GYN Flashcards
Perineum
- Tissue between vaginal opening and anus
- Stretches out during childbirth and may tear
-Obstetrician may perform an episiotomy
•Places an incision in this tissue that is easier to repair and heals better than the torn tissue
Vagina
Lower portion of the birth canal
Uterus
- Pear shaped organ
* Made up of the lower, narrow (neck) or cervix the middle or body, and the uppermost, dome-shaped fundus
Endometrium
- Inner lining of the uterus
* Nutrient-rich area of implantation of fertilized egg
Myometrium
- Muscular, middle lining of uterus
- Responsible for contractions
- Thickest at fundus
Fallopian Tubes
- 2 tubes connected to the uterus
- One on either side
- Lined with cilia
Ovaries
- A pair of glands located on either side of the uterus
- Release nature egg or ovum (plural; ova)
- Release reproductive hormones- estrogen & progesterone
- Ovaries ➡️
- NOT connected to Fallopian tubes
- Generally, one ovary produces an ovum on altering months
- Baby girls are born with all of the ocytes she will ever possess
Menstruation cylcle
- Approximately 29 days
- Begins with menstruation
- Blood, mucus, cellular debris is shed from the endometrium
- Normal flow averages 25-60 mL, and lasts 4-6 days
Menarche
- Onset of first menses
- Signals the beginning of childbearing age
- Around 11-14 years of age
- Average 12.5 years of age
Menopause
•End of childbearing years
•As long as a woman continues a menstrual cycle, she is capable of conceiving a child
-Average 51-52 years of age
Ovulation
- Release of mature ovum from ovary
* Occurs by release of luteinizing hormone (LH) from anterior pituitary gland
Progesterone
- The hormone of pregnancy
- Prepares uterus for implantation
- Regulation of menstrual cycle
Estrogen
•Females
- Prepares endometrium for implantation
- Secondary sex characteristics
•Males
- Mature sperm
- Increased libido
Fertilization
Takes place in the distal third of the fallopian tube
24hr window for fertilization to take place
1 sperm + 1 ovum
Implantation
•Fertilized ovum travels to the uterus
-Endometrium has grown thicker in preparation for pregnancy
•Cervix sealed with a mucus plug
•Implantation on the uterine wall takes place 1 week
•Placenta begins to form
•Embryo until the 8th week of pregnancy ➡️ then fetus
•If fertilization does not take place:
-Menstruation always occurs 14 days after ovulation
•Menstrual cycle begins again
Gynecology
Disease and routine care of female reproductive system
Obstetrics
Surgical specialty dealing with pregnancy, birth and postpartum
Care of mother after delivery
GYN & OB History
- Vaginal bleeding?
- Abdominal pain?
- Vaginal discharge?
- Pregnancy?
- LMP?
- Birth control?
- Gravida/para?
- Complications of pregnancy?
- C-section?
- STD’s?
- Medical history?
Dysmenorrhea
Painful menstruation
Amenorrhea
Absence of menstruation
-MOST common cause of which is PREGNANCY
Dyspareunia
Painful intercourse
Any Women of Childbearing Years
With Abdominal Pain
Treat as gynecological emergency until proven otherwise
Ask LMP or suspect pregnancy
Any Woman of Childbearing Years
With Vaginal Bleeding
Potential life threat until proven otherwise
SHOCK
Ask LMP or suspect pregnancy
Pelvic Inflammatory Disease (PID)
•Inflammation of uterus, ovaries, fallopian tubes
•MOST often sexually active females under 25 years of age
-Multiple sex partners
•Common cause
-STDs, chlamydia and gonorrhea (bacterial)
•Use of intrauterine devices (IUD)
•Previous episodes of PID
-Increase risk of recurrence
•Many woman go undiagnosed
-Symptoms can be mild or subtle
PID Complications
- Ectopic pregnancy
- Infertility
- Chronic pelvic pain
- Sepsis (rare)
- Scare tissue builds up in fallopian tubes, uterus
PID Assessment
•Look sick, may have fever and chills •Lower Abdominal pain -May be right sided •Vaginal discharge with foul (fishy) oder & dysuria •Dyspareunia - recent intercourse •Shuffling gait (double over when walking) with abdominal guarding -Painful palpitation •Acute onset -Within 1 week of menstrual period -Irregular Bleeding
Mittelschmerz
•Sharp, lower abdominal pain/cramping
-Unilateral (middle pain)
•Associated with ovulation
•Symptoms similar to rupture ovarian cyst
Ruptured Ovarian Cyst
•Ovary fails to release ovum and creates cyst (usually resolve)
•Sudden onset of severe lower abdominal pain
-Unilateral
•May radiate to back
-Possible vaginal bleeding
Ovarian Torsion
•Twisting ovary interrupting blood supply
•Surgical emergency
-Women with ovarian cyst most prone
•Acute onset, unilateral lower abdominal pain, may radiate to back, pelvis, or thigh
Cystitis
•Bladder infections
-Women more prone
•Female urethra is shorter than that of a male = predisposes UTI and bladder infections
•Effects bladder, ureters, may lead to pyelonephritis
-Tenderness above pubis, dysuria, cloudy urine or hematuria, polyuria
Endometritis
•Inflammation of the endometrium -Usually caused by infection •Most often after childbirth, abortion •Untreated can lead to sepsis and death -Common cause of sterility •Lower Abdominal pain, purulant vaginal discharge
Endometriosis
•Endometrial lining grows outside of uterus
-Women later 30’s who wait pregnant
•Effects Fallopian tubes, pelvic organs, bowel, bladder
•Pain lower back, dysmenorrhea, painful bowel movements, heavy menstrual bleeding, dyspareunia (painful intercourse)
-During or immediately after
Uterine Prolapse
•Uterus protrudes from vagina -Falls out of place •Older women- bearing down, coughing •Younger women- childbirth ➡️ significant bleeding risk •Treatment -See postpartum hemorrhage
Vaginitis
•Inflammation of vaginal tissues
-May include external genitalia (vulvovaginitis)
•Vaginal discharge
-Thin or sticky
-White/gray
•Foul odor (fishy odor)
•Itching, Irritation, pain
-Often worsening after menstruation/intercourse
•Can result in PID by spreading upwards into reproductive system
Vaginal Trauma
•Vaginal bleeding
-Vigorous voluntary intercourse not uncommon
•Consider violent assault possibility
•Do injuries match mechanism?
•Pt’s story confusing, or changes over time?
Vaginal Trauma Causes
•Intercourse •Straddle injuries -Impact on pudendum (external genitalia structures) •Pelvic fractures •Direct blow to perineum •Blunt force to lower abdomen -Assault, seat belt •Foreign body insertion into vagina •Abortion attempts
Sexual Assault
•Primary goal
-Treat injuries and emotional needs of patient
-Crime scene preservation important, but secondary
•Pt’s reaction
-Hysterical, agitated, angry or fearful, silent, withdrawn, denial = ALL normal
•Complete, detailed history may not be possible or warranted
•Examination of genitalia ONLY if injury is severe
-Female pt = Female EMS, likewise male
•Assess for trauma as any other
-Head injuries, abdominal, strangulation, chest injuries, extremity lacs, and fractures all common
•Pt’s should not change clothes, eat, bathe, urinate, defecate, or douche
•If you must remove clothing, place each piece in a PAPER bag
Intimate Partner Violence
•Higher incidence in women -Occurs in both men and women •Current or former spouse -Cohabiting partner/date •Pregnant women -High risk for partner violence; father of child •#1 Blunt trauma to abdomen •Also face, head, breasts •DO NOT CONFRONT suspected abuser!!
General Treatment GYN
•Assess and treat ABC’s
•Treat for shock
-Consider hypovolemic shock with bleeding
-Septic shock for bacterial infection
•IV access (Consider 2 IVs)
•Monitor vital signs
•Fluid resuscitation and analgesia per pt’s condition
•Position of comfort; maintain modesty; emotional support
•Do not pack dressing inside vagina
-Use OB pads outside (white side to woman)
•Bleeding
-Amount-describe (eg. soaked 3 maxipads in 1 hr)
-Color- bright red, dark
-Presence of clots, tissue
•Discharge
-Amount- describe as above
-Color/Nature- clear, yellow, mucus, blood tinged, fluid, foamy, tissue
-Odor- foul, none
•Transport vaginal secretions in clean, sealed container for evaluation
•Note on estimation of blood loss and subsequent treatment
-Per pt’s clinical condition/presentation
-Not based upon number of pads soaked
