Emergency medicine clinics of North America
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Any delivery in the emergency department is considered a precipitous birth and is an anxiety-producing event. Many deliveries proceed without incident. However, the emergency physician must be prepared for several dreaded scenarios, such as nuchal cord, shoulder dystocia, and breech birth. This article reviews the basics, complications, and management of such deliveries.
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Emerg. Med. Clin. North Am. · Nov 2012
Nonobstetric abdominal pain and surgical emergencies in pregnancy.
The focus of this article is the evaluation and management of pregnant patients with nonobstetric abdominal pain and surgical emergencies. The anatomic and physiologic changes that occur during pregnancy can cause difficulties in interpreting patients' signs and symptoms in emergency departments. This article reviews some of the common causes of nonobstetric abdominal pain and surgical emergencies that present to emergency departments and discusses some of the literature surrounding the use of imaging modalities during pregnancy. After a review of these changes and their causes, imaging modalities that can be used for the assessment are discussed.
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Complications of late pregnancy are managed infrequently in the emergency department and, thus, can pose a challenge when the emergency physician encounters acute presentations. An expert understanding of the anatomic and physiologic changes and possible complications of late pregnancy is vital to ensure proper evaluation and care for both mother and fetus. This article focuses on the late pregnancy issues that the emergency physician will face, from the bleeding and instability of abruptio placentae to the wide spectrum of complications and management strategies encountered with preterm labor.
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For the emergency physician tasked with evaluating the patient with an obstetric emergency, ultrasound can provide important and potentially life-saving information. Ultrasound of the pregnant patient is unique in that two possible approaches can be used: transabdominal and transvaginal. ⋯ Two of the most basic yet important uses of ultrasound in the pregnant patient are to provide information concerning the gestational age of the pregnancy and the fetal heart rate. Ultrasound has a major role in the diagnosis and management of the patient with a suspected ectopic pregnancy.
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Emerg. Med. Clin. North Am. · Nov 2012
Emergency evaluation and management of vaginal bleeding in the nonpregnant patient.
Evaluation of the nonpregnant patient presenting to the emergency department with vaginal bleeding requires the emergency physician to be aware of the potential for a variety of underlying causes. Patients with vaginal bleeding may have non-life-threatening problems such as fibroids, endometriosis, or treatable sexually transmitted diseases such as gonorrhea and chlamydial infection. However, care must be taken to differentiate these from more serious causes of pelvic pain and bleeding such as ectopic pregnancy, hemorrhagic cyst, ovarian torsion, and rare complications from fibroids such as intraperitoneal hemorrhage. Abnormal bleeding unrelated to structural problems could have an anovulatory or ovulatory cause.