Gynae and obs emergency

Bleeding in pregnancy, ectopic, pre-eclampsia and PPH in the labour room and gynae ER.

• Postpartum haemorrhage (PPH)Call for help, rub up the uterus, give oxytocin and tranexamic acid, replace blood, and work through the 4 Ts. Act early: measure the blood, do not guess it.
• Pre-eclampsia and eclampsiaHigh BP after 20 weeks with protein or organ involvement. Treat BP of 160/110 or more, give magnesium for severe disease or fits, watch for toxicity, and plan delivery.
• Vaginal bleeding in pregnancyPregnancy test first. Early pregnancy, after 24 weeks, after delivery, or not pregnant: each needs a different plan.
• Ectopic pregnancyAny woman of child-bearing age with belly pain, bleeding or fainting needs a pregnancy test. Positive test, pain and no pregnancy in the uterus: ectopic until proven otherwise.
• Ovarian torsionSudden one-sided pelvic pain with vomiting. A normal Doppler doesn't exclude torsion; laparoscopy does.
• Emergency contraceptionLevonorgestrel within 72 hours, ulipristal within 120 hours, and the copper IUD is the most effective of all.