Medical and Obstetrics/​Gynecology Study Guide for the EMT Test

Gynecologic Emergencies

A woman’s anatomy and physiology is complex, and gynecological emergencies can occur in women of all age groups. Disorders that affect the ovaries, fallopian tubes, and uterus can lead to emergency situations.

Gynecologic Anatomy and Physiology

The female genitals include the external structures including the labia majora and labia minora. The labia can be injured easily because it is very vascular. Internal structures include the ovaries, uterus, and fallopian tubes. In women of childbearing age, the ovaries release an egg each month in a process called ovulation. The egg travels down the fallopian tubes, where it is available for fertilization. If an egg is fertilized, it is implanted into the wall of the lining of the uterus.

Gynecologic Pathophysiology

There are a number of gynecological conditions that can become emergencies, such as trauma and infections. Common conditions that an EMT might encounter include pelvic inflammatory disease, sexually transmitted diseases, and abnormal vaginal bleeding.

Patient Assessment

Because bleeding is common during a gynecological emergency, take needed safety measures during your scene size-up. If the patient has been a victim of a sexual assault, try to have a female EMT provide care and be sure law enforcement is involved. During your primary assessment, determine if blood loss has made the patient unstable. During a medical history, consider questions such as the possibility of pregnancy, sexually transmitted diseases, and the date of the woman’s last menstrual period. During the secondary assessment, check for additional injuries if the woman is a victim of sexual assault. Check vital signs, mental status, and abdominal tenderness. Reassess frequently, including taking a blood pressure measurement, since blood loss may be a concern.

Gynecological Emergency Care

Be sure to maintain the patient’s privacy as much as possible when you’re treating a patient with a gynecological emergency. If possible, have a female EMT treat the patient. Bleeding may be an issue, so watch for signs of shock and treat accordingly. Injuries to the genitals can be very painful, due to the abundance of nerve fibers. Treat lacerations with sterile dressings and do not attempt to remove foreign bodies from the vaginia.

Management of Conditions

Specific gynecological conditions require certain treatment. In some cases, prehospital treatment may be limited. For example, treatment for pelvic inflammatory disease in a prehospital setting involves pain management and monitoring during transport. In a prehospital setting, you may also be called to treat a sexual assault victim. Care involves assessing for injuries, controlling bleeding, and supportive care. Careful consideration should be given to the sensitive nature of the incident. Law enforcement should be involved and they should provide information on preserving evidence as it pertains to the victim’s medical care.

Terms/Concepts to Know: chlamydia, perineum, cervix, ovulation, pelvic inflammatory disease

Obstetrics and Neonatal Care

Obstetrics and neonatal care involves taking care of women before, during, and after pregnancy and giving birth. It’s important to understand that many conditions can affect both the woman and baby.

Female Reproductive Anatomy and Physiology

Learning the gynecological anatomy discussed in the previous section is helpful to understand the female reproductive system. In women of childbearing age, an egg is released from the ovary and travels down the fallopian tube. If the egg is fertilized, it travels to the uterus where implantation occurs. The fertilized egg becomes an embryo where it continues to develop. The placenta also develops and provides the growing fetus nutrients and oxygen. The umbilical cord attaches to the fetus and the placenta. The fetus is surrounded by an amniotic sac, which contains fluid to cushion the fetus.

Normal Pregnancy

A normal pregnancy lasts about 40 weeks, but a baby is considered full-term at 39 weeks gestation. Pregnancy is also divided into three equal trimesters. During a normal pregnancy, several changes take place in a woman’s body, including an increase in blood volume. In addition, other changes are common, such as weight gain, slowed digestion, and loose joints due to pregnancy hormones.

Pregnancy Complications

Pregnancy complications can range from minor to life-threatening for both the woman and baby. These can include gestational diabetes, which is diabetes that develops during pregnancy. Uterine bleeding can also occur, for a variety of reasons, including problems with the placenta. Preeclampsia is another pregnancy complication that involves increased blood pressure.

Trauma During Pregnancy

Trauma in pregnancy can cause injuries to both the woman and baby. Due to the increased blood volume, women may be prone to excess bleeding after sustaining an injury. Special consideration should be trauma to the abdominal area. If a woman sustained trauma to the abdomen, vaginal bleeding and abdominal pain may be common complaints. Also, keep in mind that motor vehicle accidents can result in injuries from seat belts worn improperly, so careful assessment is vital when caring for a pregnant woman who has been involved in a car accident.

Cultural Values

Cultural differences affect how a woman deals with pregnancy, and it is important for EMTs and paramedics to respect these differences. For example, in some cultures, women do not want male healthcare providers to treat them. In this situation, if possible, have a female EMT treat the patient.

Pregnant Teens

Although every pregnancy is different, teens may have certain pregnancy complications, such as higher rates of low birth weight. When treating a teen who is pregnant, try to have a parent present. It is also important to be aware of laws in your state regarding a pregnant teen’s ability to refuse care for themselves. In many states, pregnant teens have the same rights as adults when it comes to medical care.

Patient Assessment

When approaching a scene involving a pregnant woman, be sure to take time to use standard precautions. If present, family members may be anxious, but don’t let that rush you through a thorough scene size-up. During a primary assessment, determine if the patient is in active labor. Assess for potentially serious problems, such as breathing difficulties or bleeding. During a history, determine how far along the pregnancy is and if the woman has had any pregnancy complications. During a secondary assessment, check for fetal movement and maternal vital signs. Be alert for a drop in blood pressure, which could indicate bleeding. Reassess the patient frequently and be alert for changes in vital signs.

Normal Delivery

During a normal delivery, labor is divided into three stages: dilation of the cervix, delivery of the baby, and delivery of the placenta. As an EMT, if you are called during early stages of labor, your role will be to monitor the patient as you transport. But there may be instances where delivery will not wait until the patient is transported to the hospital. If you have to deliver the baby, open your OB kit and position the woman appropriately for delivery and privacy. Check for crowning, which means the baby’s head is at the vaginal opening. As the woman pushes the baby out, support the baby’s head as it emerges. Check to see if the umbilical cord is around the baby’s neck. If so, gently lift it over the baby’s head. After the head is delivered, the baby will rotate to one side as the shoulders are delivered. After the shoulders, the rest of the body should emerge.

Normal Post-Delivery

After the baby is born, place the infant on the mother’s chest for skin to skin contact. Dry the baby with a towel and keep the baby warm with a clean, dry blanket. Clamp the cord after it stops pulsating. The last stage of labor is delivery of the placenta, which usually occurs on its own with only a little assistance from the EMT. The placenta may be delivered a few minutes after the baby but if not, do not delay transport to the hospital.

Neonatal Care

The immediate steps of caring for a newborn involve warming and drying the baby. Consider suctioning the baby’s mouth and nose if secretions are present. Assess the baby to determine if resuscitation is needed by checking for breathing, muscle tone, and heart rate. If the baby is not crying, provide stimulation by flicking the soles of the feet. If the baby is still not crying, he needs further intervention. Resuscitation efforts may include manual ventilation and chest compressions.

Delivery Complications

There are various possible delivery complications. One of the most common complications is a breech delivery. Normally, babies are born head first. A breech delivery involves a foot or buttocks first presentation. The baby is at a higher risk of trauma during a breech delivery. A prolapsed umbilical cord is another possible complication. A prolapsed cord involves the umbilical cord coming out before the baby. Anytime you think you may have a delivery complication, it is vital to call for Advanced Life Support (ALS) backup.

Post-Delivery Complications

The most common post-delivery complication you may deal with is bleeding. Some bleeding is normal during and after delivery. But if the uterus does not start to contract, bleeding can become excessive and lead to life-threatening complications. Use a sterile pad to absorb blood loss, administer oxygen, and transport immediately if a patient experiences post-delivery complications.

Terms/Concepts to Know: abruptio placenta, birth canal, apgar score, preeclampsia, lightening, meconium, term gestation