Aemt Gynecology (Mwn)

Front 1

gynecologic problems requiring urgent care

Back 1

Excessive bleeding
Soft-tissue injuries
STDs
Vaginal discharge

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Vulva

Back 2

The visible external female genitalia

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Vagina

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Outermost cavity of reproductive system
Forms lower part of birth canal
Begins at cervix and ends as external opening

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Uterus (womb)

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Where the fetus grows
Made up of fundus, body, uterine cavity, endometrium, and myometrium

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Ovaries also produce hormones

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Estrogen and progesterone

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Hormone levels rise each month causing

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Stimulate development of eggs
Cause endometrium of uterus to thicken
Ovum is released around 14 days from beginning of menstrual cycle.
If no fertilized egg implants, menstruation begins.
Shedding of uterine lining

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_____________ is initial onset of menstruation.
Occurs during puberty

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Menarche

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_____________ is cessation of menstruation and ovarian function. Usually occurs between ____ and ____years

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Menopause

Usually occurs between 45 and 55 years

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characteristics of Pelvic Inflammatory Disease

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Caused by acute or chronic infection in the pelvic cavity
Chief symptoms are pelvic pain and fever
Complications:
-Sepsis
-Abscess formation
-Generalized peritonitis
-Infertility
May find lower abdominal pain, fever, vaginal discharge, dyspareunia
Patient will generally walk doubled-over.
Place patient in position of comfort.
Provide transport to appropriate facility.

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Chancroid

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Highly contagious, yet curable STD
May cause painful sores and swollen, painful lymph glands, May be asymptomatic

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Bacterial vaginosis

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STD Common condition to afflict women
Normal bacteria replaced by an overgrowth of other bacteria
Symptoms - Itching, burning, pain
Treated with metronidazole

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Chlamydia

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STD with mild or absent symptoms
Some women experience lower abdominal pain, low back pain, nausea, fever, pain during intercourse, bleeding between menstrual periods.
Untreated, can spread to rectum and progress to PID

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Cytomegalovirus (CMV)

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Common STD infection with no known cure
Can cause high fever, chills, headache, malaise, extreme fatigue, enlarged spleen
People at risk for active infection: Those with immune disorders, Chemotherapy patients, Pregnant women

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Genital herpes

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Infection of genitals, buttocks, anal area
Caused primarily by herpes simplex virus - Type 1 and Type 2
Occurs in “outbreaks”
Small red bumps can develop into painful sores

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Gonorrhea

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Grows and multiplies rapidly in warm, moist areas of reproductive tract
Causes painful urination and occult blood associated with intercourse
If untreated, can enter bloodstream and spread to other parts of body - Including the brain

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Genital warts

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The most common STD
Can produce multiple growths in genital areas
HPV is a causative agent in cervical, vulvar, anal cancer.
In pregnant women, warts may impede urination or obstruct birth canal.

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Syphilis

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STD
“Great imitator”
Transmission through direct contact
Primary stage: one or more sores
Secondary stage: mucous membrane lesions and rash
Late stage: internal damage

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Trichomoniasis

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Symptoms, if present, include:
-Vaginal discharge with strong odor
Irritation and itching
-Discomfort during intercourse
-Dysuria
-Lower abdominal pain
Untreated, can lead to premature birth, low birthweight, or increased HIV susceptibility

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Vaginal Yeast Infections

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Normal acidic environment of vagina keeps yeast from growing.
-If less acidic, yeast population can grow and infect.
-Affected by oral contraceptives, antibiotics, etc.
Symptoms include itching, burning, soreness, vulvar swelling.

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Ectopic Pregnancy

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Pregnancy that develops outside uterus - Generally in a fallopian tube
Abdominal pain
Causes include previous surgical adhesions, PID, tubal litigation, IUD.
Rupture of fallopian tube can lead to life-threatening emergency
Signs of hypovolemic shock
Severe abdominal pain radiating to back
Amenorrhea
Rupture can cause excessive bleeding.
Expect and monitor symptoms of shock.
Treat as true medical emergency.
Transport rapidly.

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Causes of Vaginal Bleeding

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Can be simple as normal menstrual cycle
Can be extreme as ruptured uterus
Causes may include:
-Spontaneous abortion
-Onset of labor
-PID and infections
-Lesions from previous surgeries
May also result from traumatic causes
-Straddle injury
-Blows to perineum
Blunt force to lower abdomen
-Foreign bodies inserted into vagina
-Abortion attempt
-Soft-tissue injury

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Postpartum Eclampsia

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After a baby is born, mother is at risk for eclampsia -Seizures and hypertension
A thorough history is important.
Paramedic backup is required.

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SAMPLE history in gynecological emergencies

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Investigate chief complaint.
Remember, questions may be personal and embarrassing.
Pain and discomfort?
Previous gynecologic problems or pregnancies?
Recent surgeries?
If currently bleeding, estimate amount of blood loss.
Contraceptives?
Last menstrual cycle?
Consider possibility of pregnancy.
When obtaining a SAMPLE history, the AEMT should inquire about the patient’s medications. The AEMT must ask about the use of birth control pills or birth control devices and ask specifically about the patient’s last menstrual period. The AEMT should also inquire about the possibility of sexually transmitted diseases and the possibility of pregnancy.

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First or second trimester bleeding might indicate

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spontaneous abortion

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What is the narrowest portion of the uterus?

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Cervix

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What is the outermost cavity of a woman’s reproductive system?

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The vagina is the outermost cavity of a woman’s reproductive system

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If fertilization has not occurred within about ___ days following ovulation, the lining of the uterus begins to separate and menstruation occurs.

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Women menstruate about 14 days following ovulation.

Front 28

What is the most common presenting sign of PID?

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Lower abdominal pain is the most common sign of pelvic inflammatory disease.

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What is the AEMT’s FIRST priority when dealing with a patient experiencing excessive vaginal bleeding?

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Determining the cause of the bleeding is less important than treating for shock and transporting the patient. AEMTs can control the bleeding by using sanitary pads on the external genitalia. When treating for shock, the AEMT must place the patient in the appropriate position, keep her warm, and apply oxygen

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Postpartum eclampsia

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a rare condition that occurs when a woman has high blood pressure and excess protein in her urine soon after childbirth. Most cases of postpartum preeclampsia develop within 48 hours of childbirth. However, postpartum preeclampsia sometimes develops up to four to six weeks after childbirth. This is known as late postpartum preeclampsia. requires prompt treatment. Left untreated, postpartum preeclampsia can result in seizures

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placentia previa

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Placenta previa is a problem of pregnancy in which the placenta grows in the lowest part of the womb (uterus) and covers all or part of the opening to the cervix. During pregnancy, the placenta moves as the womb stretches and grows. It is very common for the placenta to be low in the womb in early pregnancy. But as the pregnancy continues, the placenta moves to the top of the womb. By the third trimester, the placenta should be near the top of the womb, so the cervix is open for delivery.

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Vagina

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a fibromuscular tubular tract which is a sex organ and has two main functions; sexual intercourse and childbirth. In humans, this passage leads from the opening of the vulva to the uterus (womb), but the vaginal tract ends at the cervix.

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Prepuce

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The clitoral hood, which surrounds and protects the head of the clitoris

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labia majora

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The labia majora are two prominent longitudinal cutaneous folds that extend downward and backward from the mons pubis to the perineum.

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labia minora

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also known as the inner labia, inner lips, vaginal lips, or nymphae are two flaps of skin on either side of the human vaginal opening, situated between the labia majora

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The most common STD is

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HPV