O&G emergencies FM:casualty

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Presentation Description

emergencies, gynaecology, obstetrical, ressuss, ectopic pregnancy, eclampsia, PID, PV bleeding

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Gynaecological & Obstetrical Emergencies Overview:

Gynaecological & Obstetrical Emergencies Overview Dr Mbuilu J. Trauma & Emergency Unit Mafikeng Provincial Hospital April 2013

Plan :

Plan Epidemiology Specificity of O&G emergencies Review of specific entities PV Bleeding, Low abdominal pain eclampsia To take home

Introduction:

Introduction 20% of our consultation in casualty are O&G Obstetrical ressus have high rate of sucess. ectopic pregnancy high mortality odds when missed outcome on O&G patient, great impact: Mothers, young, productive Epidemiology

Introduction:

Introduction Gynaecology Ectopic pregnancy Miscariages Acute pelvic pain carcinoma and tumours common conditions Obstetric hyperemesis gravidarum third trimester bleeding Preeclampsia/Eclampsia trauma in pregnancy PPH Puerperal sepsis puerperal mastitis

Clinical reasoning:

Clinical reasoning pre-menarcheal menarche tumor, trauma, FB, Hematuria reproductive age menses (polyM or hyperM) Metrorrhagia abortion, pregnancy, endocrine, salpingitis, cervicitis, malignant, trophoblastic tumor, ovarian cyst, myoma ++, coagulop Differential diagnosis: PV Bleeding postmenopausale carcinoma (cervical, uterine) atrophic vaginitis cervical polype trauma

Clinical reasoning:

Clinical reasoning Pregnacy test positive Miscariage: Threatened, septic, missed, incomplete. Ectopic pregnancy Ovarian cyst Myoma in pregnancy Differential diagnosis: Low abdominal pain pregnancy test negative cervicitis, Endometritis -PID Salpingitis - PID Salingitis + TO Abscess Ovarian cyst torsion Dysmenorrhea endometriosis Appendicitis

Clinical reasoning:

Clinical reasoning past obstetrical history parity Menses trauma, surgery salpingitis IUCD more informations, focus examination & relevant para-clinic Conjunctiva, extremity, pulse, abdominal exam Bimanual PV examination speculum examination SONAR Urines dipstic & Pregnancy test hemoglobine level, WBC, Xmatch Ca 125

Nosocomial:

Nosocomial high index of suspicion on a LAP, Amenorrhea, spotting. CEX + Laparoscopy> Sonar> parauterine mass>culdocentesis B-HCG (urines) Ectopic pregnancy

Nosocomial:

Nosocomial Incomplete, threatened, inevitable, missed, septic Amenorrhea, sign of pregnancy +/- LAP - cramps, decreased, PV Bleeding: red, brown, products felt PV examination OS close, long, open, soft, tenderness B-HCG (urines) Sonar Miscariages

Nosocomial:

Nosocomial vomiting, dehydration, elevated specific gravity of urines, ketonuria and hemoconcentration exclude: infection, diabetes; TSH ++ hypokaliemia, urea, alkalosis met., Admission Fluids, electrolytes, promethazine or Vit B6, pantocid hyperemesis gravidarum

Nosocomial:

Nosocomial pregnancy + fits PIH during pregnacy, extreme age, extreme parity Stabilise first: ABCD- Catheters MgSO4 6g IV 30 min, 200ml NS solution - 1g/h/24h rivrotril 1 mg if fits occur Labetalol, hydralazine eclampsia

Management:

Management Airways - secretions breathing - oxygen circulation - crystalloid, drugs - Antibiotics, cardiotonics, oxytocics monitors and catheters All...

Thank you:

Thank you

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