document provides information on bleeding in early pregnancy. It defines early pregnancy bleeding as any vaginal bleeding before 20 weeks of gestation. Causes of bleeding include abortion, ectopic pregnancy, molar pregnancy, and cervical lesions. Abortion is described as the termination of pregnancy before 20 weeks or 500g birth weight, and can be spontaneous, threatened, inevitable, incomplete, missed, or septic. Ectopic pregnancy is implantation outside the uterus, usually in the fallopian tubes. Molar pregnancy refers to hydatidiform mole, which is an abnormal proliferation of placental tissue. The document discusses symptoms, signs, management, and complications of various causes of early pregnancy bleeding.
India is the highest TB burden country accounting for more than one-fourth of the global incidence .Genital TB is found in 5-10% of women with infertility problems, with low rates in Australia (1%) and high rates of up to 19% in India (ICMR,2011)
This document provides information on preterm labour and preterm premature rupture of membranes (PPROM). It defines preterm labour as onset of labour before 37 weeks of gestation. Risk factors for preterm labour include infections, cervical weakness, smoking, and a history of prior preterm births. Diagnosis involves documenting uterine contractions and assessing cervical changes. Tocolytics can be used to delay labour up to 72 hours to allow for steroid administration. Management may include antibiotics, monitoring, and planning for neonatal intensive care. PPROM is defined as rupture of membranes before 37 weeks and contributes to one third of preterm births.
Ectopic pregnancy occurs when a fertilized egg implants outside the uterus, usually in the fallopian tubes. Risk factors include previous pelvic inflammatory disease, tubal surgery, or an intrauterine contraceptive device. Patients often present with abdominal pain and vaginal bleeding. Diagnosis is confirmed through ultrasound and beta-hCG levels. Treatment depends on severity but may include surgery through laparoscopy or laparotomy, or medication with methotrexate. Location of ectopic pregnancy such as ovaries, abdomen, or cervix determine specific surgical approaches required.
Preterm labor is defined as the onset of labor before 37 weeks of gestation. It can be spontaneous or medically indicated and accounts for a majority of neonatal deaths and disabilities. Risk factors include multiple pregnancies, infections, cervical insufficiency, and genetic factors. Management involves tocolytic drugs to delay labor, corticosteroids to improve neonatal outcomes, and careful fetal monitoring during labor. Prematurity and its complications remain a major challenge in obstetrics.
Abdominal pain is a common complaint during early pregnancy. Differential diagnoses include conditions specific to pregnancy like ectopic pregnancy and ovarian cysts, as well as non-pregnancy related conditions. Evaluating abdominal pain in pregnancy can be challenging due to common symptoms of normal pregnancy. Ultrasound is often used to locate potential sources of pain like ectopic pregnancies outside the uterus. Both medical and surgical treatments may be considered depending on the severity and location of the condition causing the abdominal pain.
This document discusses abnormal uterine action during labor, including definitions, types, causes, diagnosis, and management. The main types discussed are uterine inertia, ineffective contractions, abnormal polarity, incoordinate contractions including spastic lower segment and constriction ring, cervical dystocia, precipitate labor, tonic contractions, and retraction ring. The importance of assessing uterine tone, frequency and strength of contractions is emphasized for diagnosis. Management depends on the specific abnormality but may include oxytocin augmentation, amniotomy, operative vaginal delivery, or cesarean section.
This document discusses several types of benign cervical lesions:
- Cervical polyps are benign tumors arising from the endocervical epithelium that appear as smooth reddish protrusions. They are usually asymptomatic but can cause bleeding. Treatment involves removal by forceps.
- Cervical ectropion (erosion) is the replacement of stratified squamous epithelium with columnar epithelium around the external cervical os. It has various causes and may cause discharge or bleeding.
- Cervical stenosis is pathological narrowing of the endocervical canal, often due to prior surgical or medical treatments for premalignant cervical conditions. It can cause issues like hematometra or infertility. Treatment involves physically dil
Puerperal genital hematomas are collections of blood outside blood vessels in the genital tract that can develop after childbirth or gynecological surgery due to damage to blood vessels. They range in size and location, from small superficial wounds to large subfascial hematomas. Risk factors include nulliparity, advanced maternal age, large birth weight, preeclampsia, instrumental delivery, and coagulation disorders. Ultrasound is useful for diagnosis and monitoring resolution. Small, stable hematomas can be managed conservatively with pain control and observation, while larger or expanding hematomas often require surgical evacuation to prevent infection and further blood loss. Prompt diagnosis and treatment are important to reduce long-term complications.
This document discusses jaundice in pregnancy. It notes that clinical jaundice occurs in 1 in 1000 pregnancies in India. The most common cause of jaundice in pregnancy is viral hepatitis. Mortality from infectious hepatitis is 3.5 times higher in pregnancy compared to non-pregnant women. Some of the specific causes of jaundice discussed in more detail include hyperemesis gravidarum, intrahepatic cholestasis of pregnancy, HELLP syndrome, acute fatty liver of pregnancy, and various types of viral hepatitis. The document also discusses physiological changes in the liver during pregnancy and provides guidelines for diagnosis and management of different conditions that can cause jaundice.
Uterine rupture is a life-threatening condition where the wall of the uterus tears, potentially exposing the fetus and placenta to the mother's abdominal cavity. It most commonly occurs in women with a previous cesarean section scar. Signs include acute abdominal pain, fetal distress, and hemorrhage. Diagnosis is often made using ultrasound or MRI to detect tears in the uterine wall. Immediate exploratory laparotomy and cesarean delivery is usually required for treatment. Conservative uterine repair may be attempted for some cases but hysterectomy is often necessary due to severe hemorrhage. Prevention focuses on careful management of trial of labor for women with previous scars.
Venous Thromboembolism (VTE) refers to deep vein thrombosis (DVT) and pulmonary embolism (PE). Pregnancy is a risk factor for VTE due to physiological changes in the coagulation system that promote clotting. The risk is highest in the first trimester through 6 weeks postpartum. Management involves risk assessment, diagnosis, anticoagulation therapy like heparin, prevention through prophylaxis for high risk women, and consideration of risk factors when stopping treatment.
Prolonged labour – cpd, fetal malposition andArsenic Halcyon
1) Prolonged labor is defined as labor exceeding 18 hours for the first and second stages combined. It can be caused by cephalopelvic disproportion (CPD) where the fetal head is too large for the maternal pelvis.
2) CPD can be absolute due to a permanently contracted pelvis or relative due to fetal malpositions or malpresentations. Management depends on the degree of disproportion and may include a trial of labor or cesarean section.
3) Careful monitoring during labor is important when there is suspected CPD to detect complications early and intervene if needed to deliver the baby safely.
Antepartum haemorrhage (APH) is bleeding from the genital tract between 28 weeks of pregnancy and the onset of labor. Placenta previa and placenta abruption are major causes of APH. Placenta previa occurs when the placenta is implanted in the lower uterine segment or covers all or part of the cervical os. It can be diagnosed by ultrasound and treated with caesarean section. Complications of APH include maternal and fetal mortality due to factors like pre-existing anemia, transport difficulties, and inadequate medical care.
This document provides guidance on the management of adnexal torsion. It discusses the definition, epidemiology, diagnosis and treatment. For diagnosis, ultrasound with Doppler is the preferred imaging method. Findings suggestive of torsion include decreased or absent blood flow and increased ovarian volume. For treatment, laparoscopy is preferred and conservative management including detorsion with or without cystectomy is recommended, even in cases of discolored ovaries, as ovarian function can be preserved. Delaying cystectomy may avoid further trauma. The goal is to preserve ovarian tissue when possible.
The document discusses the evaluation and management of acute abdomen in pregnancy. It defines acute abdomen and notes the diagnostic approach is similar to non-pregnant patients but physiological changes of pregnancy must be considered. Common causes of abdominal pain in pregnancy include urinary tract infections, appendicitis, round ligament pain, and complications of pregnancy like placental abruption. A thorough history, physical exam, and testing are important to diagnose the source of pain while also monitoring the mother and fetus. Both pregnancy-related and non-pregnancy related conditions can cause abdominal pain and require appropriate treatment.
Ectopic pregnancy occurs when a fertilized egg implants outside the uterus, usually in the fallopian tubes. Risk factors include prior pelvic infections, surgery, IUD use, and infertility treatments. Symptoms include abdominal pain, vaginal bleeding, and signs of internal bleeding such as low blood pressure. Diagnosis is made through clinical exam, pregnancy tests, ultrasound, and sometimes laparoscopy. Treatment depends on the severity but may include medication or surgery to terminate the ectopic pregnancy and stop bleeding. Differential diagnoses that can have similar symptoms include pelvic infections, miscarriage, appendicitis, and ovarian cyst complications.
Abdominal pain during pregnancy can have many causes and requires careful diagnosis. A thorough history and physical exam are important to determine the nature, timing, and location of the pain. Common causes include conditions of the reproductive organs like ectopic pregnancy or ovarian cysts. Other medical issues like appendicitis, pancreatitis, or infections must also be considered. The diagnosis and treatment plan aim to address the mother's needs while minimizing risk to the fetus. Proper evaluation and early intervention are important to prevent life-threatening complications for both mother and baby.
Palpate for uterine tenderness and contractions. Check cervix for effacement and dilation. Rule out PPROM by checking for amniotic fluid pooling or leaking. Consider infection/bleeding as potential causes based on history and exam findings.
This document provides information on Pelvic Inflammatory Disease (PID), including its definition, epidemiology, microbiology, pathogenesis, clinical presentation, diagnosis, differential diagnosis, staging, and management. PID is an inflammatory condition of the female upper genital tract that is usually caused by sexually transmitted pathogens like Neisseria gonorrhoeae and Chlamydia trachomatis. It is commonly associated with sexually transmitted infections and can lead to long-term complications if not properly treated. Diagnosis is based on clinical criteria established by the CDC and may involve imaging and laboratory tests. Treatment involves antibiotics according to CDC guidelines.
Preterm labor is defined as the onset of labor between 20 weeks of gestation and 37 weeks. Risk factors include a previous preterm birth, low socioeconomic status, infections, and short cervical length. Diagnosis involves assessing for contractions and cervical changes. Treatment aims to delay delivery through tocolysis, corticosteroids to aid lung maturation, antibiotics for infections, and magnesium sulfate for neuroprotection. Progesterone supplementation and cerclage placement can help prevent preterm birth in high risk women. The goal is to prolong pregnancy and improve neonatal outcomes.
Hyperemesis Gravidarum is a severe form of nausea and vomiting during pregnancy that results in dehydration, weight loss and electrolyte imbalance. It affects 0.3-3% of pregnancies. Risk factors include multiple gestation, family history and nulliparity. Nausea is caused by hormonal changes that relax the gastrointestinal tract. Treatment ranges from dietary changes for mild cases to intravenous hydration and antiemetics for severe cases. Corticosteroids may help refractory nausea and vomiting.
This document provides information on bleeding in early pregnancy. It defines early pregnancy bleeding as any vaginal bleeding before 20 weeks of gestation. Causes of bleeding include abortion, ectopic pregnancy, molar pregnancy, and cervical lesions. Abortion is described as the termination of pregnancy before 20 weeks or 500g birth weight, and can be spontaneous, threatened, inevitable, incomplete, missed, or septic. Ectopic pregnancy is implantation outside the uterus, usually in the fallopian tubes. Molar pregnancy refers to hydatidiform mole, which is an abnormal proliferation of placental tissue. The document discusses symptoms, signs, management, and complications of various causes of early pregnancy bleeding.
India is the highest TB burden country accounting for more than one-fourth of the global incidence .Genital TB is found in 5-10% of women with infertility problems, with low rates in Australia (1%) and high rates of up to 19% in India (ICMR,2011)
This document provides information on preterm labour and preterm premature rupture of membranes (PPROM). It defines preterm labour as onset of labour before 37 weeks of gestation. Risk factors for preterm labour include infections, cervical weakness, smoking, and a history of prior preterm births. Diagnosis involves documenting uterine contractions and assessing cervical changes. Tocolytics can be used to delay labour up to 72 hours to allow for steroid administration. Management may include antibiotics, monitoring, and planning for neonatal intensive care. PPROM is defined as rupture of membranes before 37 weeks and contributes to one third of preterm births.
Ectopic pregnancy occurs when a fertilized egg implants outside the uterus, usually in the fallopian tubes. Risk factors include previous pelvic inflammatory disease, tubal surgery, or an intrauterine contraceptive device. Patients often present with abdominal pain and vaginal bleeding. Diagnosis is confirmed through ultrasound and beta-hCG levels. Treatment depends on severity but may include surgery through laparoscopy or laparotomy, or medication with methotrexate. Location of ectopic pregnancy such as ovaries, abdomen, or cervix determine specific surgical approaches required.
Preterm labor is defined as the onset of labor before 37 weeks of gestation. It can be spontaneous or medically indicated and accounts for a majority of neonatal deaths and disabilities. Risk factors include multiple pregnancies, infections, cervical insufficiency, and genetic factors. Management involves tocolytic drugs to delay labor, corticosteroids to improve neonatal outcomes, and careful fetal monitoring during labor. Prematurity and its complications remain a major challenge in obstetrics.
Abdominal pain is a common complaint during early pregnancy. Differential diagnoses include conditions specific to pregnancy like ectopic pregnancy and ovarian cysts, as well as non-pregnancy related conditions. Evaluating abdominal pain in pregnancy can be challenging due to common symptoms of normal pregnancy. Ultrasound is often used to locate potential sources of pain like ectopic pregnancies outside the uterus. Both medical and surgical treatments may be considered depending on the severity and location of the condition causing the abdominal pain.
This document discusses abnormal uterine action during labor, including definitions, types, causes, diagnosis, and management. The main types discussed are uterine inertia, ineffective contractions, abnormal polarity, incoordinate contractions including spastic lower segment and constriction ring, cervical dystocia, precipitate labor, tonic contractions, and retraction ring. The importance of assessing uterine tone, frequency and strength of contractions is emphasized for diagnosis. Management depends on the specific abnormality but may include oxytocin augmentation, amniotomy, operative vaginal delivery, or cesarean section.
This document discusses several types of benign cervical lesions:
- Cervical polyps are benign tumors arising from the endocervical epithelium that appear as smooth reddish protrusions. They are usually asymptomatic but can cause bleeding. Treatment involves removal by forceps.
- Cervical ectropion (erosion) is the replacement of stratified squamous epithelium with columnar epithelium around the external cervical os. It has various causes and may cause discharge or bleeding.
- Cervical stenosis is pathological narrowing of the endocervical canal, often due to prior surgical or medical treatments for premalignant cervical conditions. It can cause issues like hematometra or infertility. Treatment involves physically dil
Puerperal genital hematomas are collections of blood outside blood vessels in the genital tract that can develop after childbirth or gynecological surgery due to damage to blood vessels. They range in size and location, from small superficial wounds to large subfascial hematomas. Risk factors include nulliparity, advanced maternal age, large birth weight, preeclampsia, instrumental delivery, and coagulation disorders. Ultrasound is useful for diagnosis and monitoring resolution. Small, stable hematomas can be managed conservatively with pain control and observation, while larger or expanding hematomas often require surgical evacuation to prevent infection and further blood loss. Prompt diagnosis and treatment are important to reduce long-term complications.
This document discusses jaundice in pregnancy. It notes that clinical jaundice occurs in 1 in 1000 pregnancies in India. The most common cause of jaundice in pregnancy is viral hepatitis. Mortality from infectious hepatitis is 3.5 times higher in pregnancy compared to non-pregnant women. Some of the specific causes of jaundice discussed in more detail include hyperemesis gravidarum, intrahepatic cholestasis of pregnancy, HELLP syndrome, acute fatty liver of pregnancy, and various types of viral hepatitis. The document also discusses physiological changes in the liver during pregnancy and provides guidelines for diagnosis and management of different conditions that can cause jaundice.
Uterine rupture is a life-threatening condition where the wall of the uterus tears, potentially exposing the fetus and placenta to the mother's abdominal cavity. It most commonly occurs in women with a previous cesarean section scar. Signs include acute abdominal pain, fetal distress, and hemorrhage. Diagnosis is often made using ultrasound or MRI to detect tears in the uterine wall. Immediate exploratory laparotomy and cesarean delivery is usually required for treatment. Conservative uterine repair may be attempted for some cases but hysterectomy is often necessary due to severe hemorrhage. Prevention focuses on careful management of trial of labor for women with previous scars.
Venous Thromboembolism (VTE) refers to deep vein thrombosis (DVT) and pulmonary embolism (PE). Pregnancy is a risk factor for VTE due to physiological changes in the coagulation system that promote clotting. The risk is highest in the first trimester through 6 weeks postpartum. Management involves risk assessment, diagnosis, anticoagulation therapy like heparin, prevention through prophylaxis for high risk women, and consideration of risk factors when stopping treatment.
Prolonged labour – cpd, fetal malposition andArsenic Halcyon
1) Prolonged labor is defined as labor exceeding 18 hours for the first and second stages combined. It can be caused by cephalopelvic disproportion (CPD) where the fetal head is too large for the maternal pelvis.
2) CPD can be absolute due to a permanently contracted pelvis or relative due to fetal malpositions or malpresentations. Management depends on the degree of disproportion and may include a trial of labor or cesarean section.
3) Careful monitoring during labor is important when there is suspected CPD to detect complications early and intervene if needed to deliver the baby safely.
Antepartum haemorrhage (APH) is bleeding from the genital tract between 28 weeks of pregnancy and the onset of labor. Placenta previa and placenta abruption are major causes of APH. Placenta previa occurs when the placenta is implanted in the lower uterine segment or covers all or part of the cervical os. It can be diagnosed by ultrasound and treated with caesarean section. Complications of APH include maternal and fetal mortality due to factors like pre-existing anemia, transport difficulties, and inadequate medical care.
This document provides guidance on the management of adnexal torsion. It discusses the definition, epidemiology, diagnosis and treatment. For diagnosis, ultrasound with Doppler is the preferred imaging method. Findings suggestive of torsion include decreased or absent blood flow and increased ovarian volume. For treatment, laparoscopy is preferred and conservative management including detorsion with or without cystectomy is recommended, even in cases of discolored ovaries, as ovarian function can be preserved. Delaying cystectomy may avoid further trauma. The goal is to preserve ovarian tissue when possible.
The document discusses the evaluation and management of acute abdomen in pregnancy. It defines acute abdomen and notes the diagnostic approach is similar to non-pregnant patients but physiological changes of pregnancy must be considered. Common causes of abdominal pain in pregnancy include urinary tract infections, appendicitis, round ligament pain, and complications of pregnancy like placental abruption. A thorough history, physical exam, and testing are important to diagnose the source of pain while also monitoring the mother and fetus. Both pregnancy-related and non-pregnancy related conditions can cause abdominal pain and require appropriate treatment.
Ectopic pregnancy occurs when a fertilized egg implants outside the uterus, usually in the fallopian tubes. Risk factors include prior pelvic infections, surgery, IUD use, and infertility treatments. Symptoms include abdominal pain, vaginal bleeding, and signs of internal bleeding such as low blood pressure. Diagnosis is made through clinical exam, pregnancy tests, ultrasound, and sometimes laparoscopy. Treatment depends on the severity but may include medication or surgery to terminate the ectopic pregnancy and stop bleeding. Differential diagnoses that can have similar symptoms include pelvic infections, miscarriage, appendicitis, and ovarian cyst complications.
The document provides an overview of the approach to acute abdomen. It defines acute abdomen and outlines the general approach using the SOAP method - taking a history, performing a physical exam, ordering investigations, and creating a treatment plan. Common causes of acute abdomen are then discussed through various case scenarios involving factors like age, location of pain, onset, character, and associated symptoms. A detailed guide is given for examining the abdomen and evaluating vital signs, jugular venous pressure, lymph nodes, and potential referrals from other organ systems. Key blood tests are also outlined to check for indicators of issues like infection, hemorrhage, or electrolyte imbalances.
Abruptio placenta, or premature separation of the placenta from the uterine wall, can occur anytime after 20 weeks of pregnancy. It poses risks to both the mother and fetus, such as bleeding, shock, and restricted blood flow between the placenta and fetus. Risk factors include advanced maternal age, smoking, and prior abruption. Management may involve bed rest, monitoring of the fetus and mother, and sometimes surgical delivery of the baby via cesarean section.
This document discusses various types of ectopic pregnancies. It begins by defining an ectopic pregnancy as implantation outside the uterine cavity, most commonly in the fallopian tubes. It then discusses the signs, symptoms, risk factors, diagnosis and treatment of tubal, abdominal, ovarian, angular, cornual and cervical ectopic pregnancies. Medical treatments include methotrexate, while surgical treatments include laparoscopy or laparotomy to remove the ectopic pregnancy. Complications can include rupture and internal bleeding. The document provides detailed information on the locations, causes and management of different ectopic pregnancy types.
This document defines abortion and describes the different types, including spontaneous abortions like threatened, inevitable, incomplete, complete and missed, as well as induced abortions. It discusses the causes of abortion and management approaches for different types, including complications like sepsis. Post-abortion care is also summarized, including counseling, contraception and follow up. Ectopic pregnancy and advanced abdominal pregnancy are briefly covered at the end.
An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, usually in the fallopian tubes. Ectopic pregnancies are not viable and can be life-threatening if the embryo ruptures the fallopian tube, causing internal bleeding. Common symptoms include abdominal pain and vaginal bleeding. Treatment involves either medication with methotrexate or surgery, depending on the severity of the case. Prognosis depends on the treatment method, with fertility rates generally better when only part of the fallopian tube is removed.
1. Ruptured ectopic pregnancy presents with sudden onset of severe abdominal pain and vaginal bleeding. Diagnosis is confirmed with transvaginal ultrasound and beta-hCG levels. Treatment depends on stability and may include medical or surgical options like salpingectomy.
2. Acute pelvic inflammatory disease is caused by ascending bacterial infection and presents with abdominal pain and abnormal discharge. Diagnosis involves screening for infections and inflammatory markers. Treatment involves intravenous antibiotics.
3. Testicular torsion presents with sudden severe scrotal pain. Diagnosis involves physical exam showing a high-riding painful testicle. Immediate surgical detorsion is required to save the testis.
Obstructed labor occurs when there is a failure of descent of the presenting fetal part despite adequate uterine contractions due to a mechanical obstruction. It is a leading cause of maternal and neonatal morbidity and mortality in developing countries. Management involves timely diagnosis through close monitoring of labor and prompt relief of obstruction, usually via caesarean section if detected early. However, in neglected cases destructive procedures may be required to deliver a dead fetus to prevent further complications in the mother. Prevention focuses on improving access to skilled birth attendance and addressing risk factors like malnutrition and short stature.
This document discusses acute abdomen, defined as sudden abdominal pain that requires urgent treatment. It lists over 1000 potential causes organized by system, pathology, and area affected. Common causes include appendicitis, cholecystitis, diverticulitis, pancreatitis, bowel obstructions, ectopic pregnancy, and renal colic. A thorough history and physical exam are important for diagnosis, with symptoms varying depending on the specific condition. Factors like onset, location, radiation, aggravating/relieving factors, and associated symptoms provide clues to the underlying etiology.
1. Inversion of the uterus is a life-threatening complication where the uterus turns inside out, either partially or completely. It most commonly occurs within 24 hours of delivery.
2. Inversion of the uterus can be classified based on the severity, from first degree where only the fundus is inverted to the internal os, to third degree where the entire uterus, cervix and vagina are inverted.
3. Symptoms include severe abdominal pain, a vaginal mass, and cardiovascular collapse. Diagnosis involves inability to palpate the fundus of the uterus. Treatment aims to manually reposition the uterus or use hydrostatic pressure with saline. Surgery may be required if conservative methods fail.
1. Antepartum hemorrhage (APH) refers to bleeding from the genital tract during pregnancy after viability (24 weeks) and before labour. It affects 4% of pregnancies and is a medical emergency due to risks of fetal and maternal morbidity and mortality.
2. The two main causes of APH are placenta previa and abruption placentae. Placenta previa is when the placenta implants in the lower uterine segment, partially or fully covering the cervical os. Abruptio placentae is the premature separation of a normally implanted placenta.
3. Management of APH depends on the severity of bleeding, gestational age, and fetal/m
Git Disorders2( Need To Review Changes)Jessie Madz
The document discusses several chronic inflammatory bowel diseases including ulcerative colitis, Crohn's disease, and diverticulitis. It describes their causes, symptoms, diagnostic tests, and management approaches which focus on diet, medications, surgery and lifestyle changes to control symptoms and complications.
An ectopic pregnancy occurs when a fertilized egg implants and grows outside of the uterus, usually in one of the fallopian tubes. Risk factors include previous ectopic pregnancies, pelvic inflammatory disease, tubal surgery or damage. Symptoms can include abdominal pain, vaginal bleeding and shoulder pain. Diagnosis is often made through blood tests of beta-HCG levels and transvaginal ultrasound showing fluid in the fallopian tubes or abdomen. Treatment depends on whether the ectopic pregnancy has ruptured but may include methotrexate injections or laparoscopic or open surgery to remove the pregnancy.
Ovarian torsion refers to the rotation of an ovary, cutting off its blood supply. It most commonly affects women ages 20-39 and can occur at any age. Risk factors include ovarian tumors, pregnancy, assisted reproduction, and abnormally large or positioned ovaries. The twisting of the ovary leads to venous congestion and ischemia over time. Patients experience sudden, severe, unilateral abdominal pain that may radiate to the back. Ultrasound and surgery are used to diagnose and treat the condition by detorsion of the ovary within 8 hours to restore blood flow before tissue necrosis occurs. Delayed diagnosis can lead to loss of ovarian function or infection.
The document presents information on several medical conditions that can occur during pregnancy:
1) Hyperemesis gravidarum is severe nausea and vomiting during pregnancy that prevents adequate food/fluid intake and can cause weight loss and nutritional deficiencies.
2) Ectopic pregnancy is when a fertilized egg implants outside the uterus, usually in the fallopian tubes.
3) Gestational trophoblastic disease involves abnormal cell growth in the uterus during early pregnancy that can cause bleeding and other symptoms.
The document discusses abortion and post-abortion care. It defines abortion as the termination of pregnancy before viability and notes definitions vary by country and gestational age cut-offs. It describes spontaneous versus induced abortion and classifications of incomplete versus complete abortion. Post-abortion care aims to reduce morbidity and mortality through treatment of complications, counseling, contraceptive services, and other health services while partnering with communities.
A 58-year-old woman presents with pelvic heaviness and sensation of something protruding from her vagina that worsens with exertion. She sometimes feels and sees a bulge from her vagina and needs to push it back in to empty her bladder fully. The most likely diagnosis is pelvic organ prolapse. The doctor will examine her with a speculum while straining to determine the degree of prolapse. Conservative management with pelvic floor exercises and potentially a pessary will be recommended initially, with surgery as an option if symptoms persist or worsen.
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
The Nervous and Chemical Regulation of Respiration
Abdominal pain during pregnancy
1. Abdominal pain during pregnancy
Introduction
Abdominal pain in pregnancy may be difficult to diagnose. Urgent hospital referral is often
required, unless a benign cause can be established with certainty in the absence of maternal or
fetal distress.
In early pregnancy, ectopic pregnancy must be excluded before diagnosing any other cause of
abdominal pain.
Assessment of abdominal pain is more complex in pregnant women because uterine enlargement
may hide classical signs. Peritoneal signs may be absent due to lifting of the abdominal wall.
Abdominal organs can change position as the pregnancy progresses - for example, the appendix
is displaced upwards and laterally towards the gallbladder after the first trimester.[1]
The assessment must consider both maternal and fetal wellbeing, bearing in mind intra-
abdominal infection or inflammation can be associated with premature labour or fetal loss,[1] and
that acute conditions such as appendicitis carry higher risks in pregnancy.[2] Patients may need
joint assessment by both gynaecological/obstetric and surgical teams. Where the diagnosis is
unclear, the risks of exploratory surgery must be balanced against the risks of delayed
diagnosis.[3]
Emergencies[4]
Do a 'primary survey' and start treatment following 'ABCD' resuscitation principles:
Do not lie a heavily pregnant woman on her back (risk of hypotension from inferior vena
cava (IVC) obstruction). Resuscitate in the left lateral position if the uterus is palpable
above the umbilicus.
Give oxygen.
Large-bore intravenous (IV) access.
For hypovolaemic shock, give fluids until the radial pulse is palpable.
Immediate referral/transfer to hospital.
If there is heavy bleeding from an incomplete miscarriage, removal of products from the
cervical os can reduce bleeding (see 'Examination', below).
Pain relief: IV opiate analgesia can be given - titrate small doses and monitor closely.
For eclamptic seizures, give magnesium sulphate.
2. Look for the most urgent/serious problems:
Shock or haemorrhage.
Sepsis.
Pregnancy-related problems - ectopic pregnancy, incomplete miscarriage with heavy
bleeding, severe pre-eclampsia, HELLP syndrome (= H aemolysis, EL (elevated liver)
enzymes, LP (low platelet) count), placental abruption or placenta praevia, uterine
rupture.
Surgical problems - peritonitis, obstructed or ischaemic bowel.
Medical problems - lower lobe pneumonia, pulmonary embolus, diabetic ketoacidosis,
sickle cell crisis, myocardial infarction (may present with abdominal pain).
Fetal distress.
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Aetiology[1][2][3][5]
Acute appendicitis is the most common cause of an acute abdomen during pregnancy. Urinary
tract infection (UTI) or stones and cholecystitis are also relatively common.
The following section lists the more likely causes of abdominal pain during pregnancy. For a
more extensive list of non-pregnancy-related causes, see separate Abdominal Pain article.
Obstetric causes[6][7]
Labour pain - premature labour or term.
Pre-eclampsia or HELLP syndrome - epigastric or right upper quadrant pain.
Placental abruption:[6]
o Typically, sudden severe pain and a 'woody' hard, tender uterus; fetal distress, ±
vaginal bleeding.
o With posterior placenta, pain and shock may be less severe, with pain felt in the
back; diagnose by pattern of fetal contractions (excessive and frequent) with fetal
heart pattern suggesting hypoxia.
Uterine rupture:
3. o Constant pain, profound shock, fetal distress and vaginal bleeding; usually
presents during labour and with history of uterine scar.
o Rarely, occurs without labour and without uterine scar.
Chorioamnionitis:
o This usually follows premature rupture of membranes, but can occur with
membranes intact.
Acute fatty liver of pregnancy:
o Presents in the second half of pregnancy with abdominal pain, nausea/vomiting,
jaundice, malaise and headache.
Acute polyhydramnios
Rupture of utero-ovarian vessels.[8]
Severe uterine torsion[9] - rare; may be due to structural abnormalities in the pelvis.
o Presents in the second half of pregnancy with variable symptoms, including
severe abdominal pain, tense uterus, retention of urine ± shock and fetal distress;
or, it may be asymptomatic; the fetus is at risk.
Gynaecological causes
Ectopic pregnancy:[10]
o Usually presents between 5-9 weeks' gestation.
o The classical triad of bleeding, abdominal pain, and amenorrhoea is not present in
many women; symptoms and signs are often nonspecific; the diagnosis can only
be confirmed in secondary care.
o Symptoms vary and include: syncope, dysuria (including dipstick urine findings
suggesting UTI), diarrhoea and vomiting, subtle changes in vital signs; adnexal
tenderness may be absent; a history of 'missed period' may be absent if vaginal
bleeding is mistaken for a normal period.
Miscarriage ± septic abortion.
Torsion of the ovary or Fallopian tube.[11]
Ovarian cysts - torsion, haemorrhage or rupture.
Fibroids - red degeneration or torsion.[12]
Ovarian hyperstimulation syndrome:[13]
o A complication of gonadotrophin-assisted conception; can occur pre-conception
or in early pregnancy.
o Large ovarian cysts cause abdominal pain and distention and, in severe cases, also
fluid shifts, ascites, pleural effusion and shock.
Salpingitis.
Round ligament pain.
'Surgical' causes
Acute appendicitis.[14]
o Presents with fever, anorexia, nausea, vomiting, right iliac fossa (RIF) pain.
o After the first trimester, the pain may shift upwards towards the right upper
quadrant, but does not always do so - and patients in all trimesters may have RIF
pain.
4. o With retrocaecal appendix, may have back or flank pain.
Cholecystitis and gallstones.
Urinary tract - renal calculi, urinary tract obstruction (including acute urinary retention
due to retroverted gravid uterus).
Intestinal obstruction - most often due to adhesions.
Peritonitis from any cause.
Abdominal trauma, including domestic violence.[15]
Mesenteric adenitis.
Meckel's diverticulitis.
Peptic ulcer.
Inflammatory bowel disease.
Abdominal wall - hernias, musculoskeletal pain, rupture of rectus abdominis muscle.
Acute pancreatitis - rare and usually due to gallstones.
Mesenteric venous thrombosis (rare) - most reported cases have occurred where
dehydration complicated an underlying hypercoagulable state.[1]
Rupture of visceral artery aneurysm (rare).
PatientPlus
Common Problems of Pregnancy
Read more articles
'Medical' causes
UTI ± pyelonephritis.
Constipation.
Diabetic ketoacidosis.
Sickle-cell anaemia crisis.
Lower lobe pneumonia.
Venous thromboembolism - deep vein thrombosis or pulmonary embolus may cause
lower or upper abdominal pain respectively.[16]
Myocardial infarction.
Gastroenteritis.
Irritable bowel syndrome.
Musculoskeletal causes
Round ligament pain - low abdominal or groin pain due to the uterus pulling on the round
ligament.
General aches - due to uterine enlargement.
Rectus muscle haematoma - due to rupture of inferior epigastric vessels in late
pregnancy:
o Presents with sudden severe abdominal pain, often after coughing or trauma.
Pelvic girdle pain:
o Symphysis pubis dehiscence.
5. o Osteomalacia may present in pregnancy due to increasing vitamin D
requirements.
Assessment
History
Pain history - nature, location and radiation, onset, exacerbating or relieving factors.
These will give clues about the cause (see separate article on Abdominal Pain for details).
Other abdominal symptoms - vaginal bleeding, bowel and urinary symptoms; pre-
eclampsia symptoms (eg headache, visual change, nausea).
Fetal movements.
Obstetric history - last menstrual period (LMP); confirm whether the patient's last bleed
was 'normal' for the patient (ectopic pregnancy may have some bleeding which can be
mistaken for menstrual bleed); ascertain if there has been any difficult or assisted
conception; confirm use of any contraception (coil and progestogen-only pill (POP)
increase ectopic risk).
Past medical and gynaecological history, medication, allergies, last meal.
Examination[1][3]
General examination - well/ill, signs of sepsis, shock or haemorrhage, blood pressure,
urine dipstick protein and glucose.
Assess the pregnancy and uterus:
o Palpate uterus for fundal height, contractions or hard uterus, polyhydramnios,
fetal position and presentation.
o Assess fetal wellbeing - movements or heartbeat (auscultate, Doppler scan or
cardiotocography (CTG)).
Abdominal examination - see separate Abdominal Examination article, but note the
differences in pregnant patients:
o To distinguish extra-uterine from uterine tenderness, lie the patient on her side,
thus displacing the uterus.
o Clinical signs may be less distinct.
o Peritoneal signs may be absent in pregnancy, as the uterus can lift the abdominal
wall away from the area of inflammation.
o Note the changing positions of the intra-abdominal contents as the pregnancy
progresses. The appendix is located at McBurney's point in patients in the first
trimester, but then moves upward and laterally towards the gallbladder. The
bowel can be displaced into the upper abdomen.
Consider whether vaginal and/or rectal examination is indicated:
o Neverdo vaginal examination if placenta praevia is suspected (vaginal
bleeding in the second half of a pregnancy) - it could cause a massive bleed.
o Suspected rupture of membranes requires sterile examination and should be done
in an obstetric unit.
o For incomplete miscarriage with heavy bleeding, examine the cervical os.
Products in the os may cause heavy bleeding, and also bradycardia/shock due to
6. vagal stimulation. Remove products in the os (using sponge forceps) to reduce
bleeding and pain.[4]
Investigations
Bedside tests
Urine dipstick
Urine pregnancy test
o Urine beta human chorionic gonadotrophin (beta-hCG) tests are sensitive,
detecting beta-hCG at 25 IU/L (a level normally reached 9 days post-
conception).[17] A negative urine beta-hCG result does not absolutely rule out an
ectopic pregnancy - if discordant with the clinical picture, arrange serum beta-
hCG or an urgent assessment.
Bedside glucose test.
Fetal CTG monitoring.
Initial investigations
Blood tests - depending on the clinical scenario, consider:
o FBC.
o Group and save/cross-match.
o Rhesus blood group (if not known).
o Serum beta-hCG - can aid diagnosis/management decisions regarding suspected
ectopic pregnancy or miscarriage.[17][18]
o Biochemistry: renal and liver function, glucose, calcium, amylase, hepatitis
serology.
o Clotting screen if haemorrhage, placental abruption or liver disease suspected.
o Sickle cell screen.
o Blood film (for evidence of haemolysis, if HELLP syndrome is suspected).
Urine tests:
o Urine microscopy and culture.
o Urine protein quantification for suspected pre-eclampsia.
ECG if atypical epigastric pain.
Ultrasound:
o First trimester - can confirm whether pregnancy is intra-uterine and viable. From
5+ weeks a sac is visible and from 6 weeks the fetal heartbeat is seen. Free fluid
in the pelvis suggests ectopic pregnancy.[18] Transvaginal ultrasound is more
sensitive in early pregnancy.
o Second-third trimesters - gives information about fetal wellbeing, the uterus and
placenta.
o May assist surgical diagnosis, eg acute appendicitis, ovarian cysts, gallstones.[2]
Further investigations
7. Chest X-ray, if required, involves negligible radiation dose to the fetus.[16]
Swabs and/or blood cultures if there is suspected infection/sepsis.
MRI (if feasible) can be used to evaluate pregnant patients with acute lower abdominal
pain where an extra-uterine cause is suspected.[19]
CT scans have been used in the second and third trimesters, but involve significant
radiation.[14]
Diagnostic laparoscopy or laparotomy may be required. Laparoscopy is feasible and
useful in pregnancy.[2]
Further management[1]
This depends on the diagnosis, but some general points are:
Rhesus-negative women - give anti-D immunoglobulin if indicated.
Combined management by an obstetrician, surgeon and/or physician may be needed.
Indications for emergency surgery are similar to non-pregnant patients.
If non-urgent surgery is required during pregnancy, the second trimester is preferred.
Laparoscopy is increasingly used for diagnosis and treatment.
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Further reading & references
Yumi H; Guidelines for diagnosis, treatment,