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Gynaecology, Fertility and Family Planning
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Zahra Ameen, Kopal Singhal Agarwal, Chawan Baran, Lauren Laws, Maria Garcia de Frutos, Black Benjamin
Treat for upper genital tract infection if there is abnormal vaginal discharge or cervical motion tenderness. Antibiotic choice is one oral dose of 400 mg cefixime or one IM dose of 250 mg ceftriazone and 100 mg doxycycline orally twice daily for 14 days (contraindicated in pregnant women) and 500 mg metronidazole orally twice daily for 14 days. Treat the sexual partner for gonorrhoea and Chlamydia. Remove IUD if in situ. Recommend analgesia as appropriate.7
Obstetric and Gynaecological Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
On examination there is an elevated temperature with bilateral lower abdominal tenderness and guarding. Vaginal examination reveals a cervical discharge, adnexal tenderness and cervical motion tenderness (excitation pain on moving the cervix).
SBA Questions
Published in Justin C. Konje, Complete Revision Guide for MRCOG Part 2, 2019
A 23-year-old woman presents to the Gynaecology Emergency Unit with acute onset of lower abdominal pains of 5 days duration. These symptoms started 5 days after unprotected sexual intercourse. She also complained of a vaginal discharge and right upper abdominal pain. She has a temperature but does not suffer from rigors. You examine and find lower abdominal tenderness and cervical motion tenderness. You suspect that she has Chlamydia salpingitis and perihepatitis and have sent swabs for testing. What first-line treatment should she be prescribed?Azithromycin 1 g stat and metronidazole 400 mg four times a day for 10 daysAzithromycin 1 g stat and metronidazole 400 mg four times a day for 14 daysClindamycin 900 mg daily and metronidazole 400 mg four times daily for 14 daysDoxycycline 100 mg bd and metronidazole 400 mg four times a day for 14 daysOfloxacin 200 mg twice daily and metronidazole 400 mg four times a day for 14 days
An unusual complication of LEEP cervical conisation with a retained intrauterine device (IUD): a case report
Published in Journal of Obstetrics and Gynaecology, 2019
Ayhan Gül, Ayşe Gül Kebapçılar, Gözde Şahin, Serra Akar, Çetin Çelik
A 35-year-old woman (gravidity 3, parity 3) presented with the chief complaint of a persistent purulent vaginal discharge for months. She reported a malodorous vaginal discharge and a decrease in the amount of her usual menstrual bleeding. She’d had a copper-containing IUD for 4 years and underwent a LEEP procedure 6 months earlier due to a cervical dysplasia. A vaginal examination revealed a purulent malodorous vaginal discharge. A pelvic exam was significant for a cervical motion tenderness and pelvic pain. The cervix was hypertrophic and erythematous. Cervical os could not be seen, and the IUD string was invisible. A transvaginal ultrasonography (TUSG) showed a liquid collection of approximately 3 cm in diameter in the cervical canal (Figure 1). Magnetic resonance imaging (MRI) showed there was a lesion of 37 mm in diameter at the level of the cervix, suggesting an abscess (Figure 2). There was an IUD located at the cervix, at the site of the lesion.
Partial tubal devascularisation: a novel procedure for tubal conservation in ectopic pregnancy
Published in Journal of Obstetrics and Gynaecology, 2019
Sherif A. Shazly, Ahmed G. Gayar, Ahmed Y. Abdelbadee, Ahmed M. Afifi, Ahmed A. Nassr
The first woman was admitted to our hospital with a history of a missed period, acute lower abdominal pain and vaginal spotting. She only had one vaginal birth of a living female baby (2 years old) and had a smooth postpartum course. She had no history of recent contraception. Her pregnancy was confirmed by a urinary test only. Her blood pressure at presentation was 100 over 60 and her pulse was 102. First aid measures were performed and intravenous fluids were given. Lower abdominal tenderness and rebound tenderness, more at the left iliac fossa, were elicited. Cervical motion tenderness supported the diagnosis. A trans-vaginal ultrasonography confirmed the diagnosis of disturbed ectopic pregnancy; the uterus was empty, surrounded by pelvic fluid collection and a heterogeneous mass consistent with a blood clot was seen in the Douglas pouch. Unfortunately, an immediate laparotomy revealed a bilateral spontaneous ectopic pregnancy. The left ampulla ruptured and the gestational sac bulged through the upper border of the tube and was surrounded by blood clots. This tube was extensively damaged. However, the right tube had an undisturbed ectopic pregnancy in the ampulla and was suitable for conservation. In the other four cases, conservation was done for the presence of a diseased contralateral tube (one patient) and on patient request (three cases). All women were managed by an immediate laparotomy.
Diagnosing and treating postpartum uterine artery pseudoaneurysm
Published in Baylor University Medical Center Proceedings, 2018
Kathlyn Parr, Anisha Hadimohd, Adrianne Browning, Jason Moss
Upon arrival to our emergency department, her temperature was 98.1°F, her heart rate was 105 beats per minute, her blood pressure was 105/60 mm Hg, and her respiratory rate was 19 breaths per minute. The oxygen saturation was 100% on room air. The patient appeared anxious but in no acute distress. Her abdomen was soft, nondistended, and nontender. On pelvic exam, there were no labial, vaginal, or cervical lesions. A large clot was evacuated from the vaginal vault with no active bleeding appreciated. No cervical motion tenderness was noted. The cervical os was closed and her uterus measured 6-week size, anteverted. No pelvic or adnexal masses were noted. The blood hemoglobin was 11.4 g/dL and hematocrit was 34.2%. She also had a negative quantitative human chorionic gonadotropin and normal prothrombin time, partial thromboplastin time, and international normalized ratio. A transvaginal ultrasound with color Doppler was performed and showed the uterus to measure 7.9 × 4.4 × 5.7 cm, with an endometrial thickness of 4 mm, normal adnexa bilaterally without compromised blood flow, and no retained products of conception. The ultrasound did show a 1.5-cm pseudoaneurysm near the cesarean section scar that appeared to originate from the left uterine artery (Figure 1). Due to the risk of rupture with subsequent hemorrhage, the patient was admitted for pelvic arteriogram and embolization of the left UAP. Coils were placed into the UAP and the associated branch of the left uterine artery (Figure 2). After the coils were placed, no flow was noted in the UAP but flow was maintained in the remainder of the uterus. There were no complications during the procedure. The patient was discharged home the following day.