By Cecilia Bottomley
A 24-year-old girl is referred from the emergency division with unexpected onset of left iliac fossa discomfort and also you are the medic on duty...
100 circumstances in Obstetrics and Gynaecology offers a hundred regularly visible obstetric and gynaecological eventualities. The patient's historical past, exam and preliminary investigations are awarded besides questions about the prognosis and administration of every case. the reply incorporates a distinctive dialogue on each one subject, offering a vital revision relief in addition to a realistic advisor for junior clinicians.
Making scientific judgements is likely one of the such a lot tough and hard elements of educating to develop into a physician. those circumstances will educate medics and clinical scholars to acknowledge very important obstetric and gynaecological stipulations and aid them boost their diagnostic and administration talents.
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Additional info for 100 Cases in Obstetrics and Gynaecology (A Hodder Arnold Publication)
There is no other significant medical history. She has been married for 2 years and has deep dyspareunia which makes her interrupt intercourse. She does not use any contraception, as they are keen to start a family. She has never been pregnant in the past. Examination There is generalized lower-abdominal tenderness, particularly in the suprapubic area but no masses are palpable. Speculum examination is unremarkable. On bimanual palpation the uterus is axial and fixed with cervical excitation. The pouch of Douglas is very tender and contains a mass.
What are the risks? • bleeding: it is rare to bleed heavily but in the extreme situation blood transfusion could be required, or even a hysterectomy to control the loss • infection • fluid overload: during the procedure, irrigation fluid is absorbed into the circulation. Excessive absorption can cause breathing difficulties (pulmonary oedema) and the need for hospital admission • uterine perforation: rarely the hysteroscope perforates the wall of the uterus and if this occurs or is suspected then laparoscopy is needed immediately to confirm it, secure any bleeding and check for damage to surrounding bowel or bladder.
What further investigation should be performed? • How should this patient be managed? 33 100 Cases in Obstetrics and Gynaecology ANSWER 14 Raised anticardiolipin antibodies and lupus anticoagulant are suggestive of antiphospholipid syndrome. Diagnosis of antiphospholipid syndrome • The presence of one of the clinical features: • three or more consecutive miscarriages • mid-trimester fetal loss • severe early-onset pre-eclampsia, intrauterine growth restriction or abruption • arterial or venous thrombosis • And haematological features: • anticardiolipin antibody or lupus anticoagulant detected on two occasions at least 6 weeks apart Thus in this case the diagnosis must be confirmed by a second positive anticardiolipin test after at least 6 weeks.