Medical Gynecological Emergencies

 

Nobody likes to talk about them but everyone needs to know about them! 

 

Here is a quick reference to some common gynecologic emergencies.

 

 

 

First some anatomy:

 

Uterus-Site of fetal development

 

Fallopian Tubes-A pathway between the Ovaries and the Uterus traveled by eggs.

 

Ovaries (Female Gonads) where the eggs are produced and released and where hormones are secreted.

 

 

 

It is a good bet that if a woman is having abdominal pain, there is probably a Good and Gynecological explanation for it:

 

 

Pelvic Inflammatory Disease (PID)-

 

This is an infection of the female reproductive tract: the uterus, fallopian tubes and ovaries.  It is most common in sexually active women of childbearing age.  It is mostly caused by Gonorrhea or Chlamydia.  If left untreated this disease could lead to sepsis. 

 

Upon assessment of these patients your finding will be similar to that of those with appendicitis.  Your patient will complain of low abdominal pain rated severe to moderate in nature and they may or may not have a fever.  In addition these patients will have increased abdominal pain in and around menstruation and with sexual intercourse.  

 

Pre-hospital treatment of women with PID is transportation in the position of comfort.  Oxygen and IV for patients showing signs of sepsis.

 

 

 

Ruptured Ovarian Cyst-

 

Ovarian Cysts are blood filled pockets that can develop after ovulation or independent of ovulation in the ovaries.  They usually rupture with physical activity or with sexual intercourse.  When they rupture the blood leaks out to the abdomen causing pain and sometimes vaginal bleeding.

 

 

 

Cystitis-

 

Cystitis is a urinary bladder infection.  If left untreated the infection could lead to the kidneys.   Patients will complain of abdominal pain, pain with urination, fever and frequent urination.

 

 

 

Mittelschmerz-

 

This is a fancy name for pain associated with ovulation.  Patients may also report low-grade fever during this time, which is a normal side effect of ovulation.  Treatment is symptomatic.

 

 

 

Endometritis-

 

An infection of the uterine lining.  This potentially deadly condition is a complication of miscarriage, childbirth or other gynecological procedures.  Your patients will present 48-72 hours post event with fever, abdominal pain and bloody/foul smelling discharge.  Antibiotic treatment is needed.  Complications may include sterility, sepsis or death.

 

 

 

Endometriosis-

 

A condition in which endometrial tissue is found outside the uterus.  The tissue responds to hormonal changes and bleeds in a cyclic manner.  Your patients will complain of dull and cramping pelvic pain.

 

 

 

Etopic Pregnancy-

 

This is the implantation of a fetus outside the uterus.  This is considered a surgical medical emergency since the possibility of rupture of a fallopian tube and massive hemorrhage is very possible.  Your patients will complain of abdominal pain that radiates to the affected side shoulder, late or missed periods and occasionally vaginal bleeding.

 

 

 

Management of Gynecological Abdominal Pain

 

Any significant abdominal pain should be treated and transported for evaluation.  Interventions can include Oxygen administration and IV access.  Remember this can be a very emotional event for your patient.  Treat her with compassion and consideration.

 

 

Nontraumatic Vaginal Bleeding

 

Most vaginal bleeding seen in the field are severe.  Most commonly this is due to miscarriage.  If you patient's last menstrual period is over 60 days ago assume this is the reason for the bleeding.  Other causes are cancerous lesions, PID and onset of labor. 

 

 

 

Management of Nontraumatic Vaginal Bleeding

 

Treatment in the field will depend on severity of the bleeding.  Absorb the flow, do not pack the vagina.  If your patient is passing clots or tissue save this material for the physician.   Again, remember this is a very emotional event for your patient.  Treat her with compassion and consideration.

 

 

 

Source:  Brady Paramedic Care Volume 3 Medical Emergencies