Septic Shock and Cardiac Arrest in Obstetrics
Septic shock and cardiac arrest during pregnancy, despite being uncommon, carry a high mortality rate among pregnant individuals. Basic initial management strategies are fundamental to improve clinical outcomes; obstetricians and maternal-fetal medicine specialists need to be familiar with such interventions. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - September 1, 2022 Category: OBGYN Authors: Luis D. Pacheco, Megan C. Shepherd, George S. Saade Source Type: research
Endocrine Emergencies During Pregnancy
The physiologic changes and common signs and symptoms of pregnancy can make the early recognition of endocrine emergencies more challenging. Diabetic ketoacidosis (DKA) can occur at only modestly elevated glucose levels (euglycemic DKA), often accompanied by starvation ketosis due to substantial fetal-placental glucose demands and is associated with a high stillbirth rate. Thyroid storm is life threatening with a higher rate of heart failure and both require prompt and aggressive treatment to avoid maternal and fetal morbidity and mortality. Treatment of these disorders and the special considerations for recognition and ma...
Source: Obstetrics and Gynecology Clinics - September 1, 2022 Category: OBGYN Authors: Odessa P. Hamidi, Linda A. Barbour Source Type: research
Placenta Accreta Spectrum
The incidence of placenta accreta spectrum (PAS) is increasing and is now about 3 per 1000 deliveries, largely due to the rising cesarean section rate. Ultrasound is the preferred method for diagnosis of PAS. Ultrasound markers include multiple vascular lacunae, loss of the hypoechoic retroplacental zone, abnormalities of the uterine serosa –bladder interface, retroplacental myometrial thickness less than 1 mm, increased placental vascularity, and observation of bridging vessels linking the placenta and bladder. Patients with PAS should be managed by experienced multidisciplinary teams. Hysterectomy is the accepted mana...
Source: Obstetrics and Gynecology Clinics - September 1, 2022 Category: OBGYN Authors: Rebecca Horgan, Alfred Abuhamad Source Type: research
Shoulder Dystocia
This article has identified the existence of large gaps in our clinical knowledge base regarding the prevention and resolution of shoulder dystocia, as well as its long-term sequelae. We have attempted to challenge current recommendations regarding whether prophylactic cesarean delivery should be performed based on estimated fetal weight alone or a prior history of shoulder dystocia, shoulder dystocia management techniques, what defines “excessive” traction, and the role of simulation training for all clinicians. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - September 1, 2022 Category: OBGYN Authors: Suneet P. Chauhan, Robert B. Gherman Source Type: research
Pulmonary Embolism and Amniotic Fluid Embolism
Venous thromboembolism (VTE) as well as other embolic events including amniotic fluid embolism (AFE) remain a leading cause of maternal death in the United States and worldwide. The pregnant patient is at a higher risk of developing VTE including pulmonary embolism. In contrast, AFE is a rare, but catastrophic event that remains incompletely understood. Here the authors review the cause of VTE in pregnancy and look at contemporary and evidence-based practices for the evaluation, diagnosis, and management in pregnancy. Then the cause and diagnostic difficulty of AFE as well as what is known regarding the pathogenesis are re...
Source: Obstetrics and Gynecology Clinics - September 1, 2022 Category: OBGYN Authors: Ashley S. Coggins, Erin Gomez, Jeanne S. Sheffield Source Type: research
Hypertensive Crisis in Pregnancy
Severe hypertension in pregnancy is a medical emergency, defined as systolic blood pressure (BP) ≥ 160 mm Hg and/or diastolic BP ≥ 110 mm Hg taken 15 minutes to 4 or more hours apart. Outside pregnancy, acute severe hypertension (HTN) is defined as a BP greater than 180/110 to 120 reproducible on 2 occasions. The lower threshold for severe HTN in pregnancy reflects the increased risk for adverse outcomes, particularly maternal stroke and death, and may be a source of under-recognition and treatment delay, particularly in nonobstetrical health care settings. Once a severe hypertension episode is recognized, antihyper...
Source: Obstetrics and Gynecology Clinics - September 1, 2022 Category: OBGYN Authors: Cynthie K. Wautlet, Maria C. Hoffman Source Type: research
Pediatric and Adolescent Gynecologic Emergencies
This article aims to dispel common misunderstandings and aid with diagnosis and management of 3 common pediatric and adolescent gynecologic emergencies: adnexal torsion, vulvovaginal lacerations, and nonsexually acquired genital ulcers. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - September 1, 2022 Category: OBGYN Authors: Stephanie M. Cizek, Nichole Tyson Source Type: research
Ectopic Pregnancy
Ectopic pregnancy occurs in 2% of all pregnancies and is a potentially life-threatening emergency. A high level of clinical suspicion is required for any pregnant patient who presents with vaginal bleeding and/or pelvic pain. Workup should begin with immediate triage based on vital signs, a pregnancy test, and transvaginal ultrasound. Ectopic pregnancy can be treated either medically with methotrexate or surgically with either salpingectomy or salpingostomy. Carefully counseled, asymptomatic patients may be candidates for expectant management. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - September 1, 2022 Category: OBGYN Authors: Shawna Tonick, Christine Conageski Source Type: research
Identification and Treatment of Acute Pelvic Inflammatory Disease and Associated Sequelae
Pelvic inflammatory disease (PID) is an ascending polymicrobial infection of the upper female genital tract. The presentation of PID varies from asymptomatic cases to severe sepsis. The diagnosis of PID is often one of exclusion. Primary treatment for PID includes broad-spectrum antibiotics with coverage against gonorrhea, chlamydia, and common anaerobic and aerobic bacteria. If not clinically improved by antibiotics, percutaneous drain placement can promote efficient source control, as is often the case with large tubo-ovarian abscesses. Ultimately, even with treatment, PID can result in long-term morbidity, including chr...
Source: Obstetrics and Gynecology Clinics - September 1, 2022 Category: OBGYN Authors: Danielle N. Frock-Welnak, Jenny Tam Source Type: research
Sexual Assault/Domestic Violence
Sexual assault and intimate partner violence (IPV) of children, adolescents, and adult women are prevalent in the United States and have long-term physical and mental health, financial, and social effects. Pregnant women and women of color are particularly high-risk populations. Obstetrics and gynecology providers are uniquely situated to assess and treat survivors of IPV and sexual assault. A timely, thorough forensic medical examination, appropriate evaluation, and prophylactic therapy are all vital components in the care of these patients. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - September 1, 2022 Category: OBGYN Authors: Ruth E.H. Yemane, Nancy Sokkary Source Type: research
Evaluation and Management of Heavy Vaginal Bleeding (Noncancerous)
Heavy vaginal bleeding is a common, life-altering condition affecting around 30% of women at some point in their reproductive lives. Initial evaluation should focus on hemodynamic stability. A thorough history including the patient ’s menstrual cycle and personal and family bleeding history should be obtained. Causes are stratified using the structural and nonstructural International Federation of Gynecology and Obstetrics classification system. Further consideration of the patient’s age is essential because this can help to narrow the differential diagnosis. Work-up includes laboratory and imaging studies. Treatment a...
Source: Obstetrics and Gynecology Clinics - September 1, 2022 Category: OBGYN Authors: Bridget Kelly, Emily Buttigieg Source Type: research
Bleeding from Gynecologic Malignancies
Initial assessment of vaginal bleeding in gynecologic malignancies includes a thorough history and physical examination, identification of site and extent of disease, and patient goals of care. Patients who are initially hemodynamically unstable may require critical care services. Choice of treatment is disease site specific. Cervical cancer frequently is treated with chemoradiation. Uterine cancer may be treated surgically, with radiation, or pharmacologically. Gestational trophoblastic disease is treated surgically. Alternative treatment modalities include vascular embolization and topical hemostatic agents. Patients wit...
Source: Obstetrics and Gynecology Clinics - September 1, 2022 Category: OBGYN Authors: Megan L. Hutchcraft, Rachel W. Miller Source Type: research
Emergencies in Obstetrics and Gynecology: Advances and Current Practice
Welcome to the latest issue of Obstetrics and Gynecologic Clinics of North America, focused on emergencies in obstetrics and gynecology. Every medical or surgical specialty encounters the occasional emergency, and the field of obstetrics and gynecology is no exception. Urgent and emergent problems are common events in the reproductive health care of women, and providers must be equipped with the medical knowledge, surgical skills, and most up-to-date scientific evidence to guide their approach to the emergent event. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - September 1, 2022 Category: OBGYN Authors: Patricia S. Huguelet, Henry L. Galan Tags: Preface Source Type: research
First Trimester Miscarriage
First trimester miscarriage, or early pregnancy loss, is a common occurrence in the United States. Miscarriage management includes expectant, medical, or surgical approaches. Decisions about management options should be approached through shared decision making between the patient and provider and with consideration of patient ’s preferences, hemodynamic stability, cost, gestational age, and effectiveness. Emergencies requiring immediate interventions are rare. Newer developments in management, including a more effective medical regimen with the addition of mifepristone and cost-effective and convenient in-office surgic ...
Source: Obstetrics and Gynecology Clinics - September 1, 2022 Category: OBGYN Authors: Maria Shaker, Ayanna Smith Source Type: research
Simulation in Obstetric Emergencies
Simulation is a critical part of training for obstetric emergencies. Incorporation of this training modality has been shown to improve outcomes for patients and is now required by national accrediting organizations. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - September 1, 2022 Category: OBGYN Authors: Jean-Ju Sheen, Dena Goffman, Shad Deering Source Type: research
