The term "acute abdomen" in gynecology refers to all conditions characterized by a sudden acute abdominal pain syndrome and changes in the general condition of patients requiring emergency hospitalization: peritonitis, intraabdominal bleeding due to ectopic pregnancy, apoplexy or rupture of an ovarian cyst, necrosis of a uterine myoma, adnexal torsion, etc.
It is extremely important to correctly evaluate the patient's condition at the initial examination, and quickly plan the management and examination tactics, since the life and health of the patient largely depend on this.
Let us focus on the most important issues of gynecological emergencies.
6.1. Ectopic pregnancy
Ectopic pregnancy is implantation of a fertilized oocyte and development of the gestational sac outside the uterus.
The prevalence of ectopic pregnancy is 2-8% among all gynecological patients admitted to the hospital.
Progressing ectopic pregnancy increases the risk of rupture of the organ it is localized in.
Most often, ectopic pregnancy develops in the fallopian tube. Ampullary, isthmic, interstitial and fimbrial tubal pregnancies are distinguished. The gestational sac is localized in the ampullary part in 50% of patients, in the isthmic part - in up to 40%, in the interstitial part - in 2-3% of patients and in the fimbrial part - in 5-10%.
A pregnancy that develops in the ovaries, cervix, abdominal cavity, rudimentary uterine horn, and in the intraligamentary space is referred to as rare forms of ectopic pregnancy (fig. 6.1).
Occurrence of ectopic pregnancy is based on impairment of normal transport of the fertilized oocyte.
Possible ectopic pregnancy should be considered in case of a positive pregnancy test and the absence of a gestational sac in the uterine cavity on ultrasound, except when the gestational age is less than 4-5 weeks.