Chapter 24: Gynecologic Emergencies

Introduction

• Women are uniquely formed to conceive and give birth, making them susceptible to certain conditions not found in men.
• This chapter covers anatomy, conditions encountered in pre-hospital settings, vaginal bleeding, health concerns for various ages, and sexual assault treatment principles.

Anatomy and Physiology

• External Female Genitalia: Includes the vaginal opening, urethral opening, labia majora, labia minora, clitoris, anus, and perineum.
• Internal Structures:
  • Ovaries: Produce ovum (egg) leading to potential pregnancy.
  • Fallopian Tubes: Connect ovaries to the uterus.
  • Uterus: Muscular organ for fetus growth during pregnancy.
  • Cervix: Opens into the vagina.
  • Vagina: Part of the birth canal.
• Ovulation and Menstruation
  • Begins at menarche (ages 11-16) and ends at menopause (around age 50).

Pathophysiology

• Gynecologic Emergencies: Range from STDs to trauma, requiring recognition and management of female patients with abdominal or pelvic pain.

Pelvic Inflammatory Disease (PID)

• Infection of upper reproductive organs; affects sexually active women.
• Can lead to ectopic pregnancy or abscess.
• Symptoms: Lower abdominal pain, abnormal discharge, pain during intercourse, fever, nausea.
• Risk Factors: Multiple partners, untreated STDs, douching, IUD use.

Sexually Transmitted Diseases (STDs)

• Chlamydia: Mild symptoms but can cause PID if untreated.
• Bacterial Vaginosis: Overgrowth of bacteria causing discharge and odor.
• Gonorrhea: Can infect reproductive tract and other areas; symptoms often mild in women.

Vaginal Bleeding

• Can result from abnormal menstruation, trauma, ectopic pregnancy, miscarriage, polyps, or cancer.
• Should be evaluated by a physician.

Patient Assessment

• Scene Size-Up: Ensure safety, assess nature of illness, and take precautions.
• Primary Assessment: Determine stability, assess airway, breathing, and circulation.
• History Taking: Sensitive questioning about symptoms, menstrual history, pregnancy possibility, STDs.
• Secondary Assessment: Vital signs, abdominal distension, and tenderness; maintain privacy.

Emergency Medical Care

• Maintain patient privacy; use sanitary pads for bleeding.
• Treat for shock if necessary; avoid inserting items into the vagina.
• Sexual Assault and Rape
  • Ensure privacy; use a female EMT if possible.
  • Preserve evidence without judgment.
  • Address medical and psychological needs.
  • Respect patient's autonomy in reporting and treatment decisions.

Conclusion

• Gynecologic emergencies require a sensitive approach to both medical and psychological needs.
• Documentation should focus on patient statements and observable facts without personal bias.