Gynecological

The vesicular (graafian) follicle

Follicle: develops the ovum | Corpus luteum (after ovulation): produces progesterone and estrogen

Maintains the corpus luteum | Supports progesterone and estrogen production | Prevents breakdown of the endometrium | Basis of pregnancy tests

Mild tachycardia

Missed or late periods | Breast tenderness | Urinary frequency | Morning sickness | Unprotected sex

Implantation bleeding | Threatened

1 to 2% of pregnancies | Leading cause of maternal death in the first trimester (about 3% of maternal mortality) |

Threatened

It can cause significant hemorrhage

self-limiting

Cervicitis

Patient bends forward

Antibiotics | Prehospital care is supportive

They share the same pathogens (chlamydia and gonorrhea)

Removal of foreign tissue plus antibiotics

The ectopic tissue responds to hormones like the uterine lining

Myometrial contractions mediated by prostaglandins

More common in women who are not sexually active and women who have not borne children | Other contributors: infection

Primary: painful menses without underlying disease | Secondary: pain from another condition (endometriosis

Biopsy to rule out malignancy

Antifungal creams

Shorter urethra

beginning or end of reproductive life

Menstruation (rarely needs emergency care)

Ruptured ectopic: rapid (can become generalized) | Ruptured ovarian cyst: sudden | PID: gradual (can become generalized)

Ruptured ectopic: unilateral (can become generalized) | Ruptured ovarian cyst: unilateral (can become generalized) | PID: diffuse

Ruptured ectopic: cramplike

Ruptured ectopic: shoulder (intraperitoneal bleeding) | Ruptured ovarian cyst: shoulder (intraperitoneal bleeding) | PID: right upper quadrant

Ruptured ectopic: vaginal bleeding | Ruptured ovarian cyst: possible vaginal bleeding | PID: watery

Ruptured ectopic: amenorrhea

Total number of pregnancies and number carried to term

Skin and mucous membranes: color

Palpate for masses

Sanitary pads or trauma dressings | Never pack | Count soaked pads and record the number on the patient care report

Do not remove it

ovaries, fallopoin tubes, uterus, cervix, vaginla, vulva

oval glands on side of uterus
outer: dense coretx VS inner: less dense medulla

ova(eggs), estrogen, progesterone

-ducst that carry ovum towards uterus
- site of fertilization

musclura pear shapped organ

- acceps/nourishes fertilized ovum
- supports implantation
- contracts in labou
- houses endometrium
- sheds non-fetilized ovum

1. endometrium ( inner lining)
2. myometrium (muscular layer)
3. perimetrium (outer layer)

- sits between fundus + cervix

lower portion of uterus
- produces cervical mucus, dilates in labour, helps protect againts infection

canal drom cervix to outside of body

external genitalia ( protects internal organs from infection)
- labio majora, lania minora, barthilin glands, clitoris

organs of milk production

normal, periodic discharge od blood, mucus and cellular debris from uteirne mucosa

first menstruation (11-14)

permanent end of menses ( avarge 47) (35-60)

28 days
- 21-35 normal

25-60 mL

FSH, LH, estrogen, progesterone

stimulates ovarian follicle development + estrogen production

LH surge triggers ovulation + formation of corpus luteum

thickens endometrium + promotes follical maturation

maintain endometrum + supports implantation

maintain corpus luteum in early pregnancy

menstrual, follicular, ovulation, luteal

- starts on day 1
- FSH + LH stimulate the ovary to release 15-20 oocytes
- estrogen shuts off FSH

- 14 days pre-period/ midpoint
- estrogen trigegrs LH surge
- follicle rupes and releases secondary oocyte
- egg captures in fallopian tube

- day 15
- empty follicle become corpus luteum ( secretes lots of progesterone+estrogen)

hcg keeps corpus luteum alive ( menses does not occur)

corpus luteum degrades, top layer of endometrium sheds as menstural flow

FSH, estrogen , LH surge, ovulation, corpus lutum, progesterone

proliferative and secretory

estrogen driven
- endometrium gorwn/ thickens

estrogen + progesterone-driven
- begins post ovulation, endometrium is ready for inplantaion
- day 21

12-24 hours post ovulation

fertilized ovum

6-10 days post fertilization
- in endometrium

10- 12 weeks

surgical removal of the uterus
- subtomtal: upper uterus removed, cervix kept
- total: all removed
- radical: uterus + parts of vaginal, ligaments, pelvic lymph nodes

-fibriods
- uterine/cervical cancer
- heavy bleeing
- endo
- PID

- blot clots
- infection
- adhesion
- postoperative hemorrhage
- bowelrinary tract unjury

-increased blood volume, heart reate, cardiac output, tidal volume, o2 consumption

preganncy which develops outside of uteres

ectopic pregnancy

-previous ectopic
-PID
- tubal damage
- endo
- IUD ( 2years)
- high maternal age
- tetrahedrons

Before:
- missed period, postive preg test, light bleeding, crampy, abdo pain

After:
- severe abdo pain, should pain, spotting, syncope, hypotension

surgery to remove pregnancy + damaged tissue

loss of pregnacy before fetal viablity

vag bleeding, lower abdo cramping, tissue/clot, back pain

tissue passed with continued bleeding

thin walled, fluid fluid sac on surface of ovary
- rapid expansion, torsion, rupture

corpus luteum cysts during menstruation

sudden, localized, one-sided abdo pain
- minimal abdo trauma, exercise, sex

ovary twists on its vasculature or adnexal (ligaments), comprimising blood flow

congenital abnormalities
cysts/tumours
tube/ovary disease
adhesion from pelvic surgery

sudden unilateral lower abdo pain, radiate to back/pelvis, nausea, vomiting, fever

ascending infection of cervix, uterus, fallopian tubes, ovaries

sexaully or transmitted bacteria ( clamydia, gonorrhoeae)

7-10 days post end of period

lower abdo pain, fever, purulent vag discharge, bleeding, dyspareunia

infertility, chronic pelvic pain, tubal scaring, ectopic, tubo ovarian abcess, sepsis

fever, hypotension, tachycardia, altered mental status

inflammation of the uterine linning

post childbirth/aboriton, retained placental tissue

fever, purulent vag discharge, lower abdo pain

sterility, sepsis, death

endometrial tissue grows outside of uterus ( pelvic, ovaries, fallopian tubes, peritoneum, ligaments)

retrograde menstruation, gentic factors, hormones, surgery, immunue disorders

chronic pelvic pain, dysmenorrhea, dyareunia, painful defication, suprapubic soreness, spotting, infertility

middle/ovulation pain

rupture of graafian follicle with ovarian bleeding

mild, one sided, lower quadrant pain at mid cycle
-24 - 36 hours

painful menstruation

headache, faintness, dizziness, nausea, diarrhea, backache, leg pain

collection of pus in bartholin gland from blocked duct with infection

painful unilateral vulvar lump, swelling, inflammation, pain when walking, intercourse

inflammation of the vagina

postmenopausaul/postpartum

cadida(yeast), bacterial, ST, parasite, virus, poor hygine

allergic reactions, irratation, soaps, sprays, douches

genetil irritation, itching, redness, swelling, dicharge, foul odor, burning with urination

inflammatino of the inner linning of the bladder

frequent urge to pee, burning urinatino, fever, chilld, lowe abdo pain, smellylody urine

abnormal bleeding form hormone changes

anovulation -> no ovulation -> tissue necorsis -> shedsleeds

bleeding between periods, short cycles, cycle timing changes, heavy bleeding

uterus slide from its normal position into vaginal canal

stretched/weakened muscle/ligaments

vaginal childbirth, large abbies, anging muscle tone, menopause, low estrogen, pelviv tumout, obesity

first, second, third

vaginla heaviness, low back pain, painfull intercourse, vag bleeding

foul smelling, purelent discharge

menstruation, spontaneous abortion, placental disorders, cancer, hormonal imbalamce, lesions, PID

normal: under 2 oz
moderate: 2-3 oz
heavy: over 3

fever, diaphoresis, syncope, diarrhea, constipation, abdominal cramping, dizziness, dircahge, tissues/clots

1. pregnancy - total number (gravida/para)
2. previous c-sections
3.last menstrual period ( date, duraiton, regular, normal)
4. posibility/pregnacy
5. previous gyne history
6. present blood loss ( colour, amount, clots, tissue)
7. vaginal discharge ( colour, amount, odor)
8. contraceptice use/type
9. history of trauma to reproductive system
10. degree of emotional distress

cervis is widened and endometrium is scraped away
- uterine disease, heavy bleeding

- how many pads soaked
- how fast
- tissue passed
- bleeding increasing/decreasing

colour, amount of blood, clots or tissues

early - tachycardia, anixety, pallor, cool skin, delayed cap refil
late - hypotension, altered mental status, weak peripheral pulses, collapse

better (increased blood volume gives physiologic compensation)

appendicitis, renal colic, UTI, AAA, gi pathology

1. identify need to be agressive
2. ABC, high flow 02
3. position of conform
4. IV acess
5. control bleeding ( do NOT pack)
6. monitoring

65 mmhg

forcible sexual contact on another persons body without consent ( crime)

medical assesment, treat life threats, emotional support, resptful communication, privacy, rapid transport ( if needed)

- was there penetration
- sexual history
- emotional stress levels

-trauma outside pelvic area ( facial fracturs, human bites, bone fractures, abdo trauma)
-genitalia exam ( restpectfull and only if nessesary)

- emotional state
-condition of clothing
- obvious injuries
- care gicen
- pateint statement

- dont let pt change clotes
- handle them as little as possible
- if clotting needs to come off, bad individually in paper bags
- do not clean wounds unless absolutly necesarry
- disturbe scene as little as possible

- developing embryo/placenta
- hcG

1. follicular development
2. LH surge
3. ovulation
4. corpus luteum formation
5. fertilization
6. implantation

blood collects internaly in abdo cavity

out of proportion

PID

-ruptured ectopic pregnancy
- ovarian torsion
- PID with sepsis
- ruptured ovarian cyst with hemorrhage
- spontaneous abortion with hemorrhage

- hypotension, tachycardia, pallor, cool skin
- syncope/dizziness
- altered mental status
- sudden severe pain
- heavy bleeding with clots/tissue
- fever + hypotension (sepsis)