1. Gynecologic Emergencies-2
Dr. Maha Al Sedik
2015
Medical Emergency I

2. a. Occurs about every 28 days.
Ovulation: release of a secondary oocyte from a follicle.
a. Occurs about every 28 days.
b. In older women, ovary surface is pitted and scarred
i. Because many eggs were released.

4. Changes in the Ovaries:
Stage 1: An egg is beginning to mature within a cluster of cells called a follicle.
Stage 2: Rapid follicle and egg growth.
Stage 3: Ovulation occurs; fully mature egg bursts out of the follicle (fertile) empty follicle transforms into the corpus lutum.
Stage 4: Egg travels through fallopian tube (7 days) if not fertilized upon arrival in uterus the corpus lutum shrinks triggering menstruation and ripening of new egg.

5. Changes in ovarian hormones:
Estrogen: gradually increases during days 1-14; signals body to thicken the lining of the uterus.
Progesterone: Levels remain low during the first half of the cycle and then increase sharply during the second half of the cycle.

6. First day of menstruation until ovulation. Luteal phase:
Ovarian cycle
Follicular phase:
Days 1 to 13.
First day of menstruation until ovulation.
Luteal phase:
Days 14 to 28.
Time from ovulation until first day of menstruation. 6

8. After menstruation to before the next ovulation Secretory phase
Uterine cycle
Proliferative phase
Days 5 to 14
After menstruation to before the next ovulation
Secretory phase
Days 14 to 28
Time after ovulation until menstruation 8

9. Changes in the Uterus: Stage 1- Day 1-5 menstruation Stage 2 Day 5- 13
pre-ovulatory stage
Stage 3 Day 14 Ovulation
Stage 4 Day post-ovulatory stage

10. Changes in the Uterus:
Stage 1: Menstruation: Endometrium breaks down and blood, mucus, tissue, and the egg are shed through the vagina.
Stage 2: Menstrual flow stops & endometrium begins to thicken.
Stage 3: Endometrium continues to thicken.
Stage 4: The endometrium is at its thickest point.

11. Menstruation Definition:
the periodic discharge of blood and mucosal tissue from the inner lining of the uterus through the vagina. 11

12. Vagina:
Thin walled tube that provides passage way for delivery of infant and menstrual flow to leave body .
Functions:
Serves as birth canal during parturition.
Highly acidic environment, which functions to prevent bacterial infection.

13. Structural Characteristics:
a. About 9-10 cm long (3-4 inches).
b. Lies between bladder and rectum .
c. Extends from cervix to body exterior.
d. Hymen: a thin fold of mucosa at distal end of vagina that partially closes it.

14. Hymen:
a thin fold of mucosa at distal end of vagina that partially closes it.
i. Very vascular:
--Tends to bleed when ruptured during first sexual intercourse
ii. It varies:
--In some, may be torn during sports activity, tampon insertion, or pelvic examination.
--In others, may need to be surgically ruptured for intercourse to occur.

16. APC…. SI

17. Imperforate hymen Hymen completely covers the vaginal orifice
May lead to complications such as:
Blockage of menses

18. External Genital Organs:
a. Mons pubis.
b. Labia (majora and minora).
c. Clitoris.
d. Urethral and Vaginal orifices.

20. Mons Pubis:
A fatty, rounded area overlying the pubic symphysis. After puberty it is covered in hair
Labia Majora: two elongated hair covered skin folds
a. Enclose the labia minora.
b. Enclose the vestibule.
Labia Minora:
Two delicate hair-free skin folds.

21. Vestibule:
Region that contains the external openings of the urethra and vagina.
a. Urethral orifice: more anterior.
b. Vaginal orifice: more posterior.
Perineum: diamond shaped region between anterior end of labial folds and the anus posteriorly, site of episiotomy in normal labor.

22. Menarche and Menopause:
Onset of first menses.
Menopause:
Last menses.
End of childbearing age.

23. Due to decreased hormone production, postmenopausal women:
Are more susceptible to diseases like osteoporosis.
Experience atrophy of genitourinary organs.

24. Amenorrhea
Absence of menses.
Most common cause is pregnancy.
Can also be due to:
Exercise.
Drop of body fat.
Stress.
Anorexia nervosa.

25. Assessment

26. Patient assessment Scene size-up Primary assessment History taking
Secondary assessment
Reassessment

27. Patient assessment steps
Scene size-up
Primary assessment
History taking
Secondary assessment
Reassessment

29. Scene Size-up: A- Scene safety: Use standard precautions e.g. gloves
and eye protection.
Use PPE (Personal Protective Equipment) .
Consider possibility of toxic substance through determination of the number of patients.
Consider potential for violence.

30. B- Mechanism of injury ( MOI )/Nature of illness (NOI):
Nature of illness is often based on history of chronic medical problems.
Ensure that the neurological emergency is not the result of a traumatic event.
Usually the NOI can be determined by the patient’s chief complaint or by asking family members or bystanders.

31. Primary Assessment I Form a General Impression II Airway and Breathing
III
Circulation IV
Transport Decision

32. The patient’s position The patient’s face and skin
Form a general Impression
The patient’s position
The patient’s face and skin
The patient’s speech
Altered mental status
Use of the accessory muscles of respiration
Presence of body fluid around patient

33. SAMPLE History Taking Investigate chief complaint ( sample – OPQRST):
Signs and symptoms
Allergies (med allergies)
Medications
Past medical history
Last meal or intake
Events leading to call
SAMPLE

34. OPQRST O – Onset When did it begin? P – Provocation
What were you doing when it began?
Q – Quality
Can you describe the feeling you have?
R – Radiation
Does the feeling spread to any other parts of your body?

35. S – Severity
On a scale of 1-10, how bad is the trouble breathing? (1 is best, 10 worst).
T – Time
How long have you had this feeling?

36. Gynecologic and contraceptive history:
LMP ( last menstrual period )?
Possibility of pregnancy?
Vaginal discharge?
Sexual transmitted disease?
Contraception use?
Spermicides, condoms, or a diaphragm?
Implanted devise or an IUD?

37. Obstetric history
Gravida: number of times pregnant including abortion times.
Para: number of times delivering a newborn.
Abortive history: number of abortions.
Vaginal or cesarean deliveries?
How much time between pregnancies?

38. Who will answer? If there is female with obstetric history: Gravida 8
Para 4
How many kids does she have?
How many abortions does she have?

39. Menstrual history Menarche. Cycle length and regularity.
Mid cycle bleeding/pain/mucus change.
Excessively heavy or painful.
Last menstrual period.

40. Secondary Assessment I
Physical Examinations II
Vital Signs

41. Physical Examinations:
Detailed head to toe examination to detect any a typical finding regarding patient and problem.

42. Perform rapid medical assessment
Head
Neck
Chest
Abdomen
Pelvis
Extremities
Posterior

43. Gynecological examination
General examination
Head & neck , breasts, cardiorespiratory, abdominal, periphery
Abdominal palpation
Inspection external genitalia
Speculum examination vagina/cervix
Bimanual palpation of uterus and adnexae

44. Inspection Hair distribution Vulval skin
Look at the perineum for scars/tears
Look for discharge, prolapse, ulcers, warts

45. Insertion Use lubricant and warm speculum if possible
Hold speculum in dominant hand
Part labia with nondominant hand
Slowly insert and open speculum blades to visualize the cervix.

46. Visualisation of Cervix
Inspect for:
Discharge
Warts
Tumours
Size of cervical os
Bleeding

49. Reassessment I
Interventions II
Communication and documentation

50. The female genital area is highly vascular.
Bleeding may be profuse.
Applying external pressure is usually sufficient.
Exsanguinating vaginal hemorrhage must be treated as any exsanguinating hemorrhage.

51. Reference: AAOS Emergency Care in the Streets 7th Edition, Caroline
Jones & Bartlett, 2012; ISBN 13:
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