Gynaecological conditions Z. Rozkydal •Vaginal bleeding • •Severe menstrual bleeding •Miscarriage •Recent termination of pregnancy •Recent childbirth •Injury • •Signs •Vaginal bleeding, shock • •First aid •Sanitary towel •To minimise the shock •Transport •Pyosalpinx •Inflammation of uterine tube • •Inflammation fluid •Adhesions •Blockage of the tube •Peritonitis •Often in women with intrauterine device • •Signs •Pain, discharge, fever, abdominal pain •Signs of peritonitis • •First aid •Positioning, no fluids orally, transport • • •Toxic shock syndrom • •Toxins of Staphylococcus aureus go through mucose membrane •into the blood and peritoneal cavity •Often in women with vaginal swabs •Mortality 8-15 % • •Signs •Headache, fever, abdominal pain, diarhoea, letargy, •muscle pain, hypotensis, shock •Failure of kidney, liver, myolysis • •First aid •To remove the swab •To minimise the shock •Antibiotics •Ovarial cyst • •Asyptomatic •Acute situation in a case of rupture or torsion • •Signs •Sudden onset of a sharp pain in lower part of the abdomen •Signs of peritonitis • •First aid •Positioning •Transport • •Hyperemesis gravidarum • •Severe vomiting in pregnancy •in the first 3 months • •Signs •Persistent vomiting, loss on weight, dehydration • •Firts aid •Sedatives, drugs against vomiting •Admission to the hospital •Graviditas extrauterina •Extrauterine pregnancy • •Implantation of the embryo outside the uterus •(tuba uterina, ovarium, abdominal cavity) • •Signs •Pain, convulsions, intraabdominal bleeding, shock • •First aid •To minimise the shock •Transport •Spontaneous abortion •Miscarriage • •Loss of foetus before 20 weeks of pregnancy •Usually malformation of the foetus •Weight under 500 g • •Signs •Gynaecological bleeding, convulsions, abdominal pain • •First aid •To minimise the shock •Transport •Preeclampsy • •Hypertension, proteinuria, oedema •Second week of pregnancy- the firts week after birth • • •Eclampsy • •Preeclampsy •Convulsions •Unconsciousness • •Occurs in 5 % of pregnant women • •Fatal end- intracranial bleeding, respiratory failure • • •Signs •Swelling of hands, face, lungs, brain •Oliguria, headache, dizziness, high blood pressure •Convulsions, lethargy •Opistotonus, convulsions in flexion and extension •Unconsciousness • •First aid •Care as for casualty in unconsciousness •Transport to hospital • •Childbirth • •Premature childbirth between 29.– 38. week • •Normal childbirth between 39.– 42. week • •Late childbirth 43. week and later I.stage II. •The cervix of the uterus is opening • •Contractions become stronger •and more frequent •in 10- 20 minutes • •Mucose plug is expelled • •Amniotic fluid leaks out •from the vagina • •At the end is cervix fully dilated • FA- gyn1 •II. stage • •It lasts several minutes till 2 hours •Uterus contractions are strong •in frequency of two minutes •Baby´s head will press down •on the mother´s pelvis floor • •Birth canal stretches •as the baby travels through it • •The head emerges first •then the body (arms, trunk, •lower limbs) is delivered afterwards •Episiotomy • FA- gyn1 •III. stage • • •After 30 minutes •The uterus begins to contract again •pushing the placenta out • •The placenta and the umbilical cord •will be expelled from the uterus • •The uterus closes down •- it reduces the bleeding • FA- gyn1 •At the delivery • •After the umbilical cord stops pulsation •ligate it and cut it 5 cm from umbiliculus •between ligated sites •Do not pull on the baby´s head or shoulders •Check the umbilical cord is loose- to prevent strangulation • •Remove mucose membrane from the mouth •of the child and keep the child´s head down, •so the water can float out • •Healthy child will start breathing normally in several seconds • •If it does not start breathing, do 5 initial breaths •and continue CPR • •Complications in the mother • •Bleeding, trombembolism, cardiac arrest, •shock, eclampsy, infection • • •Complications in the child •Asphyxia (strangulation by umbilical cord) •Hypoxia- anaemia, heart failure •Kephalhematoma, subdural haematoma •Fracture of the clavicle, of the skull •Palsy of plexus brachialis- obstetric paralysis •Subdurální hematom •Infection •Newborn jaundice can cause damage of CNS •Foetal eryrthroblastosis can cause damage of CNS • •Foetal erythroblastosis • •Haemolytic anemia of the foetus •Incompatibility of Rh factor •Mother Rh -, father Rh+, foetus Rh+ •It´s erythrocytes go to the circulation of the woman •They produce antibodies •In the next pregnancy her antibodies go back through placenta •into the foetus causing destruction of foetal erytrocytes •High level of bilirubin causes anemia and damage of CNS • •Signs • •Haemolytic anemia •Cerebral palsy, diminished hearing •Mental deficiency, chorea •