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Obstetrics and Gynaecology Emergencies

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Urology

Emergency	Clinical Presentation	Diagnostic Tests	Treatment
Obstetric Emergencies
Placental Abruption	Sudden onset of painful vaginal bleeding. Tender, rigid uterus. Signs of fetal distress or maternal shock in severe cases.	Clinical diagnosis primarily based on symptoms. Ultrasound may show retroplacental hematoma but can miss the diagnosis. Fetal monitoring to assess distress.	Immediate delivery if fetal distress or significant maternal haemorrhage is present, usually by cesarean section. Stabilization with IV fluids and blood products. Continuous monitoring of both mother and fetus.
Placenta Previa	Painless bright red vaginal bleeding, usually in the third trimester. Soft, non-tender uterus. Possible preterm labour.	Ultrasound to confirm placental location. Fetal monitoring for signs of distress.	Bed rest and monitoring if mild bleeding and preterm. Immediate cesarean section if significant bleeding or fetal distress.
Uterine Rupture	Sudden, severe abdominal pain and vaginal bleeding. Loss of fetal station or abnormal fetal heart rate patterns. Signs of maternal shock (hypotension, tachycardia).	Clinical diagnosis based on symptoms and history (e.g., previous cesarean section). Ultrasound may help, but often the diagnosis is made during surgery.	Immediate emergency cesarean section. Surgical repair of the uterus or hysterectomy if necessary. Stabilization with IV fluids and blood transfusion.
Amniotic Fluid Embolism	Sudden onset of respiratory distress and hypotension during labour or immediately postpartum. Severe coagulopathy and disseminated intravascular coagulation (DIC). Altered mental status and seizures may occur.	Clinical diagnosis; no specific test confirms the diagnosis. Blood tests showing DIC (elevated D-dimer, prolonged PT/PTT, low platelets). Chest X-ray may show pulmonary edema.	Immediate supportive care in an ICU setting. Oxygen therapy, mechanical ventilation if necessary. IV fluids, vasopressors, and blood products to manage shock and DIC. Prompt delivery of the baby to improve maternal and fetal outcomes.
Shoulder Dystocia	Difficulty delivering the baby's shoulders after the head has emerged. Turtle sign (head retracts against the perineum). Prolonged labour and fetal distress.	Clinical diagnosis based on difficulty in delivery. Fetal monitoring for distress.	McRoberts maneuver (maternal legs flexed onto abdomen). Suprapubic pressure to dislodge the shoulder. Possible episiotomy or other maneuvers to facilitate delivery.
Postpartum Haemorrhage (PPH)	Excessive vaginal bleeding after delivery (>500 mL after vaginal birth or >1000 mL after cesarean). Signs of hypovolemic shock (hypotension, tachycardia, pallor). Uterine atony (soft and boggy uterus) is a common finding.	Clinical diagnosis based on visible blood loss and vital signs. Ultrasound may be used to identify retained products of conception. Laboratory tests: CBC, coagulation profile.	Uterotonic agents (oxytocin, misoprostol) to promote uterine contraction. Manual uterine massage. Surgical intervention (e.g., uterine tamponade, D&C, hysterectomy) if bleeding persists. IV fluids and blood transfusion to stabilize the patient.
Eclampsia	Seizures in a pregnant woman with preeclampsia (hypertension, proteinuria, edema). Severe headache, visual disturbances, and epigastric pain may precede seizures. Signs of severe hypertension.	Blood pressure monitoring. Urine analysis for proteinuria. Blood tests: liver function, kidney function, platelets.	Magnesium sulfate for seizure control. Antihypertensive medications (e.g., labetalol, hydralazine). Immediate delivery of the baby, regardless of gestational age. Intensive monitoring of both mother and fetus.
Umbilical Cord Prolapse	Visible or palpable cord in the vagina ahead of the presenting part. Fetal bradycardia or variable decelerations on monitoring. Sudden onset of fetal distress.	Clinical diagnosis based on visualization or palpation of the cord. Fetal heart rate monitoring to assess distress.	Immediate repositioning of the mother to relieve cord pressure (e.g., knee-chest position). Emergency cesarean section to deliver the baby. Oxygen administration to the mother and continuous fetal monitoring.
HELLP Syndrome	Right upper quadrant or epigastric pain. Nausea, vomiting, and malaise. Signs of preeclampsia (hypertension, proteinuria).	Blood tests: hemolysis (LDH, bilirubin), elevated liver enzymes (AST, ALT), low platelets. Urine analysis for proteinuria. Fetal monitoring for distress.	Stabilization of the mother with IV fluids, blood products if needed. Antihypertensive therapy and magnesium sulfate to prevent seizures. Immediate delivery of the baby, usually via cesarean section.
Gynaecological Emergencies
Ectopic Pregnancy	Sudden, severe lower abdominal pain. Vaginal bleeding. Signs of shock if ruptured (hypotension, tachycardia).	Transvaginal ultrasound to locate the pregnancy. Serum beta-hCG levels (low or plateauing levels). Culdocentesis may show blood in the abdominal cavity if rupture is suspected.	Medical management with methotrexate for early, unruptured ectopic pregnancies. Surgical intervention (laparoscopy or laparotomy) if rupture has occurred or if medical management is contraindicated. Stabilization with IV fluids and blood transfusion if needed.
Ovarian Torsion	Sudden onset of severe, unilateral lower abdominal pain. Nausea and vomiting. Adnexal mass may be palpable on examination.	Pelvic ultrasound with Doppler to assess blood flow to the ovary. CT or MRI if the ultrasound is inconclusive.	Emergency surgical intervention (laparoscopy) to untwist the ovary and restore blood flow. Oophorectomy may be required if the ovary is necrotic.
Ruptured Ovarian Cyst	Sudden, sharp pelvic pain. Abdominal bloating. Possible fainting or dizziness if significant bleeding occurs.	Pelvic ultrasound to confirm the presence of a cyst and assess for free fluid. CBC to check for anaemia if bleeding is suspected.	Observation and pain management if the patient is hemodynamically stable. Surgical intervention if there is significant haemorrhage or ongoing pain.
Pelvic Inflammatory Disease (PID)	Lower abdominal pain and tenderness. Abnormal vaginal discharge, fever, and cervical motion tenderness. Pain during intercourse (dyspareunia).	Cervical swabs for gonorrhea and chlamydia. Pelvic ultrasound to rule out tubo-ovarian abscess. Urinalysis to rule out concurrent UTI.	Empiric broad-spectrum antibiotics (e.g., ceftriaxone plus doxycycline). Hospitalization for severe cases or if surgical intervention is needed for abscess drainage. Patient education on STI prevention and partner treatment.
Septic Abortion	Fever, chills, lower abdominal pain. Foul-smelling vaginal discharge. Signs of sepsis (tachycardia, hypotension).	CBC, blood cultures to assess for infection. Pelvic ultrasound to assess for retained products of conception.	Broad-spectrum IV antibiotics. Surgical evacuation of the uterus (D&C) to remove retained tissue. Stabilization with IV fluids and supportive care for sepsis.
Acute Uterine Haemorrhage	Heavy vaginal bleeding, possibly with clots. Lightheadedness or dizziness due to blood loss. Signs of hypovolemic shock in severe cases.	Pelvic ultrasound to assess for uterine or cervical pathology (e.g., fibroids, polyps). CBC to assess hemoglobin and hematocrit levels. Coagulation profile if a bleeding disorder is suspected.	IV fluids and blood transfusion if needed. Uterotonic agents if related to uterine atony. Surgical intervention (e.g., D&C, uterine artery embolization) if bleeding is uncontrolled.
Pelvic Abscess	Lower abdominal pain, fever, and possible palpable mass. Signs of systemic infection (tachycardia, elevated WBC count). History of recent pelvic surgery, PID, or postpartum period.	Pelvic ultrasound or CT scan to confirm abscess. CBC and blood cultures to assess infection severity.	Broad-spectrum IV antibiotics. Surgical drainage of the abscess if it does not respond to antibiotics. Supportive care including IV fluids and pain management.

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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