Ovarian Torsions and Other Gynecologic Emergencies A Clinician’s Guide to Managing Ob/Gyn Emergencies World Health Special Focus on Haiti Ambereen Sleemi, MD,MPH No Disclosures Torsion and other gyn emergencies • Ovarian torsion • Gynecologic cancers • Cervical cancer • endometrial cancer • ovarian cancer Ovarian Torsion • What is ovarian torsion? • Why is is an emergency? • How is it treated? Ovarian Torsion • A twisting of the ovary around its support and cutting off of the blood supply • cutting off the blood supply causes severe abdominal pain and death of the tissue • treated as a surgical emergency Ovarian Torsion The blood supply to the ovary is cut off by the twisting of an enlarged, usually cystic ovary Ovarian Torsion • An ovarian torsion presents with classic findings of severe onset of intermittent abdominal pain, that may wax and wane (over 90%) • it may be associated with nausea and vomiting (over 80%) • 60% occur on right side • risk factors are pregnancy, reproductive age (can be pre or post menopausal also) Torsion and untwisted Signs and Symptoms • Vague complaints of lower abdominal pain • Classic- sitting or sleeping and sudden severe pain that disappears and reappears • Nausea and vomiting • Often a delay in diagnosis Findings • Unilateral adnexal mass or tumor usually seen • lower abdominal pain • Pelvic exam- palpate a unilateral, tender mass • Pregnancy associated with up to 20% of torsion cases • Ultrasound with adnexal mass, low or no blood flow Management • Pregnant or not, management same • Surgical treatment is needed • Ovary is untwisted and observed for signs of necrosis and tissue damage • If ovary appears viable, may remove the cyst only • If ovary is necrotic, need to remove • Ovarian salvage possible if treated without delay Gynecologic Cancer • Cervical cancer • Haiti has highest rate in Western Hemisphere • 13x higher than US • #1 cause of cancer deaths in women in Haiti • Screening is possible - cytology or visual inspection • Not widely used Haiti cancer mortality World Health Organization - Cancer Country Profiles, 2014 Risk factors • Human Papilloma virus • Smoking • Multiple sexual partners • Immunocompromised/HIV • More kids • Long term OCP use-indirect Signs and symptoms • Abnormal vaginal bleeding • Pelvic pain • Flank pain- advanced cases • Signs of spread • Lesion on cervix Cervix cancer • Grows slowly • Can be diagnosed in early pre-cancer stages • Pap test • VIA • If caught early, treatment and cure likely • Late stages, poorer prognosis Staging and Treatment • Spread is locally • Treatment depends on stage • Excision • Surgery • Radiation • Chemotherapy Prevention of Cervix Cancer • Screening with Pap test or VIA pap testing- needs pathology • VIA- vinegar and inspection- teachable, affordable • HPV vaccine Other Considerations • Endometrial cancer • Abnormal vaginal bleeding in older patients • Postmenopausal risk factors • Ovarian- older patients • Few signs early on, often diagnosed in late stages Contact Information Ambereen Sleemi, MD, MPH Surgical Director International Medical Response www.internationalmedicalresponse.org @globalgyno @IMR_MedResponse @internationalmedicalresponse Email [email protected] .