Obstetrics and gynaecology

Abnormal Vaginal Bleeding ◽

Abdominal pain in women - Ectopic pregnancy - Pelvic inflammatory disease (PID) - Other gynaecological causes of abdominal pain - Abnormal vaginal bleeding - Emergency contraception - Bleeding in pregnancy - Hyperemesis gravidarum - Pre-eclampsia and eclampsia - Rhesus prophylaxis—anti-D immunoglobulin - Emergency delivery - Postpartum haemorrhage - Pregnancy and trauma - SAQs

Obstetrics and gynaecology

10.1093/med/9780198786870.003.0008 ◽

2017 ◽

Author(s):

Ashis Banerjee ◽

Clara Oliver

Keyword(s):

Emergency Medicine ◽

Differential Diagnosis ◽

Abdominal Pain ◽

Major Trauma ◽

Hyperemesis Gravidarum ◽

Special Circumstance ◽

Short Answer ◽

Short Answer Question ◽

The Royal College of Emergency Medicine (RCEM) curriculum covers a number of both gynaecological and pregnancy-related problems. This chapter covers the management and differential diagnosis for a female patient presenting with abdominal pain, including gynaecological causes as well as ectopic pregnancy. In addition, this chapter also focuses on the obstetric problems of bleeding in pregnancy, hyperemesis gravidarum, and eclampsia in line with the RCEM curriculum, which may all appear in the short-answer question (SAQ) paper. This chapter also covers the special circumstance of trauma in a pregnancy, which is not covered in Chapter 4 (Major trauma), and highlights the differences in managing a pregnant trauma patient.

Experience with Ectopic Pregnancy in a Tertiary Care Teaching Hospital

TAJ Journal of Teachers Association ◽

10.3329/taj.v27i2.37634 ◽

2018 ◽

Vol 27 (2) ◽

pp. 22-26

Author(s):

NA Parveen ◽

MM Sarker ◽

MK Sarker

Keyword(s):

Abdominal Pain ◽

Ectopic Pregnancy ◽

Vaginal Bleeding ◽

Tertiary Care ◽

Lower Abdominal Pain ◽

Reproductive Age ◽

Age Group ◽

Treatment Morbidity ◽

Incidence Risk ◽

Abnormal Vaginal Bleeding

Ectopic pregnancy is a common life-threating condition. Diagnosis is frequently missed and should be considered in any women in the reproductive age group presenting with abdominal pain or vaginal bleeding. This prospective observational study was conducted in RMCH to determine the incidence, risk factors, clinical presentation, treatment, morbidity and mortality associated with ectopic pregnancy. A total of 50 cases of ectopic pregnancy were operated during the study period giving the incidence of ectopic pregnancy of 8.02/1000 pregnancies. The age of the patient ranged from 18-37 years, with maximum (40%) between 26-30 years age group. 36% patients had delivered one child and 24% were nulliparous. 30% patients had pelvic inflammatory disease and 22% had history of previous abortion/ MR. All patients presented with lower abdominal pain, 68% presented with abnormal vaginal bleeding and 60% had amenorrhoea. Most of the patients were diagnosed by high clinical suspicion and confirmed by USG. 96% cases ectopic pregnancy occurred in the fallopian tube and ampullary part was mainly affected. Laparotomy followed by unilateral salphingectomy was performed in majority (60%) of cases. 22% cases ipsilateral salpingectomy with tubectomy other side and 12% cases salpingostomy were performed. The recovery of majority of patients was smooth and uneventful. There was no death in this study.TAJ 2014; 27(2): 22-26

Incidence and clinical profile of ectopic pregnancies in a tertiary hospital; A two-year Retrospective study

Bhutan Health Journal ◽

10.47811/bhj.103 ◽

2020 ◽

Vol 6 (2) ◽

pp. 6-11

Author(s):

Sonam Gyamtsho ◽

Karma Tenzin ◽

Tshering Choeda ◽

Karma Lhaden ◽

Tandin Om

Keyword(s):

Risk Factors ◽

Abdominal Pain ◽

Retrospective Study ◽

Ectopic Pregnancy ◽

Inflammatory Disease ◽

Vaginal Bleeding ◽

Morbidity And Mortality ◽

Clinical Presentations ◽

History Of ◽

Ectopic Pregnancies

Introduction: Ectopic pregnancy is an emergency and a life-threatening condition which is an important cause of major maternal morbidity and mortality. This study was designed to determine incidence, common identified risk factors, clinical presentations, management, morbidity and mortality due to ectopic pregnancy at the national referral hospital in Thimphu, Bhutan. Methods: This was a retrospective study of all cases of ectopic pregnancies for a period of two years from 1st January 2018 to 31st December 2019. Socio-demographic characteristics, risk factors, clinical presentations, investigations and mode of treatments were extracted. Simple descriptive statistics such as frequencies, percentages, mean and range were utilised. Results: There were 9603 pregnant women admitted for delivery, out of which 122 were ectopic pregnancies. The incidence of ectopic pregnancy was 12.7/1000 pregnancies. Majority of them were in the age group of 21-30 years and 32.69% of the affected were nulliparous. While Pelvic inflammatory disease was seen in 41.35%, 20.19% were unmarried. Abdominal pain, amenorrhea, and vaginal bleeding were the most common symptoms. Among the ectopic pregnancies, 99.5% were diagnosed with ultrasound. A total of 94.23% had undergone surgical intervention, of which only 1% had laparoscopic surgery. No maternal mortality had occurred. Conclusions: Women with past history of pelvic inflammatory disease, previous miscarriage, unmarried, and nulliparous presenting with history of amenorrhea, abdominal pain, vaginal bleeding should be a high index of suspicion for ectopic pregnancy. Timely diagnosis and intervention in the form of surgical or medical management will reduced the morbidity and mortality due to ectopic pregnancy.

Obstetrics and gynaecology

Oxford Handbook of Emergency Medicine ◽

10.1093/med/9780199589562.003.0013 ◽

2012 ◽

pp. 563-600

Author(s):

Jonathan P. Wyatt ◽

Robin N. Illingworth ◽

Colin A. Graham ◽

Kerstin Hogg ◽

Michael J. Clancy ◽

...

Keyword(s):

Ectopic Pregnancy ◽

Spontaneous Abortion ◽

Vaginal Bleeding ◽

Vaginal Discharge ◽

Pregnant Patient ◽

Normal Delivery ◽

Genital Injury ◽

Gynaecological problems 564 Vaginal discharge 566 Contraceptive problems 568 Genital injury and assault 570 Gynaecological pain 572 Vaginal bleeding 574 The pregnant patient 576 Emergency normal delivery 578 Difficulties in normal delivery 580 Vaginal bleeding in pregnancy 582 Spontaneous abortion 584 Ectopic pregnancy 586 Vaginal bleeding in later pregnancy ...

Spontaneous Ipsilateral Ectopic Pregnancy in the Tubal Stump of Previous Partial Salpingectomy

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v7i1.8837 ◽

2013 ◽

Vol 7 (1) ◽

pp. 50-52

Author(s):

Sian Cooper

Keyword(s):

Abdominal Pain ◽

Ectopic Pregnancy ◽

Vaginal Bleeding ◽

Unusual Case ◽

Classic Triad ◽

The Right

We present an unusual case of recurrent ectopic pregnancy in the tubal stump of a previous partial salpingectomy. The patient presented with the classic triad of amenorrhoea, per vaginal bleeding and abdominal pain paired with a void uterus on ultrasonography. Her history was notable for a previous ectopic pregnancy resulting in a laparotomy and salpingectomy-oophrectomy. A positive B-hCG and echogeneic areas in the right adnexa led to a diagnosis of recurrent ectopic pregnancy. On laparotomy, an ectopic pregnancy was found in the right tubal stump. Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 1 / Issue 13 / Jan- June, 2012 / 50-52 DOI: http://dx.doi.org/10.3126/njog.v7i1.8837

Ruptured Ectopic Pregnancy in the Presence of an Intrauterine Device

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2019.1.41345 ◽

2019 ◽

Vol 3 (1) ◽

pp. 51-54 ◽

Cited By ~ 3

Author(s):

Matthew Neth ◽

Maxwell Thompson ◽

Courtney Gibson ◽

John Gullett ◽

David Pigott

Keyword(s):

Abdominal Pain ◽

Maternal Mortality ◽

Ectopic Pregnancy ◽

Female Patient ◽

Vaginal Bleeding ◽

Intrauterine Device ◽

First Trimester ◽

Equal Protection ◽

Intrauterine Pregnancy

Ruptured ectopic pregnancy is the leading cause of first trimester maternal mortality. The diagnosis of ectopic pregnancy should always be suspected in patients with abdominal pain, vaginal bleeding or syncope. While the use of an intrauterine device (IUD) markedly reduces the incidence of intrauterine pregnancy, it does not confer equal protection from the risk of ectopic pregnancy. In this report we discuss the case of a female patient who presented with a ruptured ectopic pregnancy and hemoperitoneum despite a correctly positioned IUD.

Beta-Human Chorionic Gonadotropin Levels and the Likelihood of Ectopic Pregnancy in Emergency Department Patients with Abdominal Pain or Vaginal Bleeding

Academic Emergency Medicine ◽

10.1197/aemj.10.2.119 ◽

2003 ◽

Vol 10 (2) ◽

pp. 119-126 ◽

Cited By ~ 7

Author(s):

M. A. Kohn

Keyword(s):

Emergency Department ◽

Abdominal Pain ◽

Ectopic Pregnancy ◽

Chorionic Gonadotropin ◽

Human Chorionic Gonadotropin ◽

Vaginal Bleeding ◽

Beta Human Chorionic Gonadotropin ◽

Emergency Department Patients

Ruptured Tubal Ectopic Pregnancy at Fifteen Weeks Gestational Age

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2019.1.40860 ◽

2019 ◽

Vol 3 (1) ◽

pp. 62-64 ◽

Cited By ~ 3

Author(s):

Justine Stremick ◽

Kyle Couperus ◽

Simeon Ashworth

Keyword(s):

Abdominal Pain ◽

Ectopic Pregnancy ◽

Gestational Age ◽

Vaginal Bleeding ◽

First Trimester ◽

Second Trimester ◽

Intrauterine Pregnancy ◽

Tubal Ectopic Pregnancy ◽

Ectopic Pregnancies ◽

First Trimester Ultrasound

Tubal ectopic pregnancies are commonly diagnosed during the first trimester. Here we present a second-trimester tubal ectopic pregnancy that was previously misdiagnosed as an intrauterine pregnancy on a first-trimester ultrasound. A 39-year-old gravida 1 para 0 woman at 15 weeks gestation presented with 10 days of progressive, severe abdominal pain, along with vaginal bleeding and intermittent vomiting for two months. She was ultimately found to have a ruptured left tubal ectopic pregnancy. Second-trimester ectopic pregnancies carry a significant maternal mortality risk. Even with the use of ultrasound, they are difficult to diagnose and present unique diagnostic challenges.

Hyperemesis gravidarum in the primary care setting: Cross-sectional study of general practitioners

BJGP Open ◽

10.3399/bjgpo.2021.0119 ◽

2021 ◽

pp. BJGPO.2021.0119

Author(s):

Melanie Nana ◽

Holly Morgan ◽

Haroon Ahmed ◽

Catherine Williamson

Keyword(s):

Primary Care ◽

General Practitioners ◽

Hyperemesis Gravidarum ◽

Cross Sectional Study ◽

Evidence Based ◽

Sectional Study ◽

Cross Sectional ◽

Confidence Levels ◽

BackgroundHyperemesis gravidarum (HG), if untreated, can lead to malnutrition, dehydration and Wernicke’s encephalopathy. Fetal complications include low birth weight and neurodevelopmental delay. Recent evidence supports increased rates of termination of pregnancy and suicidal ideation. Drivers included difficulty in accessing medications which thus contributed to poor perception of care.AimIdentify factors that may influence prescribers’ confidence and knowledge regarding pharmacological therapy for HG.Design & settingCross-sectional study of qualified GPs (General Practitioners) and GP trainees in Wales.MethodDistribution of a 22-item online survey. Statistical analysis was carried out using SPSS.Results241 responses were received with 216 included in the analysis (59% qualified GPs, 41% GP trainees). In total, 93% of respondents correctly identified cyclizine as being safe in pregnancy, but no other drug recommended in the Royal College of Obstetrics and Gynaecology guidance was considered safe by more than 58%. Those reporting higher confidence levels in managing HG were more likely to correctly report guideline recommended drugs as safe in pregnancy (P=0.04). Additional qualifications related to obstetrics and gynaecology and/or prior clinical experience increased confidence levels (P=0.0001 and P=0.0002 respectively). Only 19% of participants routinely screened for signs of mental health complications and prior experience/education did not increase likelihood of this happening. 87% of participants would like additional education/access to evidence-based resources.ConclusionThis study demonstrates a demand for improved dissemination of evidence-based education to support those working in primary care. The extent to which HG is covered in pre-existing educational programmes should also be revisited.

Study of diagnosis and management of ectopic pregnancy

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20192451 ◽

2019 ◽

Vol 8 (6) ◽

pp. 2465

Author(s):

Seema Patel ◽

Ajesh Desai

Keyword(s):

Abdominal Pain ◽

Surgical Treatment ◽

Ectopic Pregnancy ◽

Clinical Presentation ◽

Lower Abdominal Pain ◽

Age Group ◽

Beta Hcg ◽

Adnexal Pathology ◽

A Prospective Study

Background: Diagnosis of ectopic pregnancy was frequently missed. Aim of the study was to determine the clinical presentation, and treatment associated with ectopic pregnancy.Methods: This is a prospective study which was carried out at Obstetrics and Gynaecology department, GMERS SOLA civil hospital from August 2017 to October 2018. Total 416 patients were admitted during study period out of them 50 patients diagnosed with ectopic pregnancy were enrolled in the study and information was collected and analysed.Results: 80% patients were between the age group of 21-30 years. 56% patients were nulliparous. Amenorrhea (92%) with lower abdominal pain (94%) is the most common presenting symptom. 26% of patients show typical triad of amenorrhea, abdominal pain and bleeding per vagina. UPT and USG were most commonly performed investigations. 96% cases showed UPT positive. 100% USG showed adnexal pathology. Serum beta-hCG was done in 37 patients as an aid for diagnosis and to decide the line of management. Conservative medical management with Injection MTX was done in 4 patients of which 1 patients required laparotomy later on. Surgical management was done in 90% of patients. Laparoscopic management was done in 54% of cases.Conclusions: Early diagnosis and timely intervention in the form of conservative or surgical treatment will help in reducing the morbidity and mortality associated with ectopic pregnancy.