Gynecologic Emergencies



Gynecologic Emergencies


Anh Do



Introduction



  • Gynecologic problems are commonly seen in both prepubertal and adolescent age groups


  • Speculum examination is contraindicated if no history of sexual intercourse


Developmental Changes by Age


Birth to 8 Weeks: Maternal Estrogen Effect



  • Thickened, enlarged labia minora


  • Large clitoris


  • Vaginal discharge/bleed


8 Weeks to 7 Years



  • Labia majora flat, minora thin


  • No breasts, no pubic hair


7-10 Years: Premenarchal



  • Labia majora filling out, labia minora thickening


  • Leukorrhea


Adolescent



  • Hormonal effects, adult genitalia


Vaginal Bleeding


History



  • Pain, discharge


  • Urinary symptoms


  • Other sites of bleeding, family history blood dyscrasia



  • Trauma


  • Menarche and sexual history (adolescent)


Exam



  • Look for signs of hormonal stimulation:



    • Breast development, pubic hair, physiologic leukorrhea


  • Pelvic examination:



    • Frog-leg position (on parent’s lap)






      Figure 50.1 Causes of Vaginal Bleeding



    • Inspect for hematoma, mass, active bleed, and foreign body (no speculum unless sexually active)


    • Knee-chest position to examine posterior fourchette


Urethral Prolapse



  • Protrusion of distal urethral mucosa beyond urethral meatus


  • Cause: estrogen deficiency, intra-abdominal pressure, poor attachment of urethral mucosa to underlying smooth muscle


  • Typical age 3-5 years


  • African-American predominance


Clinical Presentation



  • 90% present with painless vaginal bleeding/spotting


  • Acute urinary retention


  • Dysuria


  • Edema of prolapsed tissue


  • Vascular congestion: red/purple soft doughnut-shaped mass


  • If persistent, necrosis may occur: surgical removal


Treatment



  • Sitz baths several times daily


  • Topical estrogen cream +/− antibiotics


  • Medical treatment successful in up to 70% of cases


Straddle Injury



  • Caused by a blow to the perineum due to falling on surface/object with force of one’s own body


  • Mechanisms of injury: fall from bicycle/furniture/playground equipment, climbing, running into object, water injuries (water skiing, water jets, jet skiing)


  • Majority are minor lacerations/abrasions of genitalia, perineal body


  • Majority do not require suture repair


  • If repair required, consult gynecology


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Jun 22, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Gynecologic Emergencies

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