First 2 weeks of the cycle Dominated by Causes the to thicken and become engorged with blood At approximately day 14, an is released (ovulation)

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1 1 Chapter 39 Gynecology 2 External Genitalia : Muscular tissue that separates the vagina and the anus Mons pubis: Fatty layer of tissue over the pubic symphysis : Structures that protect the vagina and the urethra Clitoris: Vascular erectile tissue that lies anterior to the labia minora : Drains the urinary bladder 3 Internal Genitalia Vagina Female organ of copulation Birth canal Outlet for Uterus Site of development Fallopian tubes Transport the egg from the ovary to the uterus usually occurs here Ovaries Primary female gonads 4 The Menstrual Cycle Prepares the uterus to receive a fertilized the onset of menses, usually occurring between ages 10 and 14. Four phases: -Proliferative phase -Secretory phase -Ischemic phase -Menstrual phase Generally occurs every days on average 5 Proliferative Phase First 2 weeks of the cycle Dominated by Causes the to thicken and become engorged with blood At approximately day 14, an is released (ovulation) 6 Secretory Phase The stage immediately surrounding If egg is not fertilized, level drops sharply 1

2 7 Ischemic Phase If fertilization does not occur, changes cause the endometrium to become pale and small blood vessels 8 Menstrual Phase Ischemic endometrium is shed Menstruation occurs Discharge of blood, mucus, and cellular Average blood loss is ml Menstrual flow usually lasts from to days 9 Menopause The of menses and ovarian function resulting from decreased secretion of estrogen. Menstrual periods generally continue to occur until a woman is to. 10 Assessment of the Gynecological Patient 11 History Initial Assessment SAMPLE. Does the patient complain of? Use OPQRST. : painful menstruation : painful sexual intercourse Associated signs or symptoms. Has she ever been pregnant? : number of pregnancies (Para): delivery of live births Abortion: cessation of pregnancy < weeks gestation 12 History Document last cycle. Medications. Oral contraceptives have been associated with hypertension, stroke, heart attack, and pulmonary embolism 13 Physical Exam Respect patient s. Be professional. Explain procedures. Observe patient. Check vital signs. Assess bleeding or : Do not perform an internal vaginal exam in the field. 2

3 examination. Palpate and auscultate 14 Management of Gynecological Emergencies General management of gynecological emergencies is focused on care. Do not pack dressings in the vagina. Discourage use of Use large Consider PASG Psychological support 15 Specific Gynecological Emergencies Medical and Trauma 16 Gynecological Abdominal Pain Pelvic Inflammatory Disease Ruptured Ovarian Cyst Mittelschmerz Ectopic Pregnancy 17 Pelvic Inflammatory Disease PID: acute infection of the reproductive organs that can be caused by a, virus, or fungus Organs most commonly involved are the uterus, fallopian tubes, and Highest at risk are active females from 15 to 24 years of age 18 Pelvic Inflammatory Disease Common causes are and chlamydia Predisposing factors: sex partners Prior history of PID Recent procedure IUD (intrauteral device) May be acute or chronic 19 Pelvic Inflammatory Disease Signs/Symptoms: pain of lower abdomen Pain often intensifies about 1 week before or after menstrual period and may worsen during intercourse Patient may walk bent over, foul smelling vaginal discharge Fever, chills, nausea, vomiting 3

4 20 Pelvic Inflammatory Disease Management: are the primary treatment In prehospital setting, the goal is supportive and to make patient Establish IV and monitor ECG if sepsis if present 21 Ruptured Ovarian Cyst Ruptured cyst results in a small amount of spilled into the abdomen Causes abdominal pain and rebound tenderness Unilateral abdominal pain that to the back May be associated with vaginal bleeding 22 Cystitis Urinary infection Burning of urination, low grade fever, and pain immediately above the symphysis pubis 23 Mittelschmerz Abdominal pain associated with Marked by unilateral lower abdominal pain May be accompanied by mid cycle May have a low grade 24 Endometritis Infection of the May be a complication of a miscarriage, childbirth, or gynecological procedure. S/S include lower abdominal pain, bloody and foul smelling, low grade fever S/S appear hours after procedure Often misdiagnosed as PID 25 Endometriosis A condition in which endometrial tissue grows outside of the Causes scarring Exact cause is Dull, cramping pelvic pain that is usually related to menstruation Periods are marked by bleeding Treat/prevent shock if blood loss is high 4

5 26 Ectopic Pregnancy The implantation of a developing fetus outside of the uterus. Normally in a fallopian tube A emergency Characterized by unilateral abdominal pain 4 to 6 weeks after. Suspect ectopic pregnancy in any woman of child bearing age that presents with pain! 27 Non-Traumatic Vaginal Bleeding : excessive menstrual flow Spontaneous abortion: Most common cause Suspect if it has been greater than 60 days since LMP Management: Do not vagina. Transport Initiate oxygen and IV access based on patient condition. 28 Traumatic Gynecological Emergencies Causes of Gynecological Trauma: trauma. Sexual assault. Blunt force to lower abdomen. bodies inserted in vagina. attempts 29 Management of Gynecological Trauma Apply pressure over laceration(s) if present Apply pack to hematomas. Establish IV if patient is severe. Transport. 30 Sexual Assault Do not ask specific of a sexual assault. Keep treatment to emergency treatment only Do not examine the external genitalia of a sexual assault victim unless there is a lifethreatening. 31 Management of Sexual Assault Protect the scene. Handle as little as possible. If removing clothing, bag each item separately. Do not through any tears or holes in clothing. Place bloody articles in brown paper bags. Do not exam the area. 5

6 32 Management of Sexual Assault Do not allow patient to change, bathe, or douche. Do not allow patient to comb hair, brush teeth, or clean. Do not wounds, if possible. 33 Documentation of Sexual Assaults State patient accurately. Objectively state your observations of patient s physical condition, environment, or torn clothing. Document turned over to hospital staff. Do NOT include your as to whether rape occurred. 6