Gynaecological emergencies
Gynaecological emergencies are acute conditions involving the female reproductive system that require immediate medical or surgical intervention to prevent serious morbidity or mortality.
Gynaecological emergencies
Gynaecological emergencies are acute conditions involving the female reproductive system that require immediate medical or surgical intervention to prevent serious morbidity or mortality. These emergencies can arise from various causes such as infections, hemorrhage, ectopic pregnancy, ovarian torsion, or complications of menstruation and pregnancy. Because they often present with severe pelvic pain, abnormal bleeding, or signs of systemic illness, timely recognition and treatment are crucial.
Gynaecological emergencies affect women of all ages but are most common during the reproductive years. The complexity of these cases often necessitates collaboration among emergency physicians, gynecologists, radiologists, and anesthesiologists to optimize outcomes and preserve fertility when possible.
Ectopic Pregnancy
An ectopic pregnancy occurs when a fertilized egg implants outside the uterine cavity, most commonly in the fallopian tube. This condition is a major cause of first-trimester maternal morbidity and can be life-threatening if not diagnosed and treated promptly. Women with ectopic pregnancy typically present with lower abdominal or pelvic pain, vaginal bleeding, and signs of early pregnancy such as missed periods. If the ectopic gestation ruptures, patients may rapidly develop hypovolemic shock due to internal bleeding, presenting with dizziness, hypotension, and severe abdominal pain.
Diagnosis is aided by transvaginal ultrasound and serial measurements of beta-hCG hormone levels, which often show abnormal rises compared to normal pregnancy. Management varies depending on the stability of the patient and size of the ectopic mass; options include medical therapy with methotrexate for stable cases and surgical intervention for ruptured or unstable patients.
Ovarian Torsion
Ovarian torsion is a surgical emergency that occurs when the ovary twists around its supporting ligaments, compromising its blood supply. This condition leads to sudden onset of severe unilateral lower abdominal pain, often accompanied by nausea and vomiting. Ovarian torsion can occur in normal ovaries but is more common in those with cysts or masses. Delay in diagnosis may result in ovarian ischemia and necrosis, leading to loss of ovarian function and infertility.
Ultrasound with Doppler flow studies is the key diagnostic tool, although absence of blood flow does not entirely exclude torsion. Treatment requires urgent surgical detorsion to restore blood flow; in cases where the ovary is non-viable, oophorectomy may be necessary. Early intervention improves the chances of ovarian salvage and preserves reproductive potential.
Pelvic Inflammatory Disease and Tubo-Ovarian Abscess
Pelvic inflammatory disease (PID) is an infection of the upper female genital tract, usually caused by sexually transmitted bacteria like Chlamydia trachomatis and Neisseria gonorrhoeae. When untreated, PID can lead to severe complications including tubo-ovarian abscess (TOA), where pus collects in the fallopian tubes and ovaries. Women with PID or TOA present with lower abdominal pain, fever, vaginal discharge, and sometimes nausea or vomiting. TOA can cause systemic toxicity and requires urgent attention to prevent rupture, which can lead to generalized peritonitis and sepsis.
Diagnosis is clinical but supported by pelvic ultrasound and laboratory tests indicating infection. Management includes broad-spectrum intravenous antibiotics, with surgical drainage reserved for abscesses that do not respond to medical therapy. Early treatment is vital to prevent infertility and chronic pelvic pain.