Obstetrical and Gynecological Conditions

Table of Contents

Aliases

None noted

Patient Care Goals

  1. Recognize serious conditions associated with hemorrhage during pregnancy even when hemorrhage or pregnancy is not apparent (e.g. ectopic pregnancy, abruptio placenta, placenta previa)
  2. Provide adequate resuscitation for hypovolemia

Patient Presentation

Inclusion Criteria

  1. Female patient with vaginal bleeding in any trimester
  2. Female patient with pelvic pain or possible ectopic pregnancy
  3. Maternal age at pregnancy may range from 10 to 60 years of age

Exclusion Criteria

  1. Childbirth and active labor [see Childbirth guideline]
  2. Post-partum hemorrhage [see Childbirth guideline]

Differential Diagnosis

  1. Abruptio placenta: Occurs in third trimester of pregnancy; placenta prematurely separates from the uterus causing intrauterine bleeding
    1. Lower abdominal pain and uterine rigidity
    2. Shock, with minimal or no vaginal bleeding
  2. Placenta previa: placenta covers part or all of the cervical opening
    1. Generally, late second or third trimester
    2. Painless vaginal bleeding, unless in active labor
    3. For management during active labor [See Childbirth guideline]
  3. Ectopic pregnancy (ruptured)
    1. First trimester
    2. Abdominal/pelvic pain with or without minimal bleeding.
  4. Spontaneous abortion (miscarriage)
    1. Generally first trimester
    2. Intermittent pelvic pain (uterine contractions) with vaginal bleeding

Patient Management

Assessment

  1. Obtain history
  2. Obstetrical history [see Childbirth guideline]
  3. Abdominal pain – onset, duration, quality, radiation, provoking or relieving factors
  4. Vaginal bleeding – onset, duration, quantity (pads saturated)
  5. Syncope/lightheadedness
  6. Nausea/vomiting
  7. Fever
  8. Monitoring
    1. Monitor EKG if history of Syncope or lightheadedness
    2. Monitor pulse oximetry if signs of hypotension or respiratory symptoms
  9. Secondary survey pertinent to obstetric issues
    1. Constitutional: vital signs, orthostatic vital signs, skin color
    2. Abdomen: distention, tenderness, peritoneal signs
    3. Genitourinary: visible bleeding
    4. Neurologic: mental status

Treatment and Interventions

  1. If signs of shock or orthostasis:
    1. Position patient supine and keep patient warm
    2. Volume resuscitation – normal saline 20 mL/kg up to 1 liter, repeat as needed
    3. Reassess vital signs and response to fluid resuscitation
  2. Disposition – transport to closest appropriate receiving facility

Notes – Obstetrical and Gynecological Conditions