#ob-gyn
| Diagnosis | Risk factor | Risk factor |
|:------------------|:---------------------------------------------------|:--------------------------------------|
| Ectopic pregnancy | Assisted fertility, prev ectopic, PID | endometriosis |
| PID | sexually active and no barrier protection, prev PID | recent insrumentation eg IUD insertion |
| miscarriage | prior miscarriage | gestational DM, prior C section |
# DDx
**Gynaecolological**
- [[Ectopic pregnancy]]
- miscarriage
- ovarian cyst/mass
- pelvic inflammatory disease
- [[ovarian torsion]]
- leiomyoma
**intestinal**
- appendicitis
- diverticulitis
- inflammatory bowel disease
- bowel obstruction
**urological**
- cystitis/UTI
- pyelonephritis
- urinary retention
- renal colic
**other**
- hernia
- pelvic vein thrombophlebitis
## mittelschmerz
- transient mid-cycle pain at or after ovulation
- related to increasing ovarian capsular pressure due to ovulation
- initially poorly defined, then localised following follicular rupture and release of fluid and/or blood causing peritoneal irritation
- Tx NSAIDs and reassurance
- pain usually resolves spontaneously
# Pelvic examination
- visual examination of vulva and urethral meatus
- varicosities, infection, abnormal lesions
- speculum examination to visualise the cervix, cervical os, and the vaginal vault
- note any discharge
- take endocervical and vaginal swabs
- bimanual examination
- examine cervix, uterus, and adnexae
- uterus is normally mobile, but endometriosis or adhesions may cause fixation
## Speculum examination
see [pelvic exam UCSD](https://meded.ucsd.edu/clinicalmed/pelvic.html)
basically if you cannot find it just go in deeper
![[Pasted image 20231116173905.png]]
![[Pasted image 20231116174015.png]]
![[Pasted image 20231116174203.png]]
# Ultrasound
3 features that help make diagnosis?
| feature | justification |
|:-------------------------------|:-----------------------------------------------------------------------------|
| free fluid in pouch of douglas | ruptured/bleeding ectopic, ruptured ovarian or haemorrhagic cyst |
| intrauterine gestatinal sac | indicates ongoing pregnancy if fetal pole present, or threatened miscarriage |
| mass in adnexa | haemorrhagic cyst ?toA |