Prehospital

Gynecology,
Obstetrics,
Childbirth,
Care of newborn
November, 2005
Gynecology
Gynecology Review Topics

You should be able to describe...

• Anatomy and physiology of the female genitalia (reproductive

system)
• Assessment of the gynecological patient
• Management some specific gynecological emergencies
Anatomy and
Physiology
Female External Genitalia (1 of 2)
Female 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.
Female Internal Genitalia (1 of 2)
Female 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.
Assessment of the Gynecological Patient
History—Subjective Assessment

• Initial Assessment—SAMPLE.
• Complaints: Does the patient complain of pain? Where?
• Use OPQRST.
– Dysmenorrhea:
Painful menstruation; cramps, sometimes debilitating
– Dyspareunia: Pain during intercourse
• Associated signs or symptoms; pertinent negatives.
• Has she ever been pregnant?
– Gravida / Parity (or Para) / Abortion’; G2P2A1
(pregnancies / live births / abortions and miscarriages)
– Document last menstrual cycle
• Medications—Contraceptives.
Physical Exam—Objective Assessment

• Respect patient’s privacy.

• Be professional.
• Explain procedures.
• Observe patient.
• Check vital signs.
• Assess bleeding or discharge
– Do not perform an internal vaginal exam
• Abdominal examination.
Specific Gynecological Emergencies
Medical
Trauma
Sexual Assault
Overview of General Management of
Gynecological Emergencies

• No internal examination
• Do not pack dressings in the vagina
• Supportive care
• Transport
Medical Gynecological Emergencies

• Gynecological Abdominal Pain

– Pelvic Inflammatory Disease (subsequent to STD?)
– Ruptured Ovarian Cyst
– Cystitis
– Mittelschmerz [pain near the ovary site at ovulation]
– Endometriosis
– Ectopic Pregnancy ⇦ True Emergency!
• Vaginal bleeding
– Menorrhagia [excessive menstrual bleeding]
– Spontaneous abortion
– Ectopic Pregnancy ⇦ True Emergency!
– Placenta Previa ⇦ True Emergency!
– Abruptio Placentae ⇦ True Emergency!
Signs and Symptoms Management

• Pain
– Make the patient comfortable

• Bleeding
– Initiate oxygen
– IV access and ECG monitor based on patient condition
Traumatic Gynecological Emergencies

• Causes of Gynecological Trauma

– Blunt Trauma
– Sexual Assault
– Blunt force to Lower Abdomen
– Foreign Bodies Inserted in Vagina
– Abortion Attempts
Management of
Gynecological Trauma

• Apply direct pressure over laceration.

• Apply cold pack to hematoma.
• Establish IV and ECG monitor, if warranted.
Sexual Assault

• 1 in 3 women will be raped in their life time

• Only 10 - 30% will report it
Sexual Assault Management
Do

• Protect the scene

• Manage threats to life aggressively
• Be gentle; provide emotional support
• Minimize history taking
• Handle clothing as little as possible
• If removing clothing, bag each item separately
• Place bloody articles in (brown) paper bags (not plastic)
• Carefully document everything
Sexual Assault Management
Do Not

• Do not cut through any tears or holes in clothing.

• Do not ask specific details of a sexual assault.
• Do not examine the external genitalia or perineal area unless there
is a uncontrolled hemorrhage.
• 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.
Sexual Assault Documentation

• Write objectively, dispassionately, thoroughly

• State patient remarks accurately
• State your observations of the scene (environment), patient’s
physical condition, torn clothing, interventions and results
• Document all items turned over to hospital staff
• Do NOT include your opinions or conclusions
– Especially whether rape or other crime occurred
• If victim is a minor, remember that you are a mandated reporter of
child abuse
Gynecology Wrap-up

Questions?