HY lecture notes:
Young woman, high fever, foul-smelling discharge per vaginum, small laceration on the cervix, unwanted pregnancy –> septic abortion; laceration is from an attempt to self-terminate the pregnancy; bacterial self-inoculation.
Severe pelvic pain/cramping is how labor presents in first trimester. E.g., women who take mifepristone + misoprostol to abort in early pregnancy will often experience severe cramping.
Major risk of ectopic = previous PID –> scarring of Fallopian tubes.
Ectopic pregnancy may present as pelvic pain, but is often asymptomatic and is merely picked up as a positive beta-hCG without a visible intrauterine pregnancy after 6-ish weeks.
Treat ectopic with methotrexate if beta-hCG <6000, the embryo is small (<3.5 cm), there’s no fetal HR detected, the woman is stable, and there’s evidence of fluid leakage into the cul de sac. If not treating with methotrexate, do laparoscopic salpingostomy or salpingectomy.
Parametrium of the uterus = ectopic pregnancy.
Corpus luteum cyst –> extremely common in early pregnancy; stimulated by beta-hCG; uni- or bilateral simple cysts; they’re completely benign and they’re observed; they will regress (beta-hCG peaks at 8-10 weeks of pregnancy); greater risk of cysts with hydatidiform mole, multiple gestation pregnancy; choriocarcinoma.
Ruptured corpus luteum cyst vs adnexal/ovarian torsion:
Ruptured cyst –> sharp pelvic pain + no mass + 10-15 mL of serosanguinous fluid in the cul de sac (pouch of Douglas). Tx is just observation + pain meds. Surgery rare.
Torsion –> intermittent pain that becomes constant + large mass (sometimes 6-10 cm) + no fluid seen in cul de sac. Tx = laparoscopic detorsion.
For torsion, I’ve seen one Q where they didn’t mention the intermittent pain prior to the constant pain, but it’s usually of this sequence. I’ve also seen Qs where the pain is intermittent for hours before becoming constant, and other Qs where they said weeks, so the timeline isn’t concrete.
