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OXFORD MEDICAL PUBLICATIONS

Emergencies in
Obstetrics and
Gynaecology
Published and forthcoming titles in
the Emergencies in... series:

Emergencies in Adult Nursing

Edited by Philip Downing

Emergencies in Anaesthesia, Third Edition

Edited by Keith Allman, Andrew McIndoe, and Iain H. Wilson

Emergencies in Children’s and Young People’s Nursing

Edited by E.A. Glasper, Gill McEwing, and Jim Richardson

Emergencies in Critical Care, Second Edition

Edited by Martin Beed, Richard Sherman, and Ravi Mahajan

Emergencies in Gastroenterology and Hepatology

Marcus Harbord and Daniel Marks

Emergencies in Obstetrics and Gynaecology, Second Edition

Edited by Stergios K. Doumouchtsis and S. Arulkumaran

Emergencies in Paediatrics and Neonatology, Second Edition

Edited by Stuart Crisp and Jo Rainbow

Emergencies in Palliative and Supportive Care

Edited by David Currow and Katherine Clark

Emergencies in Respiratory Medicine

Edited by Robert Parker, Catherine Thomas, and Lesley Bennett

Emergencies in Sports Medicine

Edited by Julian Redhead and Jonathan Gordon
OXFORD MEDICAL PUBLICATIONS

Emergencies
in Obstetrics and
Gynaecology
SECOND EDITION

Edited by
Stergios K. Doumouchtsis,
MPH, MSc, PhD, MRCOG
Consultant Obstetrician, Gynaecologist and
Urogynaecologist
Honorary Senior Lecturer, St George’s University
Hospitals NHS Foundation Trust,
London, UK
Visiting Professor, University of Athens, Athens, Greece

Professor Sir S. Arulkumaran,

MD, PhD, FRCOG
Professor Emeritus in Obstetrics and Gynaecology
St George’s University Hospitals NHS Foundation Trust,
London, UK
Visiting Professor, Imperial College, London, UK

1
1
Great Clarendon Street, Oxford, OX2 6DP,
United Kingdom
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and education by publishing worldwide. Oxford is a registered trade mark of
Oxford University Press in the UK and in certain other countries
© Oxford University Press 2016
The moral rights of the authors‌have been asserted
First Edition published in 2006
Second Edition published in 2016
Impression: 1
All rights reserved. No part of this publication may be reproduced, stored in
a retrieval system, or transmitted, in any form or by any means, without the
prior permission in writing of Oxford University Press, or as expressly permitted
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Published in the United States of America by Oxford University Press
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British Library Cataloguing in Publication Data
Data available
Library of Congress Control Number: 2015953378
ISBN 978– ​0 –​19–​965138–​2
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and the most recent codes of conduct and safety regulations. The authors and
the publishers do not accept responsibility or legal liability for any errors in the
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otherwise stated, drug dosages and recommendations are for the non-​pregnant
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 v

Preface to second edition

The obstetrician and gynaecologist practises in a working environment

where emergencies are common. Managing an emergency requires
good knowledge of the condition and a systematic and logical approach.
Preparation to manage emergencies requires planning and multidiscipli-
nary teamwork. The first edition of the handbook provided succinct and
easily accessible information to manage such emergencies and promote
efficient management of emergencies at the point of care.
The second edition of this handbook serves the same vision and pro-
vides up-​to-​date knowledge and practical guidance in managing common
emergencies in obstetrics and gynaecology. We aimed to keep the same
format for ease of access and navigation and enriched the previous edi-
tion with symptom-​based topics as well as updated information. New
chapters have been added to cover new areas or topics not previously
covered.
These chapters include obstetric complications associated with
complex psychosocial needs, laparoscopy and emergencies following
laparoscopic surgery, identifying sick patients and choosing monitor-
ing, communication and handover, and preoperative assessment and
consent.
We hope that this handbook will be a useful companion to students,
doctors in training, as well as consultants, midwives, nurses, and other
allied healthcare professionals in the triage areas, wards, theatres, and
any clinical settings where rapid access to practical guidance may prove
essential in the management of the acutely unwell woman.
Stergios K. Doumouchtsis
S. Arulkumaran
 vii

Acknowledgements

We wish to express our gratitude to our families for their selfless sup-
port, patience, and encouragement.
We are also grateful to the Editorial and Publishing Team at Oxford
University Press for their assistance and support in completing this book.
Stergios K. Doumouchtsis
S. Arulkumaran
 ix

Contents

First edition contributors xi

Second edition contributors xiii
Symbols and abbreviations xvii

Part 1 Obstetrics
1 Pregnancy changes and early pregnancy
complications   3
2 Medical emergencies in pregnancy   21
3 Obstetric complications   63
4 Concerns for the fetus and surveillance   97
5 Intrapartum procedures and complications 113
6 Post-​delivery procedures and complications 155
7 Sepsis in pregnancy 179
8 Complications associated with complex
psychosocial needs 187
9 Miscellaneous topics in obstetrics 197

Part 2 Gynaecology
10 Abnormal menses and bleeding 229
11 Chronic and acute abdominal pain 241
12 Intra​operative emergencies 249
13 Postoperative complications 255
14 Ovarian hyperstimulation syndrome 273
15 Contraception and termination of pregnancy 277
16 Vaginal discharge 285
17 Vulval problems 291
x Contents

297 18 Miscellaneous topics in gynaecology

315 19 Diagnostic laparoscopy and emergencies following
laparoscopic surgery
323 20 General issues in obstetrics and gynaecology

Index 341
 xi

First edition contributors

Rukma Bhattacharya, Sandeep Mane,

Specialist Registrar, Consultant Obstetrician and
Torbay Hospital, Torquay, UK Gynaecologist, Convenor of Basic
Surgical Skills Course, RCOG,
Tom Bourne, London, UK
Consultant Gynaecologist, Early
Pregnancy Unit, St George’s Avidha Nejad,
Hospital, London, UK SpR in Obstetrics & Gynaecology,
Espom and St Helier University
James Clarke, Hospitals NHS Trust, Surrey, UK
Consultant Anaesthetist, St
George’s Hospital, London, UK Nicholas Ngeh,
Specialist Registrar, Fetal Medicine
George Condous, Unit, St George’s Hospital,
Clinical Fellow, Early Pregnancy London, UK
Unit, St George’s Hospital,
London, UK Penny Oakley,
Honorary Senior Lecturer in Family
Kate Farrer, Planning, St George’s, University of
Consultant Neonatologist, St London, UK
George’s Hospital, London, UK
Malini Prasad,
Michelle Fynes, Specialist Registrar in Obstetrics
Consultant Urogynaecologist, St and Gynaecology, Norfolk &
George’s Hospital, London, UK Norwich University Hospital,
Norwich, UK
Sarah Harper,
Specialist Registrar, Nottingham Jyothi Shenoy,
City Hospital, Nottingham, UK Specialist Registrar in Obstetrics
and Gynaecology, The Queen
Emma Kirk, Elizabeth Hospital, King’s Lynn, UK
Clinical Fellow, Early Pregnancy
Unit, St George’s Hospital, Abdul H. Sultan,
London, UK Consultant Obstetrician and
Gynaecologist, Honorary Senior
Krishna Kumar, Lecturer, Mayday University
Clinical Fellow in Maternal Hospital, Croydon, UK
Medicine, Espom and St Helier
University Hospitals NHS Trust,
Surrey, UK
xii First edition contributors

Ranee Thakar, Barry Whitlow,

Consultant Obstetrician and Consultant Obstetrician &
Urogynaecology Subspecialist, Gynaecologist, Colchester General
Mayday University Hospital, Hospital, Colchester, UK
Croydon, UK
 xiii

Second edition
contributors

S. Arulkumaran, Deepika Deshpande,

Professor Emeritus in Obstetrics Clinical Fellow in Obstetrics &
and Gynaecology, St George’s Gynaecology, St George’s
University Hospitals NHS University Hospitals NHS
Foundation Trust, London, UK Foundation Trust, London, UK

Maya Basu, Jonathan

Consultant Obstetrician and Dominguez-​Hernandez,
Gynaecologist, Medway NHS Specialist Midwife, University
Foundation Trust, Kent, UK College London Hospitals,
London, UK
Joanna Bécares Doumouchtsi,
Specialist Mental Health Midwife, Claudine Domoney,
Kingston Hospital NHS Foundation Consultant Obstetrician and
Trust, Kingston upon Thames, UK Gynaecologist, Chelsea and
Westminster Hospital, London, UK
Amar Bhide,
Consultant, St George’s University Stergios K. Doumouchtsis,
Hospitals NHS Foundation Trust, Consultant Obstetrician,
London, UK Gynaecologist and
Urogynaecologist, Honorary Senior
Hugh Byrne,
Lecturer, St George’s University
Consultant Gynaecologist, St Hospitals NHS Foundation Trust,
George’s University Hospitals NHS London, UK
Foundation Trust, London, UK
Vishalli Ghai,
Edwin Chandraharan,
Specialist Registrar Obstetrics
Clinical Director for Women’s and Gynaecology, Kingston NHS
Services , St George’s University Hospital Trust, Kingston, UK
Hospitals NHS Foundation Trust,
St George’s Hospital, London, UK Kevin Hayes,
Consultant Obstetrician and
Eleftheria
Gynaecologist, St George’s
L. Chrysanthopoulou, University Hospitals NHS
Specialty Registrar, King’s College Foundation Trust, London, UK
Hospital NHS Foundation Trust,
London, UK Anna Haestier,
Consultant Obstetrician and
Christina Coroyannakis, Gynaecologist, The Norfolk and
Senior Registrar, St George’s Norwich University Hospital NHS
University Hospitals NHS Foundation Trust, Norwich, UK
Foundation Trust, London, UK
xiv Second edition contributors

Claire Hordern, Christiana Nygaard,

Specialty Trainee in Obstetrics Instructor of Urogynecology,
and Gynaecology, Norfolk and São Lucas Hospital, Pontificia
Norwich University Hospital, Universidade Católica do Rio
Norwich, UK Grande do Sul, Brazil

George Iancu, Kamal Ojha,

Assistant Professor, Filantropia Care Group Lead for Gynaecology,
Clinical Hospital, Bucharest, St George’s University Hospitals
Romania NHS Foundation Trust,
London, UK
Olujimi Jibodu,
Consultant Obstetrician and Astrid Osbourne,
Gynaecologist, York Teaching Consultant Midwife and Supervisor
Hospital Foundation Trust, of Midwives, University College
York, UK London Hospitals, London, UK

Emma Kirk, Aris Papageorghiou,

Consultant Obstetrician and Consultant in Fetal Medicine and
Gynaecologist, North Middlesex Obstetrics, St George’s University
University Hospital, London, UK Hospitals NHS Foundation Trust,
London, UK
Tahir Mahmood,
Consultant Gynaecologist, Victoria Leonie Penna,
Hospital, Kirkcaldy, UK Consultant in Obstetrics and Fetal
Medicine, King’s College NHS
Edward Morris, Foundation Trust, London, UK
Consultant, Norfolk and Norwich
University Hospital, Norwich, UK Edward Prosser-​Snelling,
National Medical Director’s
Sambit Mukhopadhyay, Clinical Fellow (2014–15),
Consultant Gynaecologist and Royal College of Obstetricians and
Clinical Director, Norfolk and Gynaecologists, London, UK
Norwich University Hospital
Foundation, Norwich, UK Sheila Radhakrishnan,
Consultant in Community
Kostis I. Nikolopoulos, Gynaecology, Royal Free Hospital,
Specialty Registrar in Obstetrics London, UK
and Gynaecology, Barking, Havering
and Redbridge University Hospitals Kanchan Rege,
NHS Trust, Queen’s Hospital, Medical Director and Consultant
London, UK Haematologist, Peterborough City
Hospital, Peterborough, UK
David Nunns,
Consultant Gynaecological Justin Richards,
Oncologist, Nottingham University Consultant Neonatologist,
Hospitals, Nottingham, UK Honorary Senior Lecturer,
St George’s University Hospitals
NHS Foundation Trust,
London, UK
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