EMERGENCY IN GYNECOLOGY Precise Diagnosis History Physical Examination

EMERGENCY IN GYNECOLOGY

Precise Diagnosis History Physical Examination Pelvic Examination – Gentle , Careful *** Investigation and Laboratory tests Prompt treatment * Surgical VS Non-surgical * Consultation, justification

Common GYN Emergency • Acute pelvic pain • Abnormal vaginal bleeding • Rape

Pelvic Pain • Gynaecologic diseases * • Gastrointestinal • Genitourinary • Musculoskeletal • Others

Gynaecologic diseases • • • Dysmenorrhea, Mittelschmerz Pregnancy related : Ectopic, Abortion, OHSS Adnexal Complications - Ruptured Corpus Luteal Cyst - Ruptured Endometriotic Cyst - Twisted Ovarian Tumor - Twisted Pedunculated Subserous Myoma • Pelvic Inflammatory Diseases - Acute PID - Tubo-ovarian Abscess

Pregnancy related • Abnormal intrauterine pregnancy • Spontaneous abortion • Threatened abortion • Inevitable abortion • Incomplete abortion

Pregnancy related • Ectopic pregnancy • Triad: Amenorrhea, pain, vaginal bleeding UPT: positive No IUP S&S ruptured ectopic B-h. CG Sx!!!

Ultrasound uterus Blood clot Free fluid in culdesac

Ectopic pregnancy • Ultrasound no IUP, no extrauterine pregnancy • DDx: • Early pregnancy • Recent abortion • Ectopic pregnancy • Nonpregnancy

Ectopic pregnancy • Ultrasound no IUP, no extrauterine pregnancy • TVS: discrimination zone: 1000 -2000 m. IU/m. L • IUP: F/U h. CG increase 66% within 48 hr • Ectopic: plateau, decrease level h. CG

Ectopic pregnancy • Surgery: Laparotomy/Laparoscopy, Salpingectomy/salpingostomy, salpingotomy • Medical: Methotrexate (Lab: CBC, BUN, Cr, E’lyte, LFT, CXR, Rh, Bl gr. ) • F/U d 4, 7 decrease 15%

Causes of vaginal bleeding in age group Pre-pubertal - vulvovaginal & ext. lesion - foreign body - tumor Adolescent Reproductive Perimenopause Menopause - anovulation - pregnancy - exogenous hormone - coagulopathy - pregnancy - anovulation - exogenous hormone - uterine pathology - cervical/ endometrial polyps - thyroid dz. - anovulation - uterine pathology - cervical lesion - thyroid dz. - endometrial pathology - exogenous hormone - atrophic vaginitis - tumor

Common GYN Urgency • Acute pelvic pain • Abnormal vaginal bleeding • Rape

Emergency contraception · Levonorgestrel (0. 75 mg) · 1 tab PO stat then 12 hr later · 2 tabs PO stat · Combined pill : Ethinyl Estradiol 100 µg · ถาอาเจยนภายใน 1 ชวโมงหลงรบประทานยา ใหรบประทานยาซำอกครง · > 72 hr พจารณา Copper IUD

STDs Gonorrhea : Ceftriaxone or Chlamydia or Cefixime 250 mg IM single dose 400 mg : Azithromycin PO single dose 1 g PO single dose Doxycycline 100 mg PO BID X 7 D Trichomonas : Metronidazole 2 g PO single dose

STDs q Hepatitis B vaccine / HBIG กรณทราบผกระทำวาตดเชอ q HIV prophylaxis - High risk group, อยางชาไมเกน 72 hr - TDF )300 (+ 3 TC )300 (OD x 28 D - TDF) 300(/FTC) 200 (OD x 28 D