Acute obstetric and gynecologic emergencies

Acute gynecologic emergencies occur mostly in women of reproductive age but can affect women of all ages. The most common and most important gynecologic conditions to be considered include ovarian or adnexal torsion, ruptured hemorrhagic cyst, pelvic inflammatory disease, and hematometrocolpos. In patients with a positive pregnancy test, diagnostic considerations should be given to the possibility of ectopic pregnancy, molar pregnancy, or threatened abortion. In the second and third trimesters of pregnancy, vaginal bleeding may be due to placenta previa or abruption. The postpartum patient with fever or excessive postpartum hemorrhage may have retained products of conception, complicated endometritis, or infected hematoma. Sonography plays a key role in patient evaluation. Computed tomography and magnetic resonance imaging may be helpful in postoperative patients or young patients who cannot tolerate transvaginal scanning. A high level of suspicion and knowledge of the sonographic features of obstetric and gynecologic conditions that may present in the acute care setting are essential for prompt diagnosis. Awareness of the limitations of sonography will enable more accurate diagnosis and help expedite patient management.[PUBLICATION ABSTRACT]