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Chapter 39Gynecology : 

Chapter 39Gynecology Galveston College EMS 2009

Topics : 

Topics Anatomy and Physiology of the Female Reproductive Organs The Menstrual Cycle Assessment of the Gynecological Patient Management of Gynecological Emergencies Specific Gynecological Emergencies 2/30

Anatomy and Physiology of the Female Reproductive Organs : 

Anatomy and Physiology of the Female Reproductive Organs External Genitalia Internal Genitalia 3/30

External Genitalia (1 of 2) : 

External Genitalia (1 of 2) 4/30

External Genitalia (2 of 2) : 

External Genitalia (2 of 2) Perineum Muscular tissue that separates the vagina and the anus Mons Pubis Fatty layer of tissue over the pubic symphysis Labia Structures that protect the vagina and the urethra Clitoris Vascular erectile tissue that lies anterior to the labia minora Urethra Drains the urinary bladder 5/30

Internal Genitalia (1 of 2) : 

Internal Genitalia (1 of 2) 6/30

Internal Genitalia (2 of 2) : 

Internal Genitalia (2 of 2) Vagina Female organ of copulation Birth canal Outlet for menstruation Uterus Site of fetal development Fallopian Tubes Transports the egg from the ovary to the uterus Fertilization usually occurs here Ovaries Primary female gonads 7/30

The Menstrual Cycle : 

The Menstrual Cycle Monthly hormonal cycle, usually 28 days. Prepares the uterus to receive a fertilized egg. The onset of menses, known as menarche, usually occurs between the ages of 10 and 14. 8/30

Phases of the Menstrual Cycle : 

Phases of the Menstrual Cycle The Proliferative Phase The Secretory Phase The Ischemic Phase The Menstrual Phase 9/30

Proliferative Phase : 

Proliferative Phase This is the first two weeks of the menstrual cycle. Estrogen causes the uterine lining to thicken and become engorged with blood. Secretion of LH day 14: ovulation takes place. If the egg is not fertilized, menstruation takes place. If the egg is fertilized, the corpus luteum produces progesterone until the placenta takes over. Cilia sweep the egg toward the uterus. A fertilized egg normally implants in the lining of the uterus. If the egg is not fertilized, it is expelled from the uterine cavity. 10/30

Secretory Phase : 

Secretory Phase The secretory phase is referred to as ovulation. Progesterone increases and estrogen drops if the egg is not fertilized. The uterus becomes more vascular in preparation for implantation of a fertilized egg. 11/30

The Ischemic Phase : 

The Ischemic Phase Estrogen and progesterone levels fall without fertilization. The endometrium breaks down. 12/30

The Menstrual Phase : 

The Menstrual Phase The Menstrual Cycle Premenstrual Syndrome Menopause 13/30

Assessment of the Gynecological Patient : 

Assessment of the Gynecological Patient 14/30

History : 

History Initial Assessment—SAMPLE. Does the patient complain of pain? Use OPQRST. Dysmenorrhea/dyspareunia Associated signs or symptoms. Has she ever been pregnant? Gravida/parity/abortion Document last menstrual cycle. Medications—contraceptives. 15/30

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Physical Exam : 

Physical Exam Respect patient’s privacy. Be professional. Explain procedures. Observe patient. Check vital signs. Assess bleeding or discharge: Do not perform an internal vaginal exam in the field. Abdominal examination. 17/30

Management of Gynecological Emergencies : 

Management of Gynecological Emergencies General management of gynecological emergencies is focused on supportive care. Do not pack dressings in the vagina. 18/30

Specific Gynecological Emergencies Medical and Trauma : 

Specific Gynecological Emergencies Medical and Trauma 19/30

Medical Gynecological Emergencies : 

Medical Gynecological Emergencies Gynecological abdominal pain Pelvic inflammatory disease Ruptured ovarian cyst Cystitis Mittelschmerz Endometriosis Ectopic pregnancy 20/30

Management of Gynecological Abdominal Pain : 

Management of Gynecological Abdominal Pain Make the patient comfortable and transport. 21/30

Vaginal Bleeding : 

Vaginal Bleeding Nontraumatic Menorrhagia Spontaneous abortion 22/30

Treatment for Vaginal Bleeding : 

Treatment for Vaginal Bleeding Do not pack vagina. Transport. Initiate oxygen and IV access based on patient condition. 23/30

Traumatic Gynecological Emergencies : 

Traumatic Gynecological Emergencies Causes of gynecological trauma Blunt trauma Sexual assault Blunt force to lower abdomen Foreign bodies inserted in vagina Abortion attempts 24/30

Management of Gynecological Trauma : 

Management of Gynecological Trauma Apply direct pressure over laceration. Apply cold pack to hematoma. Establish IV if patient is severe. Transport. 25/30

Sexual Assault : 

Sexual Assault Do not ask specific details of a sexual assault. Do not examine the external genitalia of a sexual assault victim unless there is a life-threatening hemorrhage. 26/30

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Management : 

Management Protect the scene. Handle clothing as little as possible. If removing clothing, bag each item separately. Do not cut through any tears or holes in clothing. Place bloody articles in brown paper bags. Do not examine the perineal area. Do not allow patient to change clothes, bathe, or douche. Do not allow patient to comb hair, brush teeth, or clean fingernails. Do not clean wounds, if possible. 28/30

Documentation : 

Documentation State patient remarks accurately. Objectively state your observations of patient’s physical condition, environment, or torn clothing. Document evidence turned over to hospital staff. Do NOT include your opinions as to whether rape occurred. 29/30

Summary : 

Summary Anatomy and Physiology of the Female Reproductive Organs The Menstrual Cycle Assessment of the Gynecological Patient Management of Gynecological Emergencies Specific Gynecological Emergencies 30/30