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Introduction to gynaecological emergencies

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Torsion often occurs with the ovary and tube together, as above.

Gynaecological emergencies form a large proportion of the workload of a gynaecologist. Diagnosis and treatments of gynaecological emergency have progressed markedly in the light of evidence-based practice and accurate diagnosis. Combined with a good clinical assessment, this allows for appropriate management.

The findings on initial clinical evaluation may help to differentiate among many potential causes and help plan further evaluation and management. Failure to diagnose and manage any gynaecological emergency at the appropriate time may lead to serious and chronic consequences. Transvaginal ultrasound has developed as an essential tool in the assessment of the majority of emergency gynaecological cases.

Management is often conservative for conditions such as ovarian cyst haemorrhage, torsion and pelvic infection. This tutorial will cover non-pregnancy related conditions presented to the gynaecologist in an emergency setting. It outlines the increasing use of minimal access surgery, which improves recovery from many emergency conditions.

Learning objectives

When you have completed this tutorial you will be able to:

Knowledge

  • Understand the epidemiology, aetiology, biological behaviour, pathophysiology, clinical characteristics, prognostic features and management of emergency gynaecological problems
  • Understand the role of ultrasound in the diagnosis and monitoring of women in the emergency gynaecological setting.

Clinical competency

  • Perform or instigate appropriate investigations after taking a thorough history and carrying out an examination of a woman in a gynaecology emergency
  • Formulate and implement a plan of management and modify as necessary according to the clinical situation and investigation findings
  • Follow appropriate referral pathways and local protocols if abnormal findings are suspected
  • Make appropriate referrals for more complex problems and liaise with colleagues in other disciplines where required.

Clinical skills

  • Perform a comprehensive gynaecological examination
  • Demonstrate competency in the laparoscopic management in the emergency gynaecology situation and in management of other common gynaecological emergencies such as vulval abscesses and pelvic inflammatory disease.

Attitudes

  • Counsel patients sensitively about their condition and prognosis in the emergency gynaecology setting
  • Explain the nature, complications and side effects of emergency medical and surgical treatments.

Last updated: 26/07/10 (tutorial was revised and updated by Mr Fadi Alfhaily and Professor Khaled M A Khaled)

22/01/10 (images showing vulval abscesses and the management of a Bartholin's abscess replaced with new, higher quality versions)

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