1. Gynae emergencies Feb 09

2. Case yr LIF pain
Charlotte attends your mid morning surgery reporting
Feeling unwell
Stomach pains
Duration 24hrs
What else would you like to know?

3. Useful info Fever Dyspareunia (deep)
Intermenstrual bleeding for a few months
Using condoms reliably
What would you do having obtained this history?

4. Examination Chaperone issues Cervical excitation Adnexal tenderness
Take swabs for chlamydia, gonorrhoea and mc+s
What other tests would you like?

5. Invst Urinalysis Preg test MSU Bloods Viscoscity/crp
What would your immediate management plan be for this patient?

6. Treatment Ofloxacin 400mg bd 14 days +metronidazole 400mg bd 14 days
Or doxycycline +metronidazole
Admission can be rqd, safety net, rvw, rvw 4 wks ?compliant, ptner screened.
Doxycycline 200mg stat if needs top

7. Case 2- the condom split Michelle 15 yrs attends asking for ‘the pill’
What do you need to ask?
What other issues does this present?

8. Emergency contraception
What actually happened?
?regular partner or one off
STI risk?
Menstrual cycle and current position, other contraception? (?earliest ovulation)
When was the accident?
Any other upsi in this cycle
?used before
?consensual, age of partner, ?Frazer competant

9. Up to 72 (120 hrs)
If >72 hrs consider copper iud
(up to 5 days or, up to 5 days> earliest ovulation)
Levonelle-2
95% - 1st 24hr, 85% 48, 70% 72
Mode of action
Vomiting
Enzyme inducing drugs
Next Period

10. FUTURE contraception,
Condoms have a 5% failure rate when used PERFECTLY

11. CASE 3 – 35 yr RIF pain Lois 35 presents with abdo pain
She has a copper iud insitu
She has not had a period for 6 weeks but ‘they are always erratic’
She has a strange pain in her right shoulder, no injury.
What diagnoses are you considering?
How could you confirm/refute these?

12. Examination RIF tender no rebound no guarding Apyrexial
Appendicectomy scar
BP 105/64 pulse 110. appears unwell.
Urinalysis, bhcg positive. Infection neg, trace blood.
PV with consent, os closed iud strings not present, small amount of brown discharge pv. Acutely tender R adnexa, cervical excitation

13. ?Now what What is your plan of action?
What may be the action in hospital