376 Obstetric and Gynaecological Emergencies
GYNAECOLOGICAL ASSESSMENT AND MANAGEMENT
General principles
1 All gynaecological emergencies that present with abdominal pain or vaginal
bleeding require a thorough history and examination. Be delicate and
empathic when taking the history of the presenting complaint and discuss-
ing the patient’s gynaecological and sexual history.
(i) Pay particular attention to the menstrual history, site of pain,
presence of vaginal discharge, and urinary symptoms.
(ii) Ascertain the patient’s contraceptive history, her potential
for being pregnant, and her gravida and parity. Also consider
possible non-gynaecological conditions.
2 Perform a thorough examination including an abdominal examination, and
vaginal examination with speculum and bimanual palpation. Allow the
patient privacy to undress and always have a chaperone in attendance.
3 Send urgent blood samples to the laboratory, perform a urine or serum
-human chorionic gonadotrophin (hCG) pregnancy test, and institute
resuscitative procedures as necessary.Prescribing in pregnancy
1 Consult the prescribing information first before giving any drug to a pregnant
patient, or breastfeeding mother. Look in the local drug formularies such as:
(i) MIMS, Australian Medicines Handbook (AMH), and the British
National Formulary (BNF).
(ii) Ideally, avoid all drugs in the first trimester of pregnancy unless
absolutely necessary.
(iii) Therefore, always enquire about the possibility of pregnancy in
every female of reproductive age. This is also important when
requesting X-rays
(a) most hospital radiology departments have their own guidelines
to minimize the risk of irradiation in early pregnancy.Gynaecological Causes of Acute Abdominal Pain
The following conditions present with acute abdominal pain in females:
● Ruptured ectopic pregnancy
● Pelvic inflammatory disease (acute salpingitis)
● Ruptured ovarian cyst
● Torsion of an ovarian tumour
● Endometriosis.