Tham khảo tài liệu 'thực hành xử lý sản khoa - trường hợp 1', y tế - sức khoẻ, y dược phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | CASE 29 A 23-ycar-old 02 Pl woman at 29 weeks gestation complains of a 12-hr history of colicky right lower abdominal pain and nausea and vomiting. She denies diarrhea or eating stale foods. She has a history of an 8-cm ovarian cyst and otherwise has been in good health. She denies dysuria or fever and has had no surgeries. Her vital signs include a BP of 100 70 HR 105 bpm RR 12 minute and temp 99 F. On abdominal examination her bowel sounds are hypoactive. The abdomen is tender in the right lower quadrant region with significant involuntary guarding. The cervix is closed. 4 What is the most likely diagnosis What is the best treatment for this condition 242 CASE FILES OBSTETRICS AND GYNECOLOGY ANSWERS TO CASE 29 Abdominal Pain in Pregnancy Ovarian Torsion Siiinniarv A 23-ycar-old G2 Pl woman at 29 weeks gestation with an 8-cm ovarian cyst complains of a 12-hr history of colicky right lower abdominal pain and nausea and vomiting. The abdomen is tender in the right lower quadrant region with significant involuntary guarding. Most likely diagnosis Torsion of the ovary. Best treatment for this condition Surgery laparotomy due to the pregnancy . Analysis Objectives 1. Know the clinical presentation of some of the common causes of abdominal pain in pregnancy acute appendicitis acute cholecystitis ovarian torsion placental abruption and ectopic pregnancy . 2. Understand that surgery is the best treatment for ovarian torsion. 3. Know that oophorectomy does not necessarily need to be performed in ovarian torsion. Considerations This woman who is pregnant at 29 weeks gestation has a history of an 8-cm ovarian cyst. The ovarian mass is most likely a dermoid cyst in this young patient. The acute onset of colicky lower abdominal pain and nausea with vomiting are consistent with ovarian torsion which is the twisting of the ovarian vessels leading to ischemia. Gastrointestinal complaints are common. The treatment for ovarian torsion is surgical. If this woman were not pregnant .
