Notes – Obstetrical and Gynecological Conditions

Obstetrical and Gynecological Conditions

Patient Safety Considerations

  1. Patients in third trimester of pregnancy should be transported on left side or with uterus manually displaced to left if hypotensive
  2. Do not place hand/fingers into vagina of bleeding patient except in cases of prolapsed cord or breech birth that is not progressing

Notes/Educational Pearls

Key Considerations

  1. Syncope can be a presenting symptom of hemorrhage from ectopic pregnancy or causes of vaginal bleeding.

Pertinent Assessment Findings

  1. Vital signs to assess for signs of shock (e.g. tachycardia, hypotension)
  2. Abdominal exam (e.g. distension, rigidity, guarding)
  3. If pregnant, evaluate fundal height

Quality Improvement

Associated NEMSIS Protocol(s) (eProtocol.01)

  • 9914159 – OB/GYN-Gynecological Emergencies
  • 9914161 – OB/GYN-Pregnancy Related Disorders

Key Documentation Elements

  • Document full vital signs and physical exam findings.

Performance Measures

  • Patients with signs of hypoperfusion or shock should not be ambulated to stretcher
  • If available, IV should be initiated on patients with signs of hypoperfusion or shock
  • Recognition and appropriate treatment of shock

References

  1. Coppola PT, Coppola M. Vaginal bleeding in the first 20 weeks of pregnancy. Emerg Med Clin N Am. 2003;21(3):667-77.
  2. Della-Giustina D, Denny M. Ectopic Pregnancy. Emerg Med Clin N Am. 2003;21(3):565-84.
  3. WHO, United Nations Population Fund, UNICEF. Pregnancy, Childbirth, Postpartum and Newborn Care: A guide for essential practice (3rd edition). Geneva, Switzeralnd: WHO Press; 2015.