{"paper_id":"45ca64dc-809c-400e-b23f-1ca48edb872b","body_text":"Abstract\nSeveral surgical and/or medical emergencies/urgencies may occur in gynecologic patients and in pregnant women during the first trimester. Particularly, ectopic pregnancies, ruptured or hemorrhagic ovarian cysts, ovarian or adnexal torsions, threatened or inevitable miscarriages, phlogistic gynecological disorders, complications involving the uterine fibroids, endometriosis, and spontaneous uterine rupture are possible acute complications. The diagnosis is suspected on the basis of symptoms (acute pelvic and/or abdominal pain, with or without vaginal bleeding or discharge, until acute abdomen with peritonitis), by means physical evaluation (abdominal, pelvic, and bimanual gynecological examinations), by means of transabdominal (TAS) and/or transvaginal (TVS) sonography, and laboratory tests. However, the diagnosis is often not that simple, especially when the symptoms and clinical signs are minimal, and ultrasound (US) examination is not diriment. The differential diagnosis of abdominal/pelvic pain is broad and includes primarily gastrointestinal and urogenital disorders. Generally, TAS should usually be used in conjunction with TVS for evaluation of the female pelvis. If the US examination is not conclusive, CT or MRI, especially in pregnant patients, should be considered.\nRiassunto\nDiverse emergenze/urgenze chirurgiche e/o mediche possono interessare le pazienti ginecologiche e le gravide al primo trimestre. In particolare, le gravidanze ectopiche, le cisti ovariche rotte o torte, le torsioni ovariche o annessiali, le minacce d’aborto o gli aborti inevitabili, le patologie infiammatorie ginecologiche, i fibromi uterini complicati, l’endometriosi e la rottura uterina spontanea rappresentano possibili complicanze acute. La diagnosi può essere sospettata in base alla sintomatologia (algie pelviche e/o addominali acute, con eventuali perdite vaginali, fino a un quadro di addome acuto con peritonite), alla visita (valutazione addominale, pelvica ed esplorazione ginecologica bimanuale), all’ecografia transaddominale (TAS) e/o transvaginale (TVS), e agli esami di laboratorio. Tuttavia, la diagnosi spesso non è semplice, soprattutto quando i sintomi e i segni clinici sono lievi e l’ecografia non è dirimente. La diagnosi differenziale del dolore addominale/pelvico comprende un’ampia varietà di disordini, in particolare gastrointestinali e urogenitali. Generalmente, la valutazione della pelvi femminile dovrebbe essere eseguita mediante ecografia sia transaddominale che transvaginale. Se l’esame ecografico non consente di fare diagnosi, dovrebbero essere presi in considerazione la TC o, specialmente nelle donne gravide, la RMI.\nSimilar content being viewed by others\nReferences\nBoyd CA, Riall TS (2012) Unexpected gynecologic findings during abdominal surgery. Curr Probl Surg 49:195–251\nGupta S, Manyonda IT (2009) Acute complications of fibroids. Best Pract Res Clin Obstet Gynaecol 23(5):609–617. doi:10.1016/j.bpobgyn.2009.01.012\nGramith F, Sirr S, Hollerman J, Hawks L (1991) Transvaginal versus transabdominal sonography in patients suspected of having ectopic pregnancy. Minn Med 74(1):27–31\nLambert MJ, Villa M (2004) Gynecologic ultrasound in emergency medicine. Emerg Med Clin North Am 22(3):683–696\nCicchiello LA, Hamper UM, Scoutt LM (2011) Ultrasound evaluation of gynecologic causes of pelvic pain. Obstet Gynecol Clin North Am 38(1):85–114, viii. doi:10.1016/j.ogc.2011.02.005\nSimsek T, Dogan A, Simsek M, Pestereli E (2008) Heterotopic triplet pregnancy (twin tubal) in a natural cycle with tubal rupture: case report and review of the literature. J Obstet Gynaecol Res 34(4 Pt 2):759–762\nCasadio P, Formelli G, Spagnolo E, De Angelis D, Marra E, Armillotta F et al (2009) Laparoscopic treatment of interstitial twin pregnancy. Fertil Steril 92:390.e13–390.e17\nNama V, Manyonda I (2009) Tubal ectopic pregnancy: diagnosis and management. Arch Gynecol Obstet 279(4):443–453\nRoyal College of Obstetricians and Gynaecologists (2004) The management of tubal pregnancy. Guideline no. 21, May 2004, Reviewed 2010\nHajenius PJ, Mol F, Mol BW, Bossuyt PM, Ankum WM, van der Veen F (2007 ) Interventions for tubal ectopic pregnancy. Cochrane Database Syst Rev (1):CD000324\nTimor-Tritsch IE, Monteagudo A, Santos R, Tsymbal T, Pineda G, Arslan AA (2012) The diagnosis, treatment, and follow-up of cesarean scar pregnancy. Am J Obstet Gynecol 207(1):44.e1–56.e13\nTimor-Tritsch IE, Monteagudo A (2012) Unforeseen consequences of the increasing rate of cesarean deliveries: early placenta accreta and cesarean scar pregnancy. A review. Am J Obstet Gynecol 207(1):14–29\nLau S et al (2013) Conservative medical and surgical management of interstitial ectopic pregnancy. Fertil Steril 72:207–215\nMoawad NS, Tulandi T (1999) Current diagnosis and treatment of interstitial pregnancy. Am J Obstet Gynecol 202(1):15–29\nVarras M, Akrivis C, Hadjopoulos G, Antoniou N (2003) Heterotopic pregnancy in a natural conception cycle presenting with tubal rupture: a case report and review of the literature. Eur J Obstet Gynecol Reprod Biol 106(1):79–82\nBai XX, Gao HJ, Yang XF, Dong MY, Zhu YM (2012) Expectant management of heterotopic cesarean scar pregnancy. Chin Med J (Engl) 125(7):1341–1344\nUgurlucan FG, Bastu E, Dogan M, Kalelioglu I, Alanya S, Has R (2012) Management of cesarean heterotopic pregnancy with transvaginal ultrasound-guided potassium chloride injection and gestational sac aspiration, and review of the literature. J Minim Invasive Gynecol 19(5):671–673\nMoragianni VA, Hamar BD, McArdle C, Ryley DA (2012) Management of a cervical heterotopic pregnancy presenting with first-trimester bleeding: case report and review of the literature. Fertil Steril 98(1):89–94\nJulania S, Tai R (2013) Heterotopic simultaneous splenic and intrauterine pregnancy after spontaneous conception and review of literature. J Obstet Gynaecol Res 39:367–370\nRoyal College of Obstetricians and Gynaecologists (2006) The management of early pregnancy loss. Green-top Guideline No. 25 October 2006\nRackow BW, Patrizio P (2007) Successful pregnancy complicated by early and late adnexal torsion after in vitro fertilization. Fertil Steril 87:697\nHoover K, Jenkins TR (2011) Evaluation and management of adnexal mass in pregnancy. Am J Obstet Gynecol 205(2):97–102\nGlanc P, Salem S, Farine D (2008) Adnexal masses in the pregnant patient: a diagnostic and management challenge. Ultrasound Q 24(4):225–240\nHuchon C, Fauconnier A (2010) Adnexal torsion: a literature review. Eur J Obstet Gynecol Reprod Biol 150(1):8–12\nValsky DV, Esh-Broder E, Cohen SM, Lipschuetz M, Yagel S (2010) Added value of the gray-scale whirlpool sign in the diagnosis of adnexal torsion. Ultrasound Obstet Gynecol 36(5):630–634\nVijayaraghavan SB (2004) Sonographic whirlpool sign in ovarian torsion. J Ultrasound Med 23(12):1643–1649 (quiz 1650–1651)\nKoo YJ, Lee JE, Lim KT, Shim JU, Mok JE, Kim TJ (2011) A 10-year experience of laparoscopic surgery for adnexal masses during pregnancy. Int J Gynaecol Obstet 113(1):36–39\nHasson J, Tsafrir Z, Azem F, Bar-On S, Almog B, Mashiach R et al (2010) Comparison of adnexal torsion between pregnant and nonpregnant women. Am J Obstet Gynecol 202(6):536.e1–536.e6\nLeiserowitz G (2006) Managing ovarian masses during pregnancy. Obstet Gynecol Surv 61:463–470\nWhitecar MP, Turner S, Higby MK (1999) Adnexal masses in pregnancy: a review of 130 cases undergoing surgical management. Am J Obstet Gynecol 181:19–24\nYuen P, Ng PS, Leung PL, Rogers MS (2004) Outcome in laparoscopic management of persistent adnexal mass during the second trimester of pregnancy. Surg Endosc 18:1354–1357\nKo ML, Lai TH, Chen SC (2009) Laparoscopic management of complicated adnexal masses in the first trimester of pregnancy. Fertil Steril 92:283–287\nMathevet P, Nessah K, Dargent D, Mellier G (2003) Laparoscopic management of adnexal masses in pregnancy: a case series. Eur J Obstet Gyncol Biol 108:217–222\nTimor-Tritsch IE, Lerner JP, Monteagudo A, Murphy KE, Heller DS (1998) Transvaginal sonographic markers of tubal inflammatory disease. Ultrasound Obstet Gynecol 12:56–66\nJaiyeoba O, Soper DE (2011) A practical approach to the diagnosis of pelvic inflammatory disease. Infect Dis Obstet Gynecol 2011:753037. doi:10.1155/2011/753037\nMirhashemi R, Schoell WM, Estape R, Angioli R, Averette HE (1999) Trends in the management of pelvic abscesses. J Am Coll Surg 188(5):567–572\nConflict of interest\nStefano Zucchini and Elena Marra declare that they have no conflict of interest.\nHuman and animal studies\nThe study described in this article did not include any procedures involving humans or animals.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nRights and permissions\nAbout this article\nCite this article\nZucchini, S., Marra, E. Diagnosis of emergencies/urgencies in gynecology and during the first trimester of pregnancy. J Ultrasound 17, 41–46 (2014). https://doi.org/10.1007/s40477-013-0059-0\nReceived:\nAccepted:\nPublished:\nIssue date:\nDOI: https://doi.org/10.1007/s40477-013-0059-0","source_license":"CC0","license_restricted":false}