Surgery during pregnancy

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  • Surgery during pregnancy
You are a doctor at the emergency department. In the evening, 29-year-old female patient is entering, primipara, in the 22nd week of pregnancy with physiological pregnancy. She complains about sharp pain localized in umbilical region with progression into right lumbar region. She feels really sick and says she vomited twice today (without hematemesis). This symptoms lasted 24 hours. It occurred suddenly. What will be your next step?

Nausea and pain are common during a pregnancy. Neither laboratory nor clinical picture is significant. I release the patient to homecare. I recommend her to come back to the emergency department in case her condition worsens.

Wrong answer

Nausea and vomits in pregnancy affect more than 60% of pregnant women, especially in the first trimester. Difficulties most often arise from 2.0-5. weeks and persist it to 8.0-14. weeks of pregnancy. Approximately 20% of pregnant women have issues after this period. In most cases, nausea is experienced in the morning. Our patient is now in the second trimester. This situation we must not, in any way, underestimate!


Try again Bury the patient

I suggest USG examination. I'll add a gynaecological and surgical consultation to consider next steps.

Correct answer

The USG is the method of choice in this case. This method is safe for both the patient and the fetus. Moreover, it is relatively fast.
Nausea and vomits in pregnancy affect more than 60% of pregnant women, especially in the first trimester. Difficulties most often arise from 2.0-5. weeks and persist it to 8.0-14. weeks of pregnancy. Approximately 20% of pregnant women have issues after this period. In most cases, nausea is experienced in the morning. Our patient is now in the second trimester. This situation we must not, in any way, underestimate!


Continue

Because I suspect acute abdomen I'll add native abdominal X-ray imaging as the best diagnostic method in this case. I'll add a gynecological and surgical consultation.

Wrong answer

Native abdominal X-ray imaging has its application in differential diagnosis. In particular, it may show air-fluid levels in the intestine that would indicate ileus or pneumoperitoneum. However our patient is pregnant and thus we try to avoid radiation exposure because of fetal damage.


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Help

USG - ultrasonography, PMH- Past Medical History, PA - Pharmacological Anamnesis, AA - Allergic Anamnesis, EA- Epidemiological Anamnesis, CRP- C-reactive protein.×
 
RR

20 bpm

HR

110 bpm

SpO2

98 %

BP

109/66 mmHg

ECG

sinus rythm, regular pace, BPM 110 bpm

Examination:
PMH: tonsillectomy as a child without complications. PA, AA, EA: 0
Physical examination: subfebrile (37.4 ° C), breathing clean, eupnoe, palpable resistance in the right lumbar and iliac region, Rovsing´s sign negative, Pleniér´s and Blumberg´s sign positive, uterus enlarged over symphysis, without urination difficulty, urine clear, stool without pathological admixtures.
CRP 57 mg/L, urea 8,4 mg/dL, creatinine 0,7 mg/dL

Gly

results

ABG

not available

CBC

results

biochemistry

results