DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20161446

Evaluation of series of 177 cases of acute gynaecological emergencies in tertiary care hospital

Vrunda Choudhary, Sonali S. Somani, Shashikant G. Somani, Rajesh Kaul

Abstract


Background: Gynecologic emergencies are relatively common and acute pain of pelvic origin is a common symptom necessitating emergency medical evaluation, because late diagnosis, potentially leading to progression to severe morbidity or death, is a matter of concern. The objective of present study is to have an overview of emergency gynecological conditions and their management.

Methods: In present retrospective observational study total 177 cases were analyzed. They were divided into three groups depending on age, adolescent group patients aged 19 year and below (group A), reproductive group between 20 to 44 year (group B) and perimenopausal/postmenopausal group aged 45year and above (group C). The data collected were expressed as mean±S.D.

Results: The distribution of cases was as follows: 29 cases (16.38%) in group A with a mean age of 15.5±2.21 years, 97 cases (54.80 %) in group B with a mean age of 24.20±4.38 years and 51 cases (28.81%) in group C with a mean age of 46.75±9.11 years. Pain was in right lower quadrant (36.70%), in left lower quadrant (27.95%), suprapubic (19.35%) and diffuse (16%). The most common etiology of APP were as follows: simple ovarian cysts in 16.9% patients followed by ectopic pregnancy (15.2%), complication of uterine fibroid (10.7%), rupture ovarian of cysts (9.7%) and haemorragic ovarian cysts (6.8%). Modality of management in all of the groups was as follows: observation in 21.5%, medical in 25.4% and surgical in 53.1%.

Conclusions: Accurate clinical and laboratory evaluation are essential in gynecological emergencies. There should be a high index of suspicion for early detection and early intervention to reduce morbidity and mortality.


Keywords


Acute pelvic pain, Gynaecological emergencies, Morbidity, Mortality

Full Text:

PDF

References


Walker JW. Abdominal and pelvic pain. Emerg Med Clin North Am. 1987;5:425-8.

Kontoravdis A, Chryssikopoulos A, Hassiakos D, Liapis A, Zourlas PA. The diagnostic value of laparoscopy in 2365 patients with acute and chronic pelvic pain. International J Gyn Obs. 1996,52(3):243-8.

Steege JF. Pelvic pain phenotyping: the key to progress. Obstet Gynecol. 2009;113:258-9.

Vandermeer FQ, Wong JJ. Imaging of acute pelvic pain. Clin Obstet Gynecol. 2009;52(1):2-20.

Kruszka PS, Kruszka SJ. Evaluation of acute pelvic pain in women. Am Fam Physician. 2010;82(2):141-7.

Cuevas C, Dubinsky TJ. Imaging evaluation of acute pelvic pain in reproductive age women: what is the best study? Ultrasound Q. 2011;27(3):211-3.

Read MD, Bigrigg MA. The management of gynaecological emergencies. Curr Obs Gyn. 1994;4:98-103.

Potter AW, Chandrasekhar CA. US and CT evaluation of acute pelvic pain of gynecologic origin in non-pregnant premenopausal patients. Radiographics.2008;28(6):1645-59.

Rapkin AJ, Pelvic pain and dysmenorrhea. In: Berek JS, Adshi EY, Hillard PA. Novak’s Gynecology, 13th edition. Pennsylvania; 2004:399-403.

Kurt S, Uyar I, Demirtas O, Celikel E, Beyan E, Tasyurt A. Acute pelvic pain: evaluation of 503 cases. Arch Iran Med. 2013;16(7):397-400.

Grover S. Pelvic pain in the female adolescent patient. Aust Fam Physician. 2006;35(11):850-3.

Gaitan H, Angel E, Sanchez J, Gomez I, Sanchez L, Agudelo C. Laparoscopic diagnosis of acute lower abdominal pain in women of reproductive age. Int J Gynaecol Obstet. 2002;76(2):149-58.

Van WJT, Simmons PS, Podratz KC. Surgically treated adnexial masses in infancy, childhood, and adolescence. Am J Obstet Gynecol. 1994;170(6):1780-6.

Del VR, Battisti S, Di Paola V, Piccolo CL, Cazzato RL, Sansoni I, et al. Herlyn-werner-wunderlich syndrome: MRI findings, radiological guide (two cases and literature review), and differential diagnosis. BMC Med Imaging. 2012;12:4.

Yenicesu C, Imir G, Cetin M, Kuckukozkan T. Evaluation of the treatment modalities and hospitalization period in patients with acute pelvic pain related to adnexal pathologies. CU Journal of Medicine. 2008;30(1):1-7.

Olarewaju RS, Ujah IAO, Otubu JAM. Trends in ectopic pregnancy in the Jos university teaching hospital, Jos, Nigeria. Nig J Med. 1994,26:57-60.

Grimes DA. The morbidity and mortality of pregnancy. Still risky business. Am J Obstet Gynecol. 1994;170:1489-94.

Kurt S, Demirtas O, Gurbuz T, Aldemir OS, Bicer H,Tasyurt A. Management of ectopic pregnancy. Retrospective analysis of 171 cases. Turkiye Klinikleri J Gynecol Obst. 2012;22(2):84-9.

Nyapathy V, Polina L. MRgFUS treatment of uterine fibroid in a nulliparous woman with acute retention of urine. Radiol Case. 2012;6(2):1-8.

Samraj GP, Curry RW Jr. Acute pelvic pain: evaluation and management. Compr Ther. 2004;30:173-84.