1. Gynecology

3. The Menstrual Cycle
 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.

4. Phases of the
Menstrual Cycle
 The Proliferative Phase
 The Secretory Phase
 The Ischemic Phase
 The Menstrual Phase

5. Proliferative 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.

6. Secretory 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.

7. The Ischemic Phase
 Estrogen and progesterone levels
fall without fertilization.
 The endometrium breaks down.

8. The Menstrual Phase
 The Menstrual Cycle
 Premenstrual Syndrome
 Menopause

9. Assessment of the
Gynecological Patient

10. History
 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.

11. Physical 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.

12. Management of Gynecological
Emergencies
 General management of
gynecological emergencies is
focused on supportive care.
 Do not pack dressings in the
vagina.

13. Specific Gynecological
Emergencies
Medical and Trauma

14. Medical Gynecological
Emergencies
 Gynecological Abdominal Pain
 Pelvic Inflammatory Disease
 Ruptured Ovarian Cyst
 Cystitis
 Mittelschmerz
 Endometritis
 Ectopic Pregnancy

15. Management of Gynecological
Abdominal Pain
 Make the patient comfortable and
transport.

16. Vaginal Bleeding
 Nontraumatic
 Menorrhagia
 Spontaneous abortion

17. Treatment for Vaginal
Bleeding
 Do not pack vagina.
 Transport
 Initiate oxygen and IV access
based on patient condition.

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

19. Management of
Gynecological Trauma
 Apply direct pressure over
laceration.
 Apply cold pack to hematoma.
 Establish IV if patient is severe.
 Transport.

20. Sexual 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.

21. Management
 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.

22. Documentation
 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.