GynecologyGynecology

The Menstrual The Menstrual CycleCycle 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.

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.

Phases of the Phases of the Menstrual CycleMenstrual Cycle

The Proliferative Phase The Secretory Phase The Ischemic Phase The Menstrual Phase

The Proliferative Phase The Secretory Phase The Ischemic Phase The Menstrual Phase

Proliferative PhaseProliferative 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.

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.

Secretory PhaseSecretory Phase The secretory phase is referred to

as ovulation. Progesterone increases and

estrogen drops if the egg is not fertilized.

The uterine becomes more vascular in preparation for implantation of a fertilized egg.

The secretory phase is referred to as ovulation.

Progesterone increases and estrogen drops if the egg is not fertilized.

The uterine becomes more vascular in preparation for implantation of a fertilized egg.

The Ischemic The Ischemic PhasePhase Estrogen and progesterone levels

fall without fertilization. The endometrium breaks down.

Estrogen and progesterone levels fall without fertilization.

The endometrium breaks down.

The Menstrual The Menstrual PhasePhase The Menstrual Cycle

Premenstrual Syndrome Menopause

The Menstrual Cycle Premenstrual Syndrome Menopause

Assessment of the Assessment of the Gynecological Gynecological

PatientPatient

HistoryHistory 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.

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.

Physical ExamPhysical 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.

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.

Management of Management of Gynecological Gynecological EmergenciesEmergencies

General management of gynecological emergencies is focused on supportive care.

Do not pack dressings in the vagina.

General management of gynecological emergencies is focused on supportive care.

Do not pack dressings in the vagina.

Specific Specific Gynecological Gynecological EmergenciesEmergencies Medical and Medical and

Trauma Trauma

Medical Medical Gynecological Gynecological EmergenciesEmergencies

Gynecological Abdominal Pain Pelvic Inflammatory Disease Ruptured Ovarian Cyst Cystitis Mittelschmerz Endometritis Ectopic Pregnancy

Gynecological Abdominal Pain Pelvic Inflammatory Disease Ruptured Ovarian Cyst Cystitis Mittelschmerz Endometritis Ectopic Pregnancy

Management of Management of Gynecological Gynecological

Abdominal PainAbdominal Pain Make the patient comfortable and

transport. Make the patient comfortable and

transport.

Vaginal BleedingVaginal Bleeding

Nontraumatic Menorrhagia Spontaneous abortion

Nontraumatic Menorrhagia Spontaneous abortion

Treatment for Treatment for Vaginal BleedingVaginal Bleeding

Do not pack vagina. Transport Initiate oxygen and IV access

based on patient condition.

Do not pack vagina. Transport Initiate oxygen and IV access

based on patient condition.

Traumatic Traumatic Gynecological Gynecological EmergenciesEmergencies

Causes of Gynecological Trauma Blunt trauma. Sexual assault. Blunt force to lower abdomen. Foreign bodies inserted in vagina. Abortion attempts.

Causes of Gynecological Trauma Blunt trauma. Sexual assault. Blunt force to lower abdomen. Foreign bodies inserted in vagina. Abortion attempts.

Management of Management of Gynecological Gynecological

TraumaTrauma Apply direct pressure over

laceration. Apply cold pack to hematoma. Establish IV if patient is severe. Transport.

Apply direct pressure over laceration.

Apply cold pack to hematoma. Establish IV if patient is severe. Transport.

Sexual AssaultSexual 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.

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.

ManagementManagement 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 exam 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.

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 exam 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.

DocumentationDocumentation 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.

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.