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Ovarian Ectopic Pregnancy
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Abdominal and pelvic findings are notoriously scarce in women with undisturbed ovarian pregnancy. Vital signs may show hemodynamic instability. Abdominal exam may show tenderness in the lower abdomen with or without positive peritoneal signs or abdominal guarding. Vaginal examination may indicate vaginal bleeding, normal uterine size, cervical motion tenderness, and/or a palpable adnexal mass [14, 19]. A pelvic mass, including fullness posterolateral to the uterus, can be palpated in approximately 20% of cases. Often, discomfort precludes detailed pelvic exam. Importantly, limiting the pelvic examinations may help avert iatrogenic rupture [20]. Abdominal and pelvic examinations help assess the need for urgent surgical intervention. Culdocentesis can be used to assist in the diagnosis of a ruptured ectopic pregnancy with hemoperitoneum.
Ovarian, Fallopian Tube, and Primary Peritoneal Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Robert D. Morgan, Andrew R. Clamp, Gordon C. Jayson
Despite considerable efforts directed at early detection, no cost-effective screening tests have been developed. The suggested screening tests for ovarian cancer include bimanual pelvic examination, TVUS, and CA 125 antigen. The Pap smear and cytological examination of peritoneal lavage obtained by culdocentesis have low sensitivities and are not recommended. Similarly, for women with no known genetic predisposition to ovarian cancer, there is no conclusive evidence to support routine screening.42,43
SBA Answers and Explanations
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
The ureters lie adjacent to the lateral fornix of the cervix. Consequently, a ureteric calculus may be felt in the lateral fornix on vaginal examination. The posterior fornix actually has overlying it the peritoneum of the recto-uterine pouch of Douglas, which is normally occupied by coils of small intestine or sigmoid colon and lies between the uterus anteriorly and the rectum posteriorly. The pouch of Douglas is the most dependent part of the pelvis. Consequently, blood may collect here in a ruptured ectopic pregnancy. A needle may be passed into this space (in an attempt to aspirate blood) in order to diagnose the condition (culdocentesis). Furthermore, the instrument used in illegal abortions, if missing the cavity of the uterus, could actually penetrate the posterior fornix and subsequently the peritoneal cavity, often leading to fatal peritonitis and sepsis.
Ovarian hyperstimulation syndrome. A new look at an old problem
Published in Gynecological Endocrinology, 2019
Aleksei Petrovich Petrenko, Camil Castelo-Branco, Dmitrij Vasilevich Marshalov, Igor Arkadevich Salov, Efim Munevich Shifman
One of the goals of OHSS treatment is to prevent the progression of the severity of the syndrome. The previously recommended criteria for paracentesis were complaints of shortness of breath, abdominal distention, abdominal pain, oliguria, and ineffective treatment. In its first edition, the «Management of ovarian hyperstimulation syndrome, Green-top guideline, № 5» recommended paracentesis when the increase in IAP higher than 20 mmHg (Level of Recommendations III) [23]. However, whether the OHSS is considered from the point of view of the IAH syndrome, then early decompression, even with a moderate form of OHSS when ascites is not expressed, may be probably justified. In recent years, a reassessment of the importance of IAH in the OHSS is in motion. In the «Ovarian Hyperstimulation Syndrome (OHSS). Diagnosis and Management. Guideline № 9» [20], a recommendation on early decompression is performed, even in an outpatient basis (Level of Recommendations 2B-II). Moreover, it has been proved that culdocentesis avoid the progression of OHSS to severe forms [20]. In the latest edition of the guideline «The management of the ovarian hyperstimulation syndrome, Green-top guideline, № 5» (2016), the specific values of IAP (20 mmHg), in which it is necessary to proceed to paracentesis, have been replaced by an abstract ‘increase’ in IAP, which indicates the possibility of development of organ dysfunction with lower values of IAP [4]. Obviously, there is insufficient clinical data to establish the critical values of IAP in patients with OHSS.
Outpatient management of severe ovarian hyperstimulation syndrome: a systematic review and a review of existing guidelines
Published in Human Fertility, 2018
Amr Gebril, Haitham Hamoda, Raj Mathur
The Canadian Society of Obstetricians and Gynaecologists (SOGC) and the Canadian Fertility and Andrology Society (CFAS) published a joint guideline on the management of OHSS in 2011 (Shmorgun et al., 2011). The guideline recommends outpatient management for patients with mild and moderate OHSS with adequate oral hydration (oral intake of 2–3 l/day) and pain relief with paracetamol. Inpatient management is recommended for patients with severe OHSS, although it is acknowledged that outpatient management would be an acceptable alternative option provided that the patient is ‘capable of adhering to clinical instructions and that there is a system in place to assess her status every 1 to 2 days’. The guidance also recommended the use of outpatient paracentesis and culdocentesis in the management of severe cases to improve symptoms and renal perfusion, prevent progression of moderate to severe disease and to minimize the need for hospital admission.
Extremely high serum CA19-9 level along with elevated D-dimer in assisting detection of ruptured ovarian endometriosis
Published in Annals of Medicine, 2022
Ting Shuang, Yiran Wang, Lanbo Zhao, Kailu Zhang, Panyue Yin, Lin Guo, Wei Jing, Xue Feng, Qiling Li
For patients with ruptured OE, we summarized their last medical history, pre-operative data, and performance during the operation. Among the 21 ruptured OE patients, 16 of them ever did ultrasonography and reported pelvic or ovarian cysts. The period from pre-existing ovarian cysts to the onset of lower abdominal pain was arranged from 17 days to 4 years, and the size of tumour was arranged from 4 to 10 cm. Among them, two patients (case 16, case 20) had a history of endometrioma surgery. Nineteen out of the 21 patients had acute lower abdominal pain, accompanied by nausea and vomiting, and appeared abdominal tenderness by physical examination. Four (case 8, 16, 17, 21) out of 19 patients who accepted pelvic examination showed chocolate fluid by culdocentesis (two patients had no sexual experience). Fluid accumulation was detected in the cul-de-sac in six cases (case 6, 8, 10, 16, 17, 21) using ultrasonography. Fever was noted in only one patient with temperature being 39.2 °C. Twenty patients accepted surgery, and the interval from pain attack to surgery arranged from 8 h to 7 days, among which, surgery was performed within 48 h in 11 patients. Only one patient (case 1) accepted selective operation five months after abdominal pain. During the operation, 19 patients were found ruptured ovarian cyst along with chocolate fluid flowing out. Two patients showed haemosiderin staining of the peritoneum, omentum, surface of ovarian cyst, or the intestinal canal (data were shown in Supplemental Table 1). Sixteen patients had laparoscopic surgery and five patients underwent laparotomy. Three patients underwent oophorectomy, and the rest had endometriosis enucleation.