Makindo Medical Notes

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Ectopic Pregnancy

• Clinical Presentation:
  • Sudden, severe lower abdominal pain.
  • Vaginal bleeding.
  • Signs of shock if ruptured (hypotension, tachycardia).
• Diagnostic Tests:
  • Transvaginal ultrasound to locate the pregnancy.
  • Serum beta-hCG levels (low or plateauing levels).
  • Culdocentesis may show blood in the abdominal cavity if rupture is suspected.
• Treatment:
  • Medical management with methotrexate for early, unruptured ectopic pregnancies.
  • Surgical intervention (laparoscopy or laparotomy) if rupture has occurred or if medical management is contraindicated.
  • Stabilization with IV fluids and blood transfusion if needed.

Ovarian Torsion

• Clinical Presentation:
  • Sudden onset of severe, unilateral lower abdominal pain.
  • Nausea and vomiting.
  • Adnexal mass may be palpable on examination.
• Diagnostic Tests:
  • Pelvic ultrasound with Doppler to assess blood flow to the ovary.
  • CT or MRI if the ultrasound is inconclusive.
• Treatment:
  • Emergency surgical intervention (laparoscopy) to untwist the ovary and restore blood flow.
  • Oophorectomy may be required if the ovary is necrotic.

Ruptured Ovarian Cyst

• Clinical Presentation:
  • Sudden, sharp pelvic pain.
  • Abdominal bloating.
  • Possible fainting or dizziness if significant bleeding occurs.
• Diagnostic Tests:
  • Pelvic ultrasound to confirm the presence of a cyst and assess for free fluid.
  • CBC to check for anaemia if bleeding is suspected.
• Treatment:
  • Observation and pain management if the patient is hemodynamically stable.
  • Surgical intervention if there is significant hemorrhage or ongoing pain.

Pelvic Inflammatory Disease (PID)

• Clinical Presentation:
  • Lower abdominal pain and tenderness.
  • Abnormal vaginal discharge, fever, and cervical motion tenderness.
  • Pain during intercourse (dyspareunia).
• Diagnostic Tests:
  • Cervical swabs for gonorrhea and chlamydia.
  • Pelvic ultrasound to rule out tubo-ovarian abscess.
  • Urinalysis to rule out concurrent UTI.
• Treatment:
  • Empiric broad-spectrum antibiotics (e.g., ceftriaxone plus doxycycline).
  • Hospitalization for severe cases or if surgical intervention is needed for abscess drainage.
  • Patient education on STI prevention and partner treatment.

Septic Abortion

• Clinical Presentation:
  • Fever, chills, lower abdominal pain.
  • Foul-smelling vaginal discharge.
  • Signs of sepsis (tachycardia, hypotension).
• Diagnostic Tests:
  • CBC, blood cultures to assess for infection.
  • Pelvic ultrasound to assess for retained products of conception.
• Treatment:
  • Broad-spectrum IV antibiotics.
  • Surgical evacuation of the uterus (D&C) to remove retained tissue.
  • Stabilization with IV fluids and supportive care for sepsis.

Acute Uterine Haemorrhage

• Clinical Presentation:
  • Heavy vaginal bleeding, possibly with clots.
  • Lightheadedness or dizziness due to blood loss.
  • Signs of hypovolemic shock in severe cases.
• Diagnostic Tests:
  • Pelvic ultrasound to assess for uterine or cervical pathology (e.g., fibroids, polyps).
  • CBC to assess haemoglobin and hematocrit levels.
  • Coagulation profile if a bleeding disorder is suspected.
• Treatment:
  • IV fluids and blood transfusion if needed.
  • Uterotonic agents if related to uterine atony.
  • Surgical intervention (e.g., D&C, uterine artery embolization) if bleeding is uncontrolled.

Pelvic Abscess

• Clinical Presentation:
  • Lower abdominal pain, fever, and possible palpable mass.
  • Signs of systemic infection (tachycardia, elevated WBC count).
  • History of recent pelvic surgery, PID, or postpartum period.
• Diagnostic Tests:
  • Pelvic ultrasound or CT scan to confirm abscess.
  • CBC and blood cultures to assess infection severity.
• Treatment:
  • Broad-spectrum IV antibiotics.
  • Surgical drainage of the abscess if it does not respond to antibiotics.
  • Supportive care including IV fluids and pain management.