Placental abruption is a serious medical condition that can occur during pregnancy, involving the premature separation of the placenta from the inner uterine wall before childbirth. This detachment often leads to severe bleeding, and if conventional methods prove ineffective in managing the bleeding, a hysterectomy may be deemed necessary to ensure the mother\'s safety. This case report details the management of a 22-year-old female, gravida IV, para III, who experienced placental abruption during her fourth pregnancy. An emergent cesarean section resulted in severe postpartum hemorrhage and disseminated intravascular coagulation (DIC). Positive drug tests for cocaine and methamphetamines added further complexity, leading to an unplanned hysterectomy for life-saving measures. This case underscores the critical importance of early recognition, multidisciplinary collaboration, and timely intervention in managing obstetric emergencies within the context of substance abuse.

Preeclampsia (PE) is a complex heterogeneous disorder with overlapping clinical phenotypes that complicate diagnosis and management. Although several pathophysiological mechanisms have been proposed, placental dysfunction due to inadequate remodelling of uterine spiral arteries leading to mal-perfusion and syncytiotrophoblast stress is recognized as the unifying characteristic of early-onset PE. Placental overgrowth and or premature senescence are probably the causes of late-onset PE. The frequency of PE has increased over the last few decades due to population-wide increases in risk factors viz. obesity, diabetes, multifetal pregnancies and pregnancies at an advanced maternal age. Whilst multimodal tools with components comprising risk factors, biomarkers and sonography are used for predicting PE, aspirin is most effective in preventing early-onset PE. The incidence and clinical consequences of PE and eclampsia are influenced by socioeconomic and cultural factors, therefore management strategies should involve multi-sector partnerships to mitigate the adverse outcomes.

Clitoral abscess is a rare gynecological condition with limited literature reports. This case report aimed to contribute to the understanding and management of clitoral abscesses, particularly in cases without identifiable causes. A 26-year-old sexually active woman with no significant medical history presented with severe perineal pain originating specifically in the clitoral region. The onset of symptoms, characterized by pulsatile perineal pain worsening over several days, was localized to the clitoris. Clinical examination indicated a clitoral abscess, confirmed through surgical incision and drainage. The medical treatment consisted of the administration of oral analgesics, flucloxacillin at a dose of 500 mg for seven days, and non-steroidal anti-inflammatory agents. The procedure preserved the dorsal artery of the clitoris, with bacteriological analysis revealing polymicrobial organisms. Post surgery, the patient recovered fully with no complications. By sharing details about this unusual clinical case and its effective treatment, we contribute to advancing the collective knowledge in the field. This dissemination supports a deeper understanding and facilitates informed decision-making for healthcare professionals.

UNASSIGNED: Uterine rupture is the most dangerous complication of labor and contributes to high maternal mortality. Despite efforts to improve basic and comprehensive emergency obstetric treatment, women continue to suffer from disastrous maternal outcomes.
UNASSIGNED: This study aimed to assess the survival status and predictors of mortality among women with uterine rupture at public hospitals in the Harari Region, Eastern Ethiopia.
UNASSIGNED: We conducted a retrospective cohort study among women with uterine rupture in public hospitals in Eastern Ethiopia. All women with uterine rupture were followed for 11 years retrospectively. Statistical analysis was conducted with STATA version 14.2. Kaplan-Meier curves together with a Log rank test were used to estimate the survival time and show the presence of differences among groups. Cox Proportion Hazard (CPH) model was used to determine the association between independent variables and survival status.
UNASSIGNED: There were 57,006 deliveries in the study period. We found that 10.5% (95% CI: 6.8-15.7) of women with uterine rupture have died. The median recovery and death time for women with uterine rupture were 8 and 3 days with interquartile range (IQR) of 7-11 days and 2-5 days, respectively. Antenatal care follow-up (AHR: 4.2, 95% CI: 1.8-9.79), education status (AHR: 0.11; 95% CI: 0.02-0.85), visiting health center (AHR: 4.89; 95% CI: 1.05-22.88), and admission time (AHR: 4.4; 95% CI: 1.89-10.18) were the predictors of survival status of women with uterine rupture.
UNASSIGNED: One out of ten study participants died due to uterine rupture. Factors including not having ANC follow-up, visiting health centers for treatment, and being admitted during the night time were predictors. Thus, a great emphasis has to be given to the prevention of uterine rupture and the linkage within health institutions has to be smooth to improve the survival of patients with uterine rupture with the help of different professionals, health institutions, health bureaus, and policymakers.

Emergency department care is common among US pregnant women. Given the increased likelihood of serious and life-threatening pregnancy-related health conditions among Black mothers, timeliness of emergency department care is vital. The objective of this study was to evaluate racial/ethnic variations in emergency department wait times for receiving obstetrical care among a nationally representative population.
The study used pooled 2016-2018 data from the National Hospital Ambulatory Medical Care Survey, a nationally representative sample of emergency department visits. Regression models were estimated to determine whether emergency department wait time was associated with the race/ethnicity of the perinatal patient. Adjusted models controlled for age, obesity status, insurance type, whether the patient arrived by ambulance, triage status, presence of a patient dashboard, and region.
There were a total of 821 reported pregnancy-related visits in the National Hospital Ambulatory Medical Care Survey sample of emergency department visits. Of those 821 visits, 40.6% were among White women, 27.7% among Black women, and 27.5% among Hispanic women. Mean wait times differed substantially by race/ethnicity. After adjusting for potential confounders, Black women waited 46% longer than White women with emergency department visits for pregnancy problems (p < .05). Those reporting another race waited 95% longer for pregnancy problems in the emergency department than White women (p < .05).
Findings from this study document significant racial/ethnic differences in wait times for perinatal emergency department care. Although inequities in wait times may emerge across the spectrum of care, documenting the factors influencing racial disparities in wait times are critical to promoting equitable perinatal health outcomes.

Women with endometriosis often present with pelvic pain and are at an increased risk of preterm labor. In this report, we discuss the case of a 27-year-old G2P1 at 29 weeks of gestation who presented to the ED with severe abdominal pain after being seen several times since 24 weeks of gestation in the obstetrics emergency triage with complaints of abdominal pain. Labs showed anemia with an elevated white blood cell (WBC) count and elevated liver function tests (LFTs) and CA-125. Due to intense pain, imaging was unavailable at the time of presentation, but the patient had a new mass the prior week, which was 9 cm in diameter and appeared to be in the uterine cavity. The patient was in preterm labor with advanced cervical dilation with the baby in double footling breech presentation, and hence a C-section was performed demonstrating a left hemorrhagic tubal mass determined to be an endometrioma on pathology. The patient had an uncomplicated postoperative course and was discharged on her third hospital day. Our case report focuses on a unique presentation and the pathophysiology of endometriosis. Endometriosis can present in various ways, leading to a delay in diagnosis and treatment. Endometriosis can create a significant burden on a woman\'s health and financial status, and hence it is important to continue to study its complex presentation, in search of more effective, affordable, and non-invasive treatments.

Spontaneous transvaginal small bowel evisceration is an extremely rare condition with a few more than 100 documented cases to date. The complications of such a rare entity revolve around its preoperative presentation as well as its operative and postoperative complications. The complications seen are intestinal incarcerations and perforations with an increased risk of post-surgical ileus and peritonitis in a time-dependent fashion. In our case, a postmenopausal female presented with sudden onset bowel evisceration through a defect in the posterior vaginal apex during straining for defecation. Past medical history was significant for intermittent abdominal pain, bloating, and chronic constipation. The patient had no signs of trauma, signs of sexual assault, preceding events, or prior urinary disturbances. The patient was treated surgically with laparotomy and bowel-packing followed by Ward-Mayo\'s repair with added on anterior and posterior colporrhaphy, and site-specific repair. Postoperatively, following a period of prolonged ileus, the patient made a full recovery. This case report aims to provide a better understanding of the mechanism and occurrence of such an event and also intends to raise awareness of this rare presentation as an emergency condition requiring prompt surgical management.

Introduction We observed clinically that prehospital deliveries locally appeared to have a high rate of complications and appeared associated with midwife deliveries. There is scant literature that addresses prehospital deliveries across a state. We set out to describe utilization, complications, and short-term outcomes of EMS-attended prehospital deliveries in Michigan in 2015, and to describe the relationship between prehospital delivery and socioeconomic status (SES). Methods We identified candidate cases for prehospital deliveries through the Michigan EMS Information System (MI-EMSIS). To assess the relationship of SES with the frequency of EMS delivery, we utilized the mean income of the patient residences\' zip codes. Results We identified 223 EMS-attended deliveries from 1.6 million MI-EMSIS records. Most births were normal vaginal deliveries on the scene or en route to the hospital (92, 40.0%) or delivered prior to EMS arrival (58, 25.4%). Maternal or fetal complications were identified in 69 (32.0%) deliveries. We identified a few midwife-attended deliveries (31), but these had a high rate of complications (19, 61.3%). The frequency of prehospital delivery was inversely related to estimated patient income (Pearson=-0.85). Conclusions EMS deliveries were rare and most were normal vaginal deliveries, but almost a third had complications. Midwife and EMS-attended deliveries were rare, but when they occurred, had high rates of complications. Although an imperfect measure of patient SES, frequency of delivery was inversely related to patient income, and agencies that provide care in these communities should have focused training.

BACKGROUND: Hepatocellular adenomas are a rare but serious cause of bleeding, which is further complicated by pregnancy. Interprofessional cooperation is a key component of residency education, thus simulations designed to integrate multiple programs are mutually beneficial. This simulation details surgical and obstetric management of a pregnant patient in hemorrhagic shock from a bleeding hepatocellular adenoma. Objectives for the study were to evaluate learners\' confidence to 1) prioritize the care of a pregnant patient with hemoperitoneum and hemorrhagic shock, 2) demonstrate interdisciplinary collaboration with other specialties, 3) apply massive transfusion protocol (MTP) in the appropriate clinical setting, and 4) analyze critical decisions for evaluating pregnant females with severe abdominal pain.
METHODS: Obstetric, general surgery, and anesthesia residents, along with labor and delivery nurses participated in a simulated clinical scenario that focused on the management of a pregnant patient in hemorrhagic shock. The learners evaluated the educational session using a standard Return on Investment in Learning survey immediately following the session.
RESULTS: A total of 23 residents and medical students gave feedback on the experience. The main learning objectives were met with increased confidence in the four learning objectives by 77.3-95.4% of responders. Overall, greater than 90% of participants felt the simulation was relevant to their training and realistic, with 100% responding that the course provided new, or clarified existing information for them.
CONCLUSIONS: A multidisciplinary simulation-based educational intervention was successful in improving learner confidence in managing a complicated surgical emergency in a pregnant patient with inter-residency cooperation.

Precipitous delivery in the emergency department is a high-acuity, low-occurrence event that requires rapid recognition and interdepartment cooperation to prevent fetal and maternal morbidity and mortality. Prompt recognition of the peripartum state can be delayed by reported usage of long-acting contraception and concurrent distracting complaints. In this case report, a young female presented to the emergency department with epigastric abdominal pain in the setting of recent workup for biliary colic and multiple doses of long-acting, depot contraceptive agents. Early utilization of bedside ultrasound confirmed a full-term, intrauterine pregnancy as well as an impacted gallbladder stone, followed by a precipitous footling breech presentation that required an emergent cesarean section.