PREFACE
Physicians are faced, increasingly, with diagnosis and management decisions in obstetric and gynecologic emergency settings. Whether the setting is the emergency department of a busy inner-city hospital or the office of a gynecologist or other primary care provider, an understanding of the pathophysiology and management considerations is critical to good patient care.
During the last decade, it has become apparent that a large portion of the young women and children at greatest risk for obstetric and gynecologic emergencies increasingly fall out of the health care system. In several areas of the country, up to 25% of women receive no prenatal care. In other areas, close to 50% of young women have no primary care providers to handle emergencies. Currently, an estimated 50 million US citizens are not medically insured. The increasing demands on the health care dollar and the increasing percentage of care delivered under managed systems create a premium on either no hospitalization or early discharge. Consequently, complications of delivery, as well as of gynecologic surgery, are not recognized until after the patient has left the hospital. To this must be added the effects of the Great Recession, which became evident on health care in mid-2008. Unemployment, underemployment, and loss of health benefits have had a severe impact on preventative care. Even if employed women still have benefits, their deductibles and co-pays have significantly increased. All of these factors result in management being provided in emergent care settings, whether in the hospital or in the office.This book intends to address the need for a continuing up-to-date understanding of these obstetric and gynecologic emergencies. It seeks its audience among obstetricians, gynecologists, emergency department physicians, family practitioners, and other primary health care providers. The book is organized in two main sections: obstetric emergencies and gynecologic emergencies.
Although the organization is along the lines of the traditional major emergencies that occur in these two disciplines, several problems are addressed by multiple authors from different perspectives. It is the editor's belief that additional understanding of the management of these conditions can be gained from divergent points of view. Finally, it must be recognized that obstetric and gynecologic emergencies change over time. What are frequent problems today may become relatively infrequent tomorrow. New challenges face the physician. For example, approximately 80% of women in this country do not have legal abortion services available to them. It is, therefore, probable that physicians will see emergency situations arising from illegal abortions. Additionally, violence has become a pervasive disease in our society; physicians who treat women must be conversant with both clinical and psychological problems that arise from rape and other traumas to the reproductive organs. Tragically, in the 21st century, emergent conditions due to terrorist acts also need to be addressed.I thank all of the contributors for their excellent work and their diligent, careful, and astute analysis of the issues raised. Thanks are also due to Louise Bierig for her efficiency and editing skills. Special thanks are due to Ms. Georgette Andreason whose technical and organizational expertise cannot be matched and without whom this project would not have been undertaken nor completed.
Guy I. Benrubi, MD