Gynaecological Conditions PDF - London Ambulance Service - May 18, 2023

Gynaecological Conditions Physiology of gynaecological conditions Clinical assessment and management Session objective Describe the following gynaecological conditions and their management within scope of practice: Vaginal tissue damage Surgical/medical termination of pregnancy...

Gynaecological Conditions Physiology of gynaecological conditions Clinical assessment and management Session objective Describe the following gynaecological conditions and their management within scope of practice: Vaginal tissue damage Surgical/medical termination of pregnancy Prolapsed uterus Menorrhagia (abnormally heavy or prolonged menstrual bleeding) Dysmenorrhea (excessive pain associated with menstruation) London Ambulance Service NHS Trust 2 Wellbeing Genital trauma and bleeding London Ambulance Service NHS Trust 4 Vaginal bleeding Most vaginal bleeding doesn’t compromise the patient’s circulation, but it can be alarming. Causes include: Menstruation Following surgical/medical termination of pregnancy Following gynaecological procedures (e.g. colposcopy) Gynaecological cancers Trauma (vaginal tissue damage) London Ambulance Service NHS Trust 5 Genital trauma Defined as any damage or trauma to the external (labia majora, labia minora, vaginal opening, perineum, clitoris), internal (hymen, vagina, cervix) or anal (anus and rectum) areas. Post-coital tears Female genital mutilation Penetrating trauma Sexual abuse/assault (any suspicion requires a safeguarding referral) London Ambulance Service NHS Trust 6 Female genital mutilation Also known as female cutting and by other terms such as Sunna, Gudniin, Halalays, Tahur, Megrez, Khitan and others. Comprises all procedures that involve partial or total removal of the external genitalia, or other injury to the female genital organs (can include piercing, stretching, staining) Usually carried out on young girls between infancy and the age of 15, most commonly before puberty starts It is illegal in the UK and is a form of child abuse. London Ambulance Service NHS Trust 7 Suspected FGM Safeguarding referral via EBS If FGM is disclosed or there are physical signs observed in children (under 18s), this must be reported to the police under the Serious Crime Act 2015 If Type 3 or Type 4 FGM (involving closure of the vaginal opening) is observed in a woman in labour, this is likely to obstruct the birth of the baby and/or cause severe trauma to the genital tract. Have a lower threshold to convey to the nearest obstetric unit London Ambulance Service NHS Trust 9 Termination of Pregnancy London Ambulance Service NHS Trust 10 Termination of pregnancy Also known as abortion Age-standardised abortion rate was 18.6 per 1,000 women in the UK in 2021. Can be for social or medical reasons (diagnosis of fetal abnormality or risk to woman’s health) Legal up to 24 weeks for social reasons. Can be carried out after 24 weeks (up to full term) in limited circumstances, such as if the woman’s life is at risk or the baby is diagnosed with a severe or life-limiting disability. London Ambulance Service NHS Trust 11 Medical Termination of Pregnancy Sometimes referred to by health professionals as ‘MTOP’ An ultrasound scan is usually performed to confirm gestational age, however since the pandemic women can access MTOP in early pregnancy via telemedicine (‘Pills by Post’) Usually comprises of 2 medicines (Mifepristone and Misoprostol) taken 24-48 hours apart, to end the pregnancy by softening the cervix and encouraging the uterus to contract London Ambulance Service NHS Trust 12 Safeguarding Considerations In rare cases, women can undergo termination of pregnancy through unsafe means and/or access MTOP medication through the Pills by Post scheme when they are over 10 weeks’ gestation. Use the Newborn Assessment Card to aid decision making (re. resuscitation) if a baby appears formed/viable. Low threshold for conveyance and safeguarding referral Police involvement may be necessary Always act with compassion London Ambulance Service NHS Trust 13 Surgical Termination of Pregnancy A procedure is performed to remove the pregnancy, performed under local anaesthetic, sedation or general anaesthetic depending on the gestation Often carried out as an outpatient surgery, women return home the same day London Ambulance Service NHS Trust 14 Post Termination Some bleeding and discomfort is normal for up to 2 weeks, however women are encouraged to call 999 if they notice any excessive bleeding Inco sheet saturated with 500mls Remember to use the Maternal Assessment Card Excessive bleeding post-termination is still defined as a post-partum haemorrhage and requires a pre-alert to the nearest obstetric unit Pad saturated with 50mls London Ambulance Service NHS Trust 15 Prolapsed Uterus London Ambulance Service NHS Trust 16 Prolapsed Uterus Defined as where the uterus has dropped down (prolapsed) into the vagina. This happens when the normal structures (such as the pelvic floor) that hold the uterus in place weaken and are no longer effective Not usually life-threatening but can cause shock/vaso-vagal symtpoms London Ambulance Service NHS Trust 17 Prolapsed Uterus Symptoms A feeling of heaviness around the lower abdomen/genitals Discomfort or numbness during sexual intercourse Feeling or seeing a bulge or lump in or coming out of the vagina Problems urinating London Ambulance Service NHS Trust 18 Management of Gynaecological Conditions (C) A B C D E approach Assess for any time critical features/red flags (If YES pre-alert) Consider paramedic assistance Oxygen if shocked, hypoxic or hypovolaemic (per JRCALC) Non time-critical- secondary survey and transfer to ED Empathy, support and offer of pain relief in all cases London Ambulance Service NHS Trust 19  Questions? London Ambulance Service NHS Trust 20