OBSTETRICS AND GYNECOLOGIC

EMERGENCIES
Dr. Tigor P. Simanjutak, SpOG., M. Kes
Obstetrics and Gynecologic Department
Medicine Faculty of UKI - Jakarta
I.
Obstetrics Emergencies
I. Obstetrics Emergencies
1. Medical Emergencies in the Pregnant Patient :
1.1 Pulmonary Embolism
1.2 Asthma / Status Asthmaticus
1.3 Thyroid Storm
1.4 Diabetic Ketoacidosis
1.5 Seizure Disorders : Epilepsy
2. Acut Abdominal Pain in Pregnancy
2.1 Appendicitis
2.2 Biliary Disease
2.3 Peptic Ulcer Disease
2.4 Intestinal Obstruction
2.5 urinary Tract Disorders
2.6 Ovarian Tumors

2.6 Ovarian Tumors
3. Ectopic Pregnancy
3. Ectopic Pregnancy
Differential Diagnosis :
1. Acute Salpingitis
2. Threatened or incomplete abortion
3. Functional Ovarian Cyst
4. Ruptured Corpus Luteum Cyst
5. Ovarian Tumor
6. Appendicitis
7. Torsion of Adnexal Cyst
8. Endometriosis
9. Pelvic Adhesions
10. Myoma Uteri
11. Polycistic Ovarian Disease
12. Cystitis
13. Renal Stone
14. Gastroenteritis

4. Trauma in Pregnancy
4.1 Blunt Abdominal trauma :
- Placental abruption
- Preterm Labor
- Fetomaternal Hemorrhage

4.2 Thoracic Injuries
4.3 Head Injuries
4.4 Burns ( Thermal, Electrical Injury )
5. Cardiac Arrest During pregnancy
Some Common Etiologiest :
1. Specifically Associated with Pregnancy:
1.1 Pregnancy induced Cardiomyopathy
1.2 Pregnancy Induced Hypertension
1.3 Obstetric Hemorrhage
1.4 Amniotic Fluid Embolism
1.5 Iatrogenic : Hyper Magnesemia,
Anasthesia during delivery

5. Cardiac Arrest During pregnancy
2. Not Specific to Pregnancy :
- Prexisting Cardiovascular Disease
1. Myocardial Infection
2. Congenital Heart Disease
3. Acquired valvular Disease
4. Arrhytmia
- Pulmonary Disease
1. Pulmonary Embolism
2. Aspiration Pneumonia
- Anaphylaxis/ Angioderma
- Intracanial Hemorrhage
- Sepsis
- Trauma
- Electrical Injury
6. Hypertensive Disorders of Pregnancy
1. Preeclmpsia

2. Eclampsia
6.PE - E
7. Infections in Pregnancy
7.1 chorioamnionitis

7.2 Pyelonephritis

7.3 Septic Shock

7.4 Primary Varicella

7.5 Primary herpes


8. Bleeding in Pregnancy
1. Bleeding in The First 20 weeks of Pregnancy
Differential Diagnosis:
1.1 Abortion ( Threatened, Inevitable,
Missed, Incomplete )
1.2 Ectopic Pregnancy
1.3 Cervical/ Vaginal Infection or Lesions
1.4 Hydatiform Mole
1.5 Incompetent Cervix
8. Bleeding in Pregnancy
2. Bleeding After 20 Weeks in Pregnancy
Differential Diagnosis:
2.1 Preterm labor
2.2 Abruptio Placenta
2.3 Placenta Previa
2.4 Incompetent Cervix
2.5 Cervical or Vaginal Lessions
9. Delivery in the Emergency
1. Shoulder Dystocia

2. Breech Delivery

3. Lacerations of the birth canal

4. Fetal distress
10. Postpartum Emergencies
Primary Medical Problems :
1. Infection
A. Genital tract :
1. Endometritis
2. Parametritis
3. Pelvic Cellulitis
4. Septic pelvic Thrombophlebitis

B. Mastitis

C. Urinay Tract
1. Cystitis
2. Pyelonephritis
10. Postpartum Emergencies
2. Postpartum hemorrhage
2.1. Early : atonia utery, Laceration,
2.2. Late : Placental Rest

3. Thrombosis and Thrombophlebitis
3.1 Superficial Thrombophlebitis
3.2 Deep Venous Thrombosis
3.3 Pulmonary Embolus

4. Postpartum Seizures
4.1 Eclampsia
4.2 Others

5. Postpartum Psychological Reactions
5.1 Postpartum blues
5.2 postpartum deprassion
5.3 postpartum Psychosis



II.
Gynecology
Emergencies
II. Gynecologic Emergencies
1. Sexually Transmitted Diseases
2. Vulvar and Vaginal Disease
3. Menorrhagia and Abnormal Vaginal Bleeding
4. Pelvic Mass
5. Torsion of the Ovary
6. Postoperative Emergencies
7. Oncologic Emergencies
8. In Childhood and Adolescence
9. Trauma
1. Sexually Transmitted Diseases
1. Pelvic Inflammatory Disease
2. Gonorrhea
3. Acquired Immune Dediciency
Syndrome (AIDS)
4. SyPhilis
5. Herpes Simplex Virus Infections
6. Chancroid

1.Pelvic Inflamatory Disease (PID)
- Young women are at greater risk :
because of the greater prevalence of STD

- Primary pathogen:
Neisseria gonorrhea and Chlamydia T

- These organisms aerobes:
Streptococcus, E. Coli, Haemophilus I

- These organisms anaerobes:
Bacteroides bivius, B. Fragilis, peptostreptococcus, peptococcus.

- Other organisms: mycoplasma, actinomycosis.

- Increased risk : IUD, Smoking, douching

Sexually Transmitted Diseases

2. Vulvar and Vaginal Disease
Bartholin gland cysts and abscesses

Ulcerative Disease of the vulva:
Herpes, Lymphogranuloma Venerum

Vaginitis and Vaginosis: Bacterial Vaginosis
(BV), Candidiasis, Trichomoniasis, Vaginal
Foreign Bodies.

3. Menorrhagia and Abnormal Vaginal
Bleeding

Etiology of Menorrhagia
I. Anovulation
- Perimanarcheal
- Perimenopausal
- Stress
- Obesity
- Androgen excess syndrome, PCOS
- Hypothyroidism
Menorrhagia and Abnormal Vaginal Bleeding

2. Low Estrogen Anovulation Less Likely to Cause Heavy
Bleeding:
- Prolactinoma
- Hyperprolactinemia
- Anoreksia, weight loss, exercise, stress

3. Bleeding Disorder
- von Wilebrand disease
- Idiothrombocytopenia
- Leukemia
- Iatrogenic thromboccytopenia

4. Anovulation and Bleeding Disorder
- Severe Hepatic Disease
- Chronic renal Failure

Menorrhagia and Abnormal Vaginal Bleeding
5. Lesions
- Fibroid uterus
- Trauma
- Endometrial Hyperplasia or Cancer
- Cercical cancer, Sexual abuse
- Vaginal, Vulvar, Ovarian Cancer
- Infection
- IUD
- Uterina or cervical polips
4. Pelvic Mass
Differential Diagnosis of Pelvic Masses :

1. Gynecologic
- Uterus Benign/ Malignant
- Ovary Benign/ Malignant
- Fallopian Tube
- Broad Ligament



4. Pelvic Mass
2. Nongynecologic
- Distended Bladder
- Feces
- Pelvic Kidney
- Urachal cyst
- Urinoma
- Diverticular abscess
- Lymphomas
- Lymphocyst
- Anterior sacral teratoma
- Retroperitoneal fibrosis or tumor
- Gastrointestinal tumor
- Metastatic carsinoma
- Abdominal wall hematoma
- Abdominal wall radiation fibrosis


5. Torsion of the Ovary
Torsion resulting in arterial, venous, or
limphatic obstruction.

Become edema, necrotic, and gangrenous

Incidence : 3 % of surgical emergencies in
woman

Treatment : Surgery
5. Torsion of the Ovary
Clinical Features: (Lomano at al)

Symptoms %
Pain 100
Nausea/ Vomiting 66
Abdominal fullness 16
Menstrual dysfunction 9
Diarrhea 7
Dysuria 7
Constipation 5
Rectal pressure 2
Syncope 2
6. Post Operative Emergencies
1. Mechanical Wound Complication:
- Dehiscence

2. Infectious Complications.

3. Tromboembolic Complication

4. Gastrointestinal Complication

5. Genitourinary injuries




7. Oncologic Emergencies
1. Vaginal Bleeding

2. Bowel Emergencies: Obstruction,
Fistula

3. Urologic Emergencies : Uretral
Obstruction, Urologic Fistulas,
Hemorrhagic Cystitis

4. Organ Failure


8. Childhood and Adolescence
Pubertal Bleeding

9. Gynecologic Trauma
1. Sexually Related Trauma

2. Accident : Pelvis Fracture.
Diagnosis
1. History

2. Physical Examination

3. Diagnostic/ Laboratory testing



References:
1. Obstetri emergency. Departemen Obs-Gin
FK. UNPAD-RSHS. Bandung. Sagung Seto.
2011

2. Guy I. Benrubi. Obstetric and Gynecologic
Emergencies. Philadelphia. J.B. Lippincount.
1994.