Overview of Gynecological Emergencies:

What is relevant to the general Practitioner?

by Sidney Wu, M.D.

 (presented at the 2002 CAMS Annual Scientific Meeting)

             Problems arising from gynecologic causes account for a significant portion of all emergency department visits.  An understanding of the key features of gynecologic emergencies with emphasis on their evaluation and timely diagnosis and treatment is an important part of medical knowledge for practitioners of almost all medical fields. 

            One approach to the general topic of gynecologic emergencies is from the perspective of the common presenting symptoms.  Of those, bleeding, infection, and pain head the list with other special gynecologic conditions being those related specifically to the vulva.  There are also a myriad of diseases that can mimic acute abdomen and is therefore of prime importance in the differential diagnosis. Finally, the problem of sexual assault and violence towards women should not be neglected as they are acute gynecologic situations.

            In the evaluation of patients with vaginal bleeding, the first step is stabilization of the patient.  As part of initial evaluation, determination of pregnancy is also crucial.  The single most important diagnosis to consider in a patient presenting with either vaginal bleeding or abdominal pain who is then found to be pregnant is an ectopic pregnancy.  Other causes of bleeding in the first and second trimester include spontaneous miscarriage at various stages of abortion, and molar pregnancies.  Patients who present with acute bleeding who are not pregnant require immediate stabilization and resuscitation followed then by a careful evaluation of the potential causes for bleeding.

            Infection is another frequent cause for prompt attention.  Pelvic inflammatory disease, tuboovarian abscesses, toxic shock syndrome, and septic abortions are among the more important causes for acute infection.

            Special consideration for gynecologists is the preservation of fertility potential for patients of childbearing age.  Therefore, ovarian torsion, though not life endangering is an important condition requiring immediate attention.  Also, aggressive care of the patient with PID or TOA is also important in future fertility of the patient.

            Conditions of the vulva such as Bartholin’s duct cysts and abscesses are common problems seen by the general practitioner.  This is an easy diagnosis to make but the proper treatment includes not only incision and drainage but marsupialization of the cyst wall or Ward catheter placement.

            Many gynecologic conditions can mimic surgical emergencies.  Among the most common is the rupture ovarian cyst which can be a great imitator of appendicitis, diverticulitis, and other acute abdomen.

            Finally, domestic violence and sexual assault are important issues that require not only social but medical and legal treatment as well. 

 Dr. Wu is clinical Instructor of Obstetrics & Gynecology, The Weill’s Medical College of Cornell University)