OB/GYN

Rapid Review

• Background
  • Common techniques for incision and drainage of bartholin gland abscesses include marsupialization and fistulization with word catheter
• Indications
  • Symptomatic abscesses that are at least 1 cm in diameter
• Contraindications
  • No absolute contraindications. Relative contraindications include complex abscesses requiring general anesthesia.
• Complications
  • Recurrence (30%), bleeding, infection.

Pearls

Deep Dive

• What’s the Word on Word Catheters? (First 10 EM)

Rapid Review

• Background
  • Uncomplicated, vaginal delivery of full-term (37-42 week) newborn. Represents the majority of births across the world.
• Indications
  • Spontaneous labor mediated by hormone cascade or induction; rupture of amniotic/chorionic membranes.
• Contraindications
  • Prolapsed cord, face/breech presentation, abnormal fetal heart patterns (bradycardia/tachycardia)
• Complications
  • Premature rupture of membranes, failure to progress, postpartum hemorrhage

Pearls

Deep Dive

• Emergency Delivery (International Emergency Medicine Education Project)

Rapid Review

• Background
  • Speculum examination of the vaginal walls and cervix, as well as a bimanual examination to evaluate the cervical os and evaluate for adnexal masses 
• Indications
  • Vaginal bleeding (if hemodynamically unstable)
  • Acute urinary retention (evaluate for prolapsed organ)
• Contraindications
  • Lack of consent
• Complications:
  • Anxiety, pain

Pearls

Deep Dive

• Speculations on the Speculum. Is a Pelvic Exam Ever Needed in the ED? (emDocs)

Rapid Review

• Background
  • Previously known as “perimortem cesarean section”. Involves delivering a fetus from a gravid mother through an abdominal incision during or after maternal cardiopulmonary arrest. Potentially life-saving for both the mother and the fetus.
• Indications
  • Maternal cardiac arrest w/o ROSC within 4 minutes
• Contraindications
  • Gestational age < 24 weeks, ROSC within 4 minutes
• Complications
  • Fetal injury, hemorrhagic shock

Pearls

Deep Dive

• Perimortem C-Section (EM Cases)

Rapid Review

• Background
  • Shoulder dystocia occurs when one or both shoulders become impacted against the bones of the maternal pelvis, preventing vaginal delivery. Management techniques include the McRobert’s, Rubin, Jacquemier, and Woods maneuvers.
• Indications
  • Any clinically significant shoulder dystocia
• Contraindications
  • Fundal pressure, strong lateral traction, and head rotation beyond 90 degrees should be avoided.
• Complications
  • Clavicle fracture, brachial plexus injury

Pearls

Deep Dive

• Shoulder Dystocia (Core EM)