Gynaecological Emergencies Flashcards
Gynaecology Definition
the study of the female reproductive system - including the uterus, ovaries, vagina and cervix
Obstetric care definition
Care concerned with pregnancy and birth, closely linked to gynaecological care
PV bleeding: Assessment
Discuss normal menstruation to identify abnormal bleeding
Assess blood loss and estimate if not possible
Identify time critical features of shock
consider age
inlcude abdominal assessment if not time critical
Miscarriage: signs and symptoms
Pain
Bleeding
lower back and abdomen cramps
passing of blood clots from vagina
Miscarriage: risk factors
History of previous miscarriage
smoking
obesity
alcohol
Managing fetal tissue before 22 weeks
Woman offered opportunity to transfer tissue with her to hospital
Inform the woman and discuss preferences about management of the fetal tissue
Transport tissue using soft item from maternity pack
If remains are in toilet, document inspection undertaken
Misoprostol used to control bleeding only if sure fetus is no longer in uterus.
Ectopic pregnancy definition
fertilised ovum implanting and maturing outside of the uterus, normally in the fallopian tube, ovary or cervix.
ectopic pregnancy: pathophysiology
transport of embryos required interaction of tubal epithelium, fluid and contents to move embryo into the uterus.
Migration difficulty can occur due to abnormal fallopian tube anatomy, molecular signalling between oocyte and implantation site and other molecular factors.
Ectopic implants into site and grows, as ectopic grows it eventually causes tubal rupture and bleeding.
Ectopic pregnancy: risk factors
Previous ectopic pregnancy
IUD
Pelvic inflammatory disease
Ectopic pregnancy: signs and symptoms
lower back and abdomen pain
shoulder tip pain referred from bleeding into the diaphragm
vaginal bleeding
amenorrhea (no menses for 3/6 months)
rupture suggested with unstable vital signs, bleeding and tenderness
endometriosis: pathophysiology
the growth of endometrium like tissue outside of the uterus, commonly in the ovaries, peritoneum, pelvic tissue and pouch of douglas.
Endometriosis: signs and symptoms
dysmenorrhea
chronic pelvic pain
abdominal pain
bloating
pain during or after sexual intercourse
haematuria
dysuria
Endometriosis: assessment
History - family history, early menarche, sexual history
Pelvic and abdominal examination
Ultrasound and laparoscopic visualisation to diagnose
Endometriosis: management
Analgesia
referral to gynaecological specialist
support and information provided
review patient for complications
Sexual assault paramedic considerations
Assess need for treatment in an emergent department
No statutory duty to report (up to patient) unless significant risk to others is present.
reassurance
forensic awareness - discourage showering/changing clothes, place clothes in plastic bag, hand in blankets if used
transfer/referral to sexual assault referral clinics
Genitourinary clinics
Ovarian Torsion: pathophysiology
Torsion of the left or right ovary in which the fallopian tube twists over a supporting ligament.
This causes swelling and obstruction of blood flow to the organ. Initially venous blood flow is obscured and eventually arterial blood flow is obscured due to increases swelling.
This leads to ischaemia and infarction.
Right side ovarian torsion is more common as more space due to sigmoid colon on left side.
Ovarian Torsion: signs and symptoms
Nausea and vomiting
dull or sharp lower abdominal pain
radiating pain to back and flank
fever if ovary is necrotic
vaginal bleeding
focal abdomen tenderness
FGM: definition
partial or total removal of the external female genitalia or other injury to female reproductive a system for cultural or non therapeutic reasons.
FGM: health complications
cysts
infection
need for surgery
infertility
increased risk of birth complications
FGM: human rights
painful as performed without anaesthesia
performed with unsterile tools
no health benefits
performed on young children without consent
right to healthy body, free from torture, to choice
Toxic shock syndrome: pathophysiology
tampons, contraceptive sponges and diaphragms are breeding grounds for toxin producing bacteria including staphylococcus aureus and streptococcal pyogenes.
TSS can also be caused by any type of infection, pneumonia, surgery complications and septicaemia.
Exotoxin (superantigen) production activates T cells when bound to MHC complex and this initiates a system inflammatory response due to cytokine and mediator release.
this leads to shock and organ failure.
TSS: signs and symptoms
Fever
Hypotension
sunburn rash
vomiting
diarrhoea
confusion
muscle aches
rash and peeling on palms and soles of feet
seizures
headaches
TSS: risk factors
Post surgery
recent childbirth
viral infections
severe burns
TSS: differentials
Cardiogenic shock
UTI
cellulitis
meningitis
septic shock
dengue fever
typhoid
