Chapter 47 Gynecologic Emergencies
A good resource for comprehensive information related to many aspects of caring for women is available at www.womenshealth.gov/health-professionals.
Abnormal Uterine Bleeding
Abnormal uterine bleeding is one of the most common gynecologic complaints in the ED and one of the most frequent complaints for which women seek care in EDs. Life-threatening bleeding must be quickly ruled out as well as pregnancy-related causes of vaginal bleeding. Medical treatment of patients with vaginal bleeding is influenced by a number of clinical factors, including the patient’s age, pregnancy status, severity of bleeding, comorbidities, and current medications. Emergency management focuses on identifying issues that present an immediate threat to the patient’s well-being. Dysfunctional uterine bleeding and other non–life-threatening causes are best addressed in the outpatient setting. See Table 47-1 for differential diagnoses related to vaginal bleeding.
TABLE 47-1 Potential Causes of Abnormal Uterine Bleeding
Data from Estephan, A., & Sinert, R. H. (2010, February 1). Dysfunctional uterine bleeding. Retrieved from http://emedicine.medscape.com/article/795587-overview
Patient Assessment
Diagnostic Procedures
• Complete blood count (CBC), type and crossmatch
• Bleeding times, coagulation panel, platelet count
• Urine or quantitative serum beta human chorionic gonadotropin (hCG) level in women of childbearing age
• Pelvic or transvaginal ultrasound
• Rule out placenta previa by ultrasound before performing a vaginal examination on a woman more than 20 weeks gestation.
Therapeutic Interventions
• If the patient is hemodynamically unstable, intervene immediately to stabilize airway, breathing, and circulation.
• Administration of blood products, including packed red blood cells, platelets, or fresh frozen plasma, may be indicated if bleeding is copious.
• Uterine curettage may be indicated.
• High-dose estrogen therapy is the treatment of choice for acute vaginal bleeding.
Pelvic Pain
In addition to vaginal bleeding, pelvic pain is a common chief complaint of women presenting to the ED. Table 47-2 lists possible causes of pelvic pain to be considered in this patient.
TABLE 47-2 POSSIBLE CAUSES OF PELVIC PAIN
Data from Kapoor, D., Ghoniem, G. M., & Davila, G. W. (2010, November 9). Gynecologic pain. Retrieved from http://emedicine.medscape.com/article/270450-overview
Ectopic Pregnancy
Ectopic pregnancy occurs when a fertilized egg becomes implanted at a site other than the endometrium of the uterine cavity; most often the ectopic location is the fallopian tube. Clinical manifestations of ectopic pregnancy typically appear 6 to 8 weeks after the last normal menstrual period but can occur later. See Chapter 46, Obstetric Emergencies, for additional information related to ectopic pregnancy.
Ruptured Ovarian Cyst
Ovarian cysts are more common during childbearing years because of the cyclic changes of the ovary associated with menstruation.1 They are generally benign and asymptomatic until hemorrhage, rupture, or torsion occurs. A ruptured ovarian cyst may leak serous fluid or can be hemorrhagic and can be confused with an ectopic pregnancy because the signs and symptoms are similar. Appendicitis, diverticulitis, ovarian torsion, and pelvic inflammatory disease also must be considered (see Table 47-2).
