OUTLINE

INTRODUCTION
AETIOLOGY; (a)Disorders of menstruation; midcycle
pain, dysmenorrhea, menorrhagia, cryptomenorrhea
(b) pregnancy related dxo; abortions, ectopic
pregnancy, GTDx.(c) Infections; acute PID,
bartholinitis. (d) tumors; complicated ovarian cyst,
fibroid polyps, degenerating fibroid,(e) others; post-
coital laceration, rape etc.
MANAGEMENT Hx, Ex, Invx, Rx.
Conclusion
Introduction
These are gynaecological conditions that
require immediate surgical or medical
intervention in order to prevent morbidity
and mortality.
Majority of gynaecologic ward admissions
are due to acute gynaecologic conditions.
Pregnancy related disorders constitute
the commonest gynae emergencies.
Aetiology
Disorders of menstruation will include congenital
cxes which may present with cryptomenorrhea such
as (1) imperforate hymen (2) transverse vaginal
septum (3) incommunicating uterine horn etc.
They will present with primary ammenorrhea,
cyclical lower abdominal pains, lower abd swelling
and occasionally with urinary symptoms.
Usually seen among young teenage girls.
Treatment aims at relieve of obstruction and
excision of non patent uterine horn.
 Aetiology contd
Disorders of menstruation such as mid cycle pain
mittelschmerz rxn seen in ovulatory cycles.
Dysmenorrhea painful menstruation; primary or
secondary.pri; Common among young girls and
nulliparas. Treatment will include the use of
Nsaids. Symptoms may improve after childbirth.
Menorrhagia excessive menstrual flow, patients
can present with symptons and signs of severe
anemia or hemorrhagic shock. Causes may
include uterine fibroid , adenomyosis, Dub.
Treatment will depend on the cause.
Pregnancy related dxos
Abortions there are various clinical types of
abortion and each can present as gynae
emergency. They are the commonest causes of
gynae emergex. They usually present with
amenorrhea,vaginal bleeding and lower abd
pains. Ultra sound is a very useful investigation
in confirming site and fetal viability. Treatment
depends on the type of abortion and post
abortion care is very necessary and life saving.
Pregnancy related contd
GTD these are spectrum of trophoblastic
diseases ranging from benign molar preg
to malignant choriocarcinoma.they
elaborate very high levels of HCG.
Clinical Presentation is similar to abortions
and USS is equally useful in their
diagnosis.Also useful diagnostic tool is the
estimation of serum levels of beta-HCG.
Post treatment monitoring is mandatory.
pregnancy related contd
Ectopic pregnancy pregnancy outside
the endometrial cavity. Tubal ectopic
commonest in 98% of cases.clinical
presentation is usually similar to abortion
but less vaginal bleeding is evident than
intraperitoneal bleeding. USS, serum
beta-HCG and laparoscopy are definitive
diagnostic measures. Treatment include
medical and surgical methods.
Ovarian cyst dxo
Ovarian cysts are common gynaecological
conditions. Occasionally acute
complications such as torsion, rupture,
hemorrhage into the cyst, or infection can
occur. The presentation is usually with
features of sudden lower abd pain,
vomitting and lower abdominal mass.
Treatment is by laparotomy , cystectomy
+/- oophorectomy.
Infections
PID usually an ascending genital tract infection
by pathogens that are mainly transmitted by
sexual route. These include the traditional
gonococcus and other nonspecific agents such
as chlamydia etc. they present with features of
generalised or localised peritonitis, lower abd
pain & tenderness and vaginal discharge. Useful
invx are wbc, genital swab test, laparoscopy.
Treatment is with potent antibiotics.
Infections contd
UTI This is an ascending urinary tract infection
usually sexually transmitted from the vestibule
to the urethra, bladder, ureters, pelvicalyceal
systems etc. Gram negative bacteria are
common cxes. The clinical features include
dysuria, lower abdominal pain and urinary
frequency. The useful investigations will include
urine m/c/s, urethral swab etc. Treatment is with
the use of good and sensitive antibiotics.
Infections contd
Bartholinitis acute inflammatory
condition of the bartholins gland. Aetiology
is related to sti and usually recurrent. The
features include localised vulva pain and
swelling,tenderness of the bartholins
gland. Treatment is with analgesics and
broad spectrum antibiotics.
marsupialisation when complicated by
abcess or cyst.
Others
Post coital laceration laceration of the vulva
and vagina during unusual coital act associated
with rape, unpreparedness,genital disproportion
and pueperium. Presenting features are usually
not straightforward but vaginal bleeding is a
common symptom. Diagnosis requires very high
level of suspicion. Speculum examination is very
useful.commonest site of tear is in the posterior
fornix. Treatment is by repair of laceration.
Conclusion
Pregnanacy related disorders constitute
the leading cause of acute gynae
emergency and they contribute
significantly to maternal deaths in
developing countries.
The ability to diagnose these conditions
early and offer treatment will help in
reducing deaths due to these conditions.
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