Handbook of Obstetric and Gynecologic Emergencies-5판

Contents
PART I: OBSTETRIC
1 Medical Emergencies in the Pregnant Patient
PULMONARY EMBOLISM
Patient Presentation
Diagnostic Tests
Therapy
ASTHMA
Pharmacologic Agents
Emergency Therapy
THYROID STORM
Diagnostic Criteria
Differential Diagnosis
Laboratory Evaluation
Management
DIABETIC KETOACIDOSIS
Pathophysiology
Diagnosis
Management
SEIZURE DISORDERS
Pregnancy Effects on Epilepsy
Fetal Effects of Anticonvulsant Medications
Management of an Acute Seizure
2 Acute Abdominal Pain in Pregnancy
PHYSIOLOGIC CHANGES IN PREGNANCY
PHYSICAL EXAMINATION CHANGES IN PREGNANCY
DIAGNOSTIC IMAGING DURING PREGNANCY
COMMON CAUSES OF ACUTE ABDOMINAL PAIN IN PREGNANCY
Appendicitis
Cholelithiasis and Cholecystitis
Acute Pancreatitis
Intestinal Obstruction
Nephrolithiasis and Pyelonephritis
Adnexal Masses
LAPAROSCOPIC SURGERY IN PREGNANCY
SUMMARY
3 Ectopic Pregnancy
ETIOLOGY
CLINICAL PRESENTATION
DIFFERENTIAL DIAGNOSIS
AMBULATORY EVALUATION
History
Physical Examination
Pregnancy Tests
Ultrasonography
Culdocentesis
Serial hCG Evaluation
Suction Curettage and Endometrial Biopsy
Serum Markers
MANAGEMENT
Surgical Management
Medical Management
Expectant Management
SUMMARY AND CONCLUSION
4 Trauma in Pregnancy
OUTCOMES
ANATOMIC AND PHYSIOLOGIC ALTERATIONS OF PREGNANCY
Anatomic Changes
Cardiovascular System
Respiratory System
Gastrointestinal System
Urinary System
Endocrine System
Neurologic System
PATTERNS OF MATERNAL AND FETAL INJURY
Blunt Abdominal Trauma
Fetomaternal Hemorrhage
Use of Restraints
Penetrating Abdominal Trauma
EVALUATION AND MANAGEMENT
Prehospital Management
Evaluation of the Mother and the Fetus
Routine Laboratory Studies
Radiographic Procedures
Ultrasonography
Fetal Monitoring
Peritoneal Lavage
Tetanus Prophylaxis
Injury Severity Score
SPECIFIC TRAUMA EPISODES
Thoracic Injuries
Pelvic Fractures
Head and Spinal Cord Injuries
Thermal Burns
Electrical Injury
PERIMORTEM CESAREAN SECTION
DOMESTIC VIOLENCE
SUMMARY
5 Cardiopulmonary Resuscitation During Pregnancy
UNIQUE ANATOMIC AND PHYSIOLOGIC CONSIDERATIONS (SEE TABLES 5.2 AND 5.3)
RESUSCITATION OVERVIEW
BASIC LIFE SUPPORT
ADVANCED LIFE SUPPORT
Cardiac Rhythm Analysis
Basic Rhythm Analysis
Bradyarrhythmias
Tachyarrhythmias
Cardiac Arrest: Ventricular Fibrillation, Pulseless Electrical Activity, and Asystole
AIRWAY MANAGEMENT IN ALS
BREATHING/RESPIRATORY INTERVENTIONS IN ALS
ADVANCED LIFE SUPPORT; OTHER INTERVENTIONS
COMPLICATIONS OF CPR
SUMMARY
6 Perimortem Cesarean Delivery
HISTORICAL BACKGROUND
Incidence and Outcomes
Physiologic Considerations
CONSIDERATIONS FOR UNDERTAKING POSTMORTEM CESAREAN DELIVERY
EQUIPMENT NECESSARY FOR PMCD
TECHNIQUE FOR PERFORMANCE OF PMCD
MEDICOLEGAL CONSIDERATIONS
SUMMARY
7 Hypertensive Disorders of Pregnancy: Preeclampsia/Eclampsia
PATHOPHYSIOLOGY
DIAGNOSIS
PREPARTUM MANAGEMENT
INTRAPARTUM MANAGEMENT
POSTPARTUM MANAGEMENT
PREVENTION
8 Bleeding in Pregnancy
VAGINAL BLEEDING BEFORE VIABILITY
ABORTION
Threatened Abortion
Missed Abortion
Inevitable Abortion
Incomplete Abortion
Complete Abortion
Postabortion Care
ADDITIONAL MARKERS
CERVICAL INCOMPETENCE
PRETERM PREMATURE RUPTURE OF THE MEMBRANES
GESTATIONAL TROPHOBLASTIC DISEASE
CERVICAL AND VAGINAL INFECTIONS OR LESIONS
VAGINAL BLEEDING APPROACHING AND AFTER FETAL VIABILITY
Placenta Previa
Abnormal Placental Implantation (Accreta, Increta, Percreta)
Placental Abruption
Vasa Previa
Uterine Rupture
Labor
NONVAGINAL SITES
WOMEN ON ANTICOAGULANTS
SUMMARY
9 Infections in Pregnancy
URINARY TRACT INFECTION
Asymptomatic Bacteriuria
Acute Cystitis
Acute Pyelonephritis
INTRA-AMNIOTIC INFECTION OR INFLAMMATION
Background
Diagnosis
Management
POSTPARTUM ENDOMETRITIS
Background
Diagnosis
Management
HERPES INFECTION
Herpes Simplex Virus
Cytomegalovirus
Varicella Zoster
10 Pregnant Women and Chemical뺹iological Warfare
GENERAL PREPARATION
BIOLOGICAL AGENTS
Anthrax
Botulism
Smallpox
Tularemia
Plague
Q Fever
Ricin
TOXINS OR CHEMICALS
Nerve Agents뾃cetylcholinesterase Inhibitors
Vesicants and Pulmonary Agents
Explosion Trauma in Pregnancy
RADIATION
11 Mosquito-Borne Infections: Chikungunya, Dengue, Malaria, West Nile Virus, Yellow Fever, and Zika Virus
INTRODUCTION
CHIKUNGUNYA
Epidemiology
Clinical Manifestations
Diagnosis
Management
DENGUE
Epidemiology
Clinical Manifestations
Diagnosis
Management
MALARIA
Epidemiology
Clinical Manifestations
Diagnosis
Management
Treatment
WEST NILE VIRUS
Epidemiology
Clinical Manifestations
Diagnosis
Management
YELLOW FEVER
Epidemiology
Clinical Manifestations
Diagnosis
Management
ZIKA VIRUS INFECTION
Epidemiology
Clinical Manifestations
Diagnosis
Management
12 Delivery in the Emergency Department
EMS PREPAREDNESS
SPONTANEOUS VAGINAL DELIVERY
Delivery of the Head
Delivery of the Shoulders
Clearing the Nasopharynx
Nuchal Cord
Clamping the Cord
Delivery of the Placenta
Oxytocin Agents
Infant Care
Breast-feeding
COMPLICATIONS OF EMERGENCY VAGINAL DELIVERY
Shoulder Dystocia
Breech Presentation
Umbilical Cord Prolapse
Neonatal Resuscitation
Postpartum Hemorrhage
Lacerations of the Genital Tract
DOCUMENTATION
Postdelivery Note
SUMMARY
13 Transport of the Pregnant Patient
MEDICAL CONDITIONS WARRANTING TRANSPORT
RESPONSIBILITIES OF THE REFERRING PROVIDER
UNDERSTANDING LEVELS OF MATERNAL CARE
LOGISTICS OF MATERNAL TRANSPORT
TEAM CONFIGURATION
TRANSPORT TEAM PRELIMINARY ASSESSMENT
PRIMARY AND SECONDARY OBSTETRIC EVALUATION
FETAL ASSESSMENT AND SURVEILLANCE
NICHD Terminology for Fetal Heart Rate Characteristics
Contractions
Interventions for Abnormal FHR Patterns
Standard of Care in the Transport Industry Regarding Fetal Monitoring
LEGAL CONSIDERATIONS
SUMMARY
14 Human Immunodeficiency Virus (HIV) Disease Pregnancy: Labor and Delivery Management
IDENTIFICATION OF HIV-INFECTED WOMEN IN LABOR
INTERVENTIONS TO REDUCE PERINATAL HIV TRANSMISSION
INTRAPARTUM CARE FOR ALL HIV-INFECTED WOMEN IN LABOR
CARE FOR INFANT
POSTPARTUM CARE
SUMMARY
15 Postpartum Emergencies
SEIZURES
POSTPARTUM HEMORRHAGE
VENOUS THROMBOEMBOLISM
CARDIOVASCULAR EMERGENCIES
Peripartum Cardiomyopathy
Acute Myocardial Infarction
OVARIAN TORSION
INFECTION
Treatment of Endometritis and Pelvic Abscess
Treatment of Abdominal Wound Infections
Treatment of Vaginal Laceration Infections
MASTITIS
PYELONEPHRITIS
PSYCHOLOGICAL EMERGENCIES
16 Role of Imaging Modalities in Obstetric Emergencies
RADIATION EXPOSURE IN PREGNANCY
Risk Related to Gestational Age (5)
IMAGING MODALITIES
OBSTETRIC EMERGENCIES AND IMAGING
VAGINAL BLEEDING IN PREGNANCY
First Trimester Bleeding
BLEEDING IN THE SECOND AND THIRD TRIMESTERS
TRAUMA IN PREGNANCY
17 Drug Therapy in Pregnancy
FOOD AND DRUG ADMINISTRATION PREGNANCY CATEGORIES
PREGNANCY AND LACTATION LABELING RULE
TERATOGENESIS
PREGNANCY REGISTRIES
Hazardous Medication Handling During Pregnancy (16?9)
ANTI-INFECTIVES
ANALGESIA
ASTHMA
COAGULATION
DEPRESSION
DIABETES
GASTROESOPHAGEAL REFLUX DISEASE
HYPERTENSION
MIGRAINES/HEADACHES
NAUSEA/VOMITTING
PSYCHOSIS/BIPOLAR DISORDER
PULMONARY HYPERTENSION
SEIZURE
PART II: GYNECOLOGIC
18 Complications of Medical and Surgical Abortion
EPIDEMIOLOGY AND HISTORY OF ABORTION IN THE UNITED STATES
SURGICAL ABORTION
MEDICAL ABORTION
MANAGING SPECIFIC COMPLICATIONS OF ABORTION
Hemorrhage
Infection
Retained Tissue
Abortion in the Second Trimester (at or After 13 Weeks of Gestation)
CONTRACEPTION FOLLOWING ABORTION
SUMMARY
19 Sexually Transmitted Diseases
PELVIC INFLAMMATORY DISEASE
GONORRHEA
ACQUIRED IMMUNODEFICIENCY SYNDROME
SYPHILIS
HERPES SIMPLEX VIRUS INFECTIONS
20 Vulvar and Vaginal Diseases
21 Abnormal Uterine Bleeding
INTRODUCTION AND OBJECTIVES
TERMINOLOGY AND DEFINITIONS
ACUTE ABNORMAL UTERINE BLEEDING뾇VALUATION AND STABILIZATION
HISTORY AND PHYSICAL EXAM
LABORATORY AND DIAGNOSTIC TESTING
ACUTE MANAGEMENT
LONG-TERM MANAGEMENT
Polyps
Adenomyosis
Leiomyomas
Malignancy
Coagulopathies
Ovulatory
Endometrial
Iatrogenic
Not Otherwise Classified
CONCLUSION
22 Pelvic Mass
INTRODUCTION
ASYMPTOMATIC PELVIC MASSES
SYMPTOMATIC PELVIC MASS
UNUSUAL SITUATIONS PRESENTING AS A PELVIC MASS
METHODS OF EVALUATING A MASS
MANAGEMENT OF PATIENTS WITH A MASS
SUMMARY
23 Torsion of Ovary
ETIOLOGY
CLINICAL FEATURES
DIFFERENTIAL DIAGNOSIS
TREATMENT
SPECIAL CONSIDERATIONS
CONCLUSIONS
24 Oncologic Emergencies
INTRODUCTION
VAGINAL BLEEDING
Cervical Cancer
Endometrial Cancer
Vulvar Cancer
Gestational Trophoblastic Disease
THROMBOEMBOLISM
POSTOPERATIVE COMPLICATIONS
Surgical Site Infections
Wound Dehiscence
Bowel Evisceration
ALTERED MENTAL STATUS
Infection
Cerebrovascular Accident
Brain Metastasis
GASTROINTESTINAL COMPLICATIONS
Bowel Obstruction
Bowel Perforation
Gastrointestinal Fistulas
Ostomy Complications
UROLOGIC COMPLICATIONS
Ureteral Obstruction
Urologic Fistulas
Urinary Conduit Complications
COMPLICATIONS OF CHEMOTHERAPY
Bone Marrow Suppression
Gastrointestinal Effects
Hypersensitivity Reactions
COMPLICATIONS OF RADIATION THERAPY
Radiation Enteritis
Late Complications
COMPLICATIONS OF IMMUNOTHERAPY
NUTRITIONAL SUPPORT COMPLICATIONS
SUMMARY
ONCOLOGIC EMERGENCY PEARLS
25 Postoperative Complications and Postoperative Emergencies After Open, Minimally Invasive, and Robotic
Procedures
COMPLICATIONS SPECIFIC TO MINIMALLY INVASIVE AND ROBOTIC PROCEDURES
COMPLICATIONS ASSOCIATED WITH ABDOMINAL ACCESS
Vascular Injuries
Bowel Injuries
Bladder Injuries
Nerve Injury
PORT COMPLICATIONS
Port-Site Hernia
Port-Site Metastasis
COMPLICATIONS RELATED TO PNEUMOPERITONEUM
Subcutaneous Emphysema
Pneumomediastinum and Pneumothorax
Hypercarbia
Persistence of Pneumoperitoneum
Gas Embolism
Postoperative Shoulder Pain
GENERAL COMPLICATIONS OF GYNECOLOGIC SURGERIES
Wound Complications
Hematoma and Seroma
Surgical Site Infections
Fascial Dehiscence and Hernia
Vaginal Cuff Dehiscence
UROLOGIC EMERGENCIES
Ureteral Injuries
Urinary Retention
Bladder Injuries
GASTROINTESTINAL EMERGENCIES
Postoperative Ileus
Postoperative Bowel Obstruction
POSTOPERATIVE INFECTIONS
Pelvic Cellulitis and Abscess
Septic Pelvic Thrombophlebitis
OTHER GYNECOLOGIC POSTOPERATIVE EMERGENCIES
Uterine Perforation
Uterine Artery Embolization
Retained Foreign Objects
SUMMARY
26 Emergency Evaluation and Treatment of the Sexual Assault Victim
TRIAGE
FORENSIC MEDICINE
OBTAINING A MEDICAL HISTORY
PHYSICAL EXAMINATION OF THE ADULT
EXAMINATION OF THE CHILD
TREATMENT OF SEXUAL ASSAULT VICTIMS
Prevention of Sexually Transmitted Disease
Postexposure Prophylaxis for Sexually Transmitted Viruses
Prevention of Pregnancy
Psychological Support and Counseling
CONCLUSION
Acknowledgment
27 Gynecologic Traumas
SEXUALLY RELATED TRAUMA
NONSEXUALLY RELATED TRAUMA
SUMMARY
28 Imaging in Gynecologic Emergencies
INTRODUCTION
THE PREGNANT PATIENT
Normal Early IUP
Abnormal Early IUP
Ectopic Pregnancy
Pregnancy of Unknown Location
Role of hCG in Early Pregnancy
PELVIC INFLAMMATORY DISEASE
Endometritis
Salpingitis and Tuboovarian Abscess
OVARIAN TORSION
RUPTURED OVARIAN CYST
29 Urogynecologic Emergencies and Urgencies
URINARY TRACT INJURY FOLLOWING PELVIC SURGERY
URINARY RETENTION FOLLOWING UROGYNECOLOGIC PROCEDURES
URETHRAL CARUNCLES AND PROLAPSE
BOWEL EVISCERATION FOLLOWING VAGINAL SURGERY
FOURNIER뭆 GANGRENE
INCARCERATED UTEROVAGINAL PROLAPSE
THE NEGLECTED PESSARY
FECAL IMPACTION
BLADDER TRAUMA
ACUTE NEPHROLITHIASIS
30 Emergency Room Communication Issues: Dealing with Crisis
COMMON EMERGENCY SITUATIONS REQUIRING SENSITIVE COMMUNICATION SKILLS
Consider the Following Situations
PROCESS ISSUES
CONTENT ISSUES
PERSONALITY ISSUES
SKILLS FOR SPECIFIC SITUATIONS
Fetal Death
Sexually Transmitted Infection
Intimate Partner Violence
Rape
Potentially Serious Diseases
Other Communication Issues
SUMMARY
31 Emergencies in the Assisted Reproductive Technology Patient
INTRODUCTION
IN VITRO FERTILIZATION
OVARIAN HYPERSTIMULATION SYNDROME
Classification and Evaluation
Management
Prevention
MULTIFETAL GESTATION IN ASSISTED REPRODUCTION
ECTOPIC PREGNANCY IN ASSISTED REPRODUCTION
OTHER COMPLICATIONS ASSOCIATED WITH IN VITRO FERTILIZATION
Ovulation Induction
CLOMIPHENE CITRATE
LETROZOLE
EXOGENOUS GONODOTROPINS
HYSTEROSALPINGOGRAPHY
Infection
Contrast Reaction
SUMMARY
32 Physician to Physician Communication During Emergent Conditions
Index