The ultrasound video clip demonstrates a transverse view of the pelvis using the endocavitary probe. The bladder can be seen on the anterior portion of the scan (yellow arrow), while the uterus with an intrauterine pregnancy is visible posteriorly (blue arrow). The thickened appearance of the uterine wall is also indicative of pregnancy. A large, anechoic cystic structure measuring approximately 5 cm is seen in the vicinity of the patient’s left adnexa (pink arrow), which raises concerns for ovarian torsion.
Due to pain out of proportion to her exam, an ultrasound of her pelvis was obtained and showed a blood-filled distended uterus, or hematometrocolpos (white arrow), with a 4.9 cm right ovarian cyst (blue arrow). A pelvic magnetic resonance imaging (MRI) then revealed an obstructed right hemi-vagina, normal left uterus and vagina and ipsilateral renal agenesis (red arrow) with normal left kidney (double arrow) consistent with obstructed hemivagina, ipsilateral renal agenesis (OHVIRA) syndrome. The patient underwent surgical repair with complete resolution of symptoms.
At the end of this simulation, learners will: 1) Recognize impending delivery and mobilize appropriate resources (ie, both obstetrics [OB] and NICU/pediatrics); 2) Identify risk factors for shoulder dystocia based on history and physical; 3) Recognize shoulder dystocia during delivery; 4) Demonstrate maneuvers to relieve shoulder dystocia; 5) Communicate with team members and nursing staff during resuscitation of a critically ill patient.
Novel Emergency Medicine Curriculum Utilizing Self-Directed Learning and the Flipped Classroom Method: Obstetric and Gynecologic Emergencies Small Group ModuleDOI: https://doi.org/10.21980/J8DK9K
We aim to teach the presentation and management of obstetric and gynecologic emergencies through the creation of a flipped classroom design. This unique, innovative curriculum utilizes resources chosen by education faculty and resident learners, study questions, real-life experiences, and small group discussions in place of traditional lectures. In doing so, a goal of the curriculum is to encourage self-directed learning, improve understanding and knowledge retention, and improve the educational experience of our residents.
By the end of this oral boards case, the learner will be able to: 1. List the potential causes of vaginal bleeding in pregnancy after 20 weeks including placental abruption, placenta previa and vasa previa. 2. Describe the bedside stabilization and evaluation in a pregnant patient with vaginal bleeding after 20 weeks. a) Stabilize the mother (patient) including placing two large bore intravenous (IV) lines, administer an IV fluid bolus, obtaining complete blood count (CBC), coagulation studies, and type & cross matching blood. b) Transvaginal ultrasound to determine the placental location. c) Sterile speculum examination. A digital or speculum pelvic examination should NOT be performed until a transvaginal ultrasound is performed to determine placental location. The resident should understand that performing a digital or speculum exam in a patient with placenta previa or vasa previa can cause or exacerbate hemorrhage. If these two conditions are not present on ultrasound, then a sterile speculum exam may be performed to further examine the bleeding. 3. Contrast the typical presentation of placenta previa with that of placental abruption. a) Placenta Previa usually causes painless vaginal bleeding. Part of the placenta is located near or over the internal cervical orifice. b) Placental Abruption usually causes painful vaginal bleeding. There is premature separation of the placenta from the uterine lining. 4) Describe the appropriate disposition of a patient with a pregnancy over 20 weeks with vaginal bleeding. After initial workup and stabilization these women are usually admitted for fetal monitoring, observation and consultation by the obstetrician (OB/gyn).
By the end of this simulation session, the learner will be able to: 1) Recognize impending delivery, 2) identify abnormal maternal vital signs and potential associated pathologies (eg: hypertension in preeclampsia), 3) discuss the evaluation and management of postpartum bleeding, 4) discuss the principles of neonatal resuscitation, 5) appropriately disposition the patients, and 6) effectively communicate with team members and nursing staff during resuscitation of a critically ill patient.
The transabdominal pelvic ultrasound shows an empty uterus (annotated) with free fluid and a right sided extrauterine gestational sac representing an ectopic pregnancy (red arrow).
We aim to teach the presentation and management of pregnancy complications through interactive teaching during small group discussions concerning patient cases. This curriculum utilizes resources chosen by education faculty, study questions, actual experience, and small group discussions in place of a traditional lecture-based format. In doing so, a goal of the curriculum is to encourage self-directed learning, improve understanding and knowledge retention, improve the educational experience of our residents, and allow assessment by the faculty concerning the knowledge base and ability of the residents.
The patient’s serum beta-hCG was 5,637 mIU/mL. The transvaginal ultrasound showed an empty uterus with free fluid posteriorly in the pelvis and Pouch of Douglas (00:00). A 4.5 cm heterogeneous mass was visible in the left adnexa concerning for an ectopic pregnancy (00:10).
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