Handbook of Obstetric and Gynecologic Emergencies

425 Pages·2010·5.81 MB·English

by  Guy I. Benrubi

FOURTH EDITION
Handbook of
Obstetric and
Gynecologic
Emergencies
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FOURTH EDITION
Handbook of
Obstetric and
Gynecologic
Emergencies
Edited by
Guy I. Benrubi, MD
Senior Associate Dean for Clinical Affairs
Robert J. Thompson Professor and Chair
Department of Obstetrics and Gynecology
University of Florida College of Medicine-Jacksonville
Jacksonville, Florida
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Printed in China
Library of Congress Cataloging-in-Publication Data
Handbook of obstetric and gynecologic emergencies / edited by Guy I. Benrubi. —4th ed.
p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-1-60547-666-7 (alk. paper)
ISBN-10: 1-60547-666-8
1. Obstetrical emergencies—Handbooks, manuals, etc. 2. Gynecologic emergencies—
Handbooks, manuals, etc. I. Benrubi, Guy I.
[DNLM: 1. Pregnancy Complications—diagnosis. 2. Pregnancy Complications—therapy.
3. Emergencies. 4. Emergency Treatment—methods. 5. Genital Diseases, Female—diagnosis.
6. Genital Diseases, Female—therapy. WQ 240 H2362 2010]
RG571.O245 2010
618'.0425—dc22
2009046290
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generally accepted practices. However, the authors, editors, and publisher are not responsible for
errors or omissions or for any consequences from application of the information in this book
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racy of the contents of the publication. Application of the information in a particular situation
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To the memory of
Michael “Bam Bam” D’Agostino
“Hi doctor…”
“Give me half…”
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“… Don’t put off things till it’s too late.
You are the DJ of your fate.”
—Vikram Seth
(The Golden Gate, 1986)
después de Purim, platicos
(loose translation: pointless after the fact)
—Old European Proverb
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PREFACE
Physicians are faced, increasingly, with diagnosis and management
decisions in obstetric and gynecologic emergency settings. Whether the set-
ting is the emergency department of a busy inner-city hospital or the offi ce
of a gynecologist or other primary care provider, an understanding of the
pathophysiology and management considerations is critical to good patient
care. During the last decade, it has become apparent that a large portion of
the young women and children at greatest risk for obstetric and gyneco-
logic emergencies increasingly fall out of the health care system. In several
areas of the country, up to 25% of women receive no prenatal care. In other
areas, close to 50% of young women have no primary care providers to han-
dle emergencies. Currently, an estimated 50 million US citizens are not med-
ically insured. Th e increasing demands on the health care dollar and the
increasing percentage of care delivered under managed systems create a
premium on either no hospitalization or early discharge. Consequently,
complications of delivery, as well as of gynecologic surgery, are not re -
cognized until after the patient has left the hospital. To this must be added
the eff ects of the Great Recession, which became evident on health care in
mid-2008. Unemployment, underemployment, and loss of health benefi ts
have had a severe impact on preventative care. Even if employed women
still have benefi ts, their deductibles and co-pays have signifi cantly increased.
All of these factors result in management being provided in emergent care
settings, whether in the hospital or in the offi ce.
Th is book intends to address the need for a continuing up-to-date
understanding of these obstetric and gynecologic emergencies. It seeks its
audience among obstetricians, gynecologists, emergency department physi-
cians, family practitioners, and other primary health care providers. Th e
book is organized in two main sections: obstetric emergencies and gyneco-
logic emergencies. Although the organization is along the lines of the
t raditional major emergencies that occur in these two disciplines, several
problems are addressed by multiple authors from diff erent perspectives. It is
the editor’s belief that additional understanding of the management of these
conditions can be gained from divergent points of view. Finally, it must be
recognized that obstetric and gynecologic emergencies change over time.
What are frequent problems today may become relatively infrequent tomor-
row. New challenges face the physician. For example, approximately 80% of
women in this country do not have legal abortion services available to them.
It is, therefore, probable that physicians will see emergency situations aris-
ing from illegal abortions. Additionally, violence has become a pervasive dis-
ease in our society; physicians who treat women must be conversant with
both clinical and psychological problems that arise from rape and other
traumas to the reproductive organs. Tragically, in the 21st century, emergent
conditions due to terrorist acts also need to be addressed.
vii
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viii Preface
I thank all of the contributors for their excellent work and their
diligent, careful, and astute analysis of the issues raised. Th anks are also
due to Louise Bierig for her effi ciency and editing skills. Special thanks are
due to Ms. Georgette Andreason whose technical and organizational
expertise cannot be matched and without whom this project would not
have been undertaken nor completed.
Guy I. Benrubi, MD
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CONTRIBUTORS
A. Ben Abdu, MD Paula H. Bednarek, MD, MPH
Obstetrics and Gynecology Assistant Professor
University of Tennessee Department of Obstetrics
College of Medicine and Gynecology
Chattanooga, Tennessee Oregon Health & Science
University
C. David Adair, MD Portland, Oregon
Professor and Vice Chair
Department of Obstetrics Guy I. Benrubi, MD
and Gynecology Senior Associate Dean
Section on Maternal Fetal Medicine for Clinical Affairs
University of Tennessee Robert J. Thompson Professor
College of Medicine and Chair
Chattanooga, Tennessee Department of Obstetrics
and Gynecology
Pam Adams, RN, EMT-P University of Florida College
Registered Nurse/Paramedic of Medicine-Jacksonville
President Jacksonville, Florida
OB STAT, Inc.
Arden, North Carolina
Kelly A. Best, MD
Sarah Adams, MD Assistant Professor
Assistant Professor Associate Residency Program
Division of Gynecologic Oncology Director
University of Pennsylvania Hospitals Department of Obstetrics
Philadelphia, Pennsylvania and Gynecology
University of Florida College
Kurt Barnhart, MD, MSCE of Medicine-Jacksonville
Associate Professor of Obstetrics Jacksonville, Florida
and Gynecology
Director, Women’s Health Clinical
Rosanne L. Botha, MD
Research Center
Family Planning Fellow
Assistant Dean for Clinical
Oregon Health & Science
Research Operations
University
University of Pennsylvania School
Portland, Oregon
of Medicine
Philadelphia, Pennsylvania
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x Contributors
David Caro, MD Alison B. Edelman, MD, MPH
Associate Professor Associate Professor
Residency Program Director Assistant Director, Family
Department of Emergency Planning Fellowship
Medicine Department of Obstetrics
University of Florida College and Gynecology
of Medicine-Jacksonville Oregon Health & Science University
Jacksonville, Florida Portland, Oregon
Gwyn Grabner, RDMS
Joseph G. Cernigliaro, MD
Registered Diagnostic Medical
Assistant Professor of Radiology
Sonographer
Mayo Clinic College of Medicine
University of Florida College
Rochester, Minnesota
of Medicine-Jacksonville
Consultant, Department
Jacksonville, Florida
of Radiology
Mayo Clinic
Victor J. Hassid, MD
Jacksonville, Florida
Fellow, Division of Plastic Surgery
University of Illinois College of
Stephen A. Contag, MD
Medicine
Clinical Instructor Maternal Fetal
Chicago, Illinois
Medicine
Wake Forest University Linda Hastings, PharmD
Winston-Salem, North Carolina Pediatric Practitioner
Department of Pharmacy
Isaac Delke, MD Shands Jacksonville
Professor Medical Center
Department of Obstetrics Clinical Assistant Professor
and Gynecology University of Florida College
University of Florida College of Pharmacy
of Medicine-Jacksonville Jacksonville, Florida
Chief, Division of Maternal-Fetal
Thanh T. Hogan, PharmD
Medicine
Clinical Associate Professor
Director, Obstetrics
University of Florida College
Director, HIV in Pregnancy
of Pharmacy
Program
Director of Pharmacy
Shands Jacksonville Medical
Shands Jacksonville Medical Center
Center
Jacksonville, Florida
Jacksonville, Florida
Cheryl B. Iglesia, MD, FACOG
Charles J. Dunton, MD
Director, Section of Female Pelvic
Professor of Obstetrics
Medicine and Reconstructive
and Gynecology
Surgery
Jefferson Medical College
Washington Hospital Center
Active Staff Physician
Associate Professor,
Main Line Gynecology
Georgetown University School
Oncology, Lankenau Hospital
of Medicine
Wynnewood, Pennsylvania
Washington, District of Columbia
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