Virgen Macarena University Hospital and area

Andalusian Health Service

HEALTH AND SOCIAL WELFARE COUNSELING

PORTFOLIO OF SERVICES OBSTETRICS AND GYNECOLOGY CLINICAL MANAGEMENT

UNIT
Medical Services Obstetrics Area

General objective: Assistance to pregnancy, childbirth and normal and pathological postpartum
• 1st level obstetric ultrasound according
Decentralized general Follow-up visits of the pregnant woman according to to PEPP
obstetric consultations the Pregnancy, Childbirth and Postpartum (PEPP) • 1st Trimester aneuploidies screening
in 16 Support Devices process. (triple screening)
• Morphological ultrasound of sem. 20
• (3rd level)
• 3rd level ultrasound
• Biochemical screening for aneuploidies
in the 2nd Trimester
Prenatal Diagnostic
Prenatal Diagnosis of Congenital Malformations
• Genetic Sonogram
Consultation • 3D ultrasound
• Echocardiography
• Echo-Doppler
• Genetic amniocentesis
• High Risk Pregnancy Unit. • Ultrasound
High risk pregnancy • Hypertension and fetal growth unit. • Echo Doppler
consultation • Diabetes and Pregnancy Unit.
• Cardiotocographic record
• Preterm birth prevention unit.
• Fetal biophysical profile
• External version unit for term pelvic
presentations. • Ultrasound
• Follow-up of pregnant women who have • Echo Doppler
Obstetric Day Hospital required hospital admission. • Cardiotocographic record
• Attention to procedures that, although they can • Fetal biophysical profile
be treated on an outpatient basis, cannot be • Amniocentesis
assumed in outpatient clinics, given the
specific nature of their care.
Hospitalization for
Assistance to pregnant women with pathologies that require hospital admission
obstetric pathology
Hospitalization of
Monitoring of the normal and pathological puerperium
puerperal women
Among others :
• Maternal analgesia
• Supervision of eutocic delivery • Induction of labor
• Monitoring fetal well-being • Intrapartum fetal monitoring
• Medical direction of delivery • Amnioscopy
• Assistance at dystocic birth. • Fetal calvaria pH
Emergencies •puerperium
Assistance to the pathological • cord pH
Obstetrics • Elective cesarean section
• Assistance to urgent pregnancy • Tocurgy: Application of Suction Cup, Spatulas and
pathologies Obstetric Forceps.
• Attention to urgent consultations of • Perineal tear suture
pregnant women in the hospital • Urgent cesarean section.
setting • Evacuative uterine curettage
• Puerperal curettage
• Postpartum hysterectomy

Prepared and approved by the Clinical Management Unit of Obstetrics and

Gynecology
Version 01-2013
Execution of
Medical
surgical Services Gynecology Area
treatment • Hemivulvectomies
of pre-invasive, • Partial resections of the vulvar lesion
Generaldisease
invasive Surgical treatment
objective: Assistance of the disease •pathologies
to all non-neoplastic Simple totalofvulvectomy
the female reproductive system.
and recurrence of preinvasive
Among others : • Subcutaneous vulvectomy.
the lower genitalgynecology
Decentralized •
vulvar and vulvar
Abdominal, • radical
cancer transvaginal, vulvectomy
transrectal, translabial ultrasound.
tract (cervix,
consultations in 16 Support • Colpocytology • Uni or bilateral inguinal lymphadenectomy
vagina and
Devices vulva)
• Endometrial biopsy
• Sentinel lymph node biopsy technique
• Surgical treatment of recurrence
• PUNCH biopsy • Partial resection
• Vaginectomy
• Cervical conization• Polypectomy
Diagnostic •hysteroscopy
Hysteroscopy Unit • Ambulatory• surgical • Endometrial biopsy
Reconstruction of neovaginas
hysteroscopy • simple trachelectomy • Definitive contraception (ESSURE)
• Vaginal radical trachelectomy
• Total hysterectomy•(single Laser or with double adnexectomy)
myomectomy
Non-surgical therapeutic approach unit for fibroids ₋ laparoscopically
₋ laparotomically
• Uterine artery embolization
Special gynecology ₋ vaginally
Gynecological care for disabled women orvaginal
₋ by combined women withassisted
route special needs
by laparoscopy
consultation
• Radical hysterectomy (Wertheim-Meiggs procedure) (single or with
Pre-surgical consultation Assessment of the patient on the
double surgical waiting list
adnexectomy)
Surgical treatment of ₋ laparoscopically
Gynecological pre-invasive disease
Gynecological emergency₋assistancelaparotomically
Emergencies and invasive cancer of ₋ vaginally (Shauta Intervention)
the vagina and cervix
Assistance to women with ₋pathologies
by combined vaginal route assisted by laparoscopy
Gynecological that require hospital admission and in the
Hospitalization
• Pelvic lymphadenectomy
postoperative period of gynecological surgery
₋ laparoscopically
or •transperitoneal
• Attention
consultations
to non-urgent Conservative treatment of ectopic pregnancy with
or retroperitoneal
in the field methotrexate and follow-up
₋ laparotomically
• Follow-up of Trophoblastic Disease (1 year)
hospitable
• • Paraortic lymphadenectomy
Attention to procedures • Care/monitoring of medical or surgical
₋ laparoscopically
Although they can be treated gynecological pathology, which continues to
Day Unit gynecology, or transperitoneal
on an outpatient basis, they require care after hospital discharge.
obstetrics, gynecological or retroperitoneal
oncology and Breast Unit
cannot be treated in outpatient • Follow-up
₋ laparotomically of patients treated in gynecological
clinics, given • Sentinel
the specific emergencies
lymph node biopsy technique who remain pending collection of
nature of their care. analytical
• Transposition of ovaries results (cultures,fields
outside the radiation group and Rh, B-
• Surgical patient• oncological
scheduling
Surgical
HCG...).
treatment of recurrence
• Insertion
• Total hysterectomy with doubleof adnexectomy
IUDs with Levonorgestrel; and
urgent Subdermal Contraceptive Implants, in coordination
₋ laparoscopically
₋ laparotomically with Primary Care
Gynecology Oncology Area ₋ vaginally
₋ by combined vaginal route assisted by laparoscopy
General objective: Assistance to all neoplastic • Radical
and preneoplastic
hysterectomy pathologies
(Wertheim-Meiggsof the female reproductive
procedure) with double
system adnexectomy
₋ laparoscopically
₋ laparotomically
• Initial diagnosis
Surgical treatment of and ₋ vaginally (Shauta
extension study of Intervention)
Among others :
cancergynecological
of the uterinecancer or ₋ofbypatients
combined high • route
withvaginal assisted by laparoscopy
Colposcopy
body (endometrium or • Pelvic lymphadenectomy• Colpocytology
suspicion of the same
• Gynecologic cancer treatment
Oncology Gynecology myometrium)
₋ laparoscopically
planning • Endometrial biopsy
Consultation • Management of the surgical or transperitoneal
waiting list for • Punch biopsy
patients with gynecological cancer or with a • Punch biopsy
or retroperitoneal
high suspicion of it. ₋ laparotomically • Ultrasound: transvaginal, transrectal,
• • Paraortic
Follow-up of treated gynecological lymphadenectomy
cancer. abdominal
• Support to other healthcare or
₋ laparoscopically
units in the
• Echo Doppler
transperitoneal
coordinated radiotherapy and chemotherapy
or retroperitoneal
treatment of gynecological cancer.
₋ laparotomically
• Omentectomy

Prepared and approved by the Clinical Management Unit of Obstetrics and

Gynecology
Version 01-2013
Prepared and approved by the Clinical Management Unit of Obstetrics and
Gynecology
Version 01-2013
 • Surgical exploration of the abdominal cavity
₋ laparoscopically
₋ laparotomically
• Uni or bilateral adnexectomy for the surgical treatment of initial stages
in patients with reproductive desires
• Total hysterectomy with double adnexectomy
₋ laparoscopically
₋ laparotomically
₋ by combined vaginal route assisted by laparoscopy
• Radical hysterectomy (Wertheim-Meiggs procedure) with double
adnexectomy
₋ laparoscopically
₋ laparotomically
Surgical treatment of ₋ by combined vaginal route assisted by laparoscopy
tubal and ovarian cancer • Pelvic lymphadenectomy
₋ laparoscopically
or transperitoneal
or retroperitoneal
₋ laparotomically
• Paraortic lymphadenectomy
₋ laparoscopically
or transperitoneal
or retroperitoneal
₋ laparotomically
• Omentectomy
• Appendectomy
• Maximum cytoreduction surgeries: partial cystectomies, intestinal
resections, pelvic or total peritonectomies, anterior, posterior or partial
exenterations.
• Colposcopy
Consultation of Secondary prevention of • Colpocytology
Cervical pathology cervical cancer • Biopsy
• HPV PCR
• Specific crops
Breast Unit
General objective: Diagnosis and treatment of benign and malignant breast pathology
• Digital mammography
Diagnosis by imaging • High resolution ultrasound
test
Diagnosis
• RN M
(benign and malignant
• PET
pathology of the
breast) • CNB (ultrasound-guided core needle biopsy)
Diagnosis by biopsy • BAV (sterotaxy-guided vacuum core biopsy)
• Biopsy guided by harpoon placed by stereotaxy or ultrasound
• Radiopaque mark placement

• ROLL (lumpectomy guided by nuclear medicine techniques in non-

Surgical treatment palpable lesions)
(benign and malignant Conservative surgical • Lumpectomy guided with harpoon placed by stereotaxy or ultrasound
breast pathology) treatment in in non-palpable lesions)
mother • Lumpectomy in palpable lesions
• Lumpectomy + oncoplasty
• All breast-conserving techniques can be done after neoadjuvant
treatment for tumor reduction.
• Mastectomy
• Subcutaneous mastectomy
Radical breast treatment • Immediate reconstruction
* Both mastectomies in cases of oncological or non-oncological
treatments or preventive in high-risk cases

Prepared and approved by the Clinical Management Unit of Obstetrics and

Gynecology
Version 01-2013
 Radical surgical • Selective sentinel lymph node biopsy (SSNB)
treatment in the armpit • SNOLL (ROLL+BSGC)
Radical surgical • Axillary emptying
treatment in the armpit • Axillary lumpectomy
Nursing Services Portfolio
General objective :
• Promote the personalization of nursing care and services
• Guarantee continuity of care for patients, especially the most fragile
• Continuity of care reports
• Case management and joint discharges.
• Knowledge management.
• Shared care for vulnerable patients.
Independent Role
• Recruitment of caregivers of dependent patients.
• Instruction and advice to the patient in the management of devices.
• Education for health, habits and diet.
• Recommendations upon discharge to patients and families.
• Income Assessment
• Standardized Care Plans
• Application of Cleansing Enema.
• General Procedure for the Execution of Nursing Techniques and
Care.
• Oral Medication Administration.
• Administration of Topical Medications.
• Care and maintenance of venous accesses.
• Intramuscular Administration.
• Intravenous Administration.
• Subcutaneous Administration.
• Rectal Medication Administration.
• Oxygen therapy.
• Administration of Blood and Blood Components.
• Discharge to the Patient Transferred Intra and Extra Hospital.
• Accompaniment to the service.
HOSPITALIZATION • Incontinence care.
• Promotion of rest and sleep.
• Bed bath.
• Busy bed arrangement.
Actions derived from • Arrange unoccupied bed.
medical diagnoses and • Determination of diets.
treatments • Patient weight.
• Care of the Patient with a Veterinary Catheter.
• Post Mortem Care.
• Culture Extraction from a Patient with a Veterinary Catheter.
• Attention to cardiorespiratory arrest.
• Blood Extraction for Culture.
• Application of bandages.
• Healing of wounds.
• Breathing frequency.
• Arterial Gases.
• Venous gases.
• Capillary Glucose.
• General Hygiene.
• Reception of the Patient upon admission to the Unit.
• Insertion of Nasogastric Tube.
• Headwashing in Bedridden Patients
• Management of the Pain Unit Catheter.
• Pain management.
• Postural Changes.
• Management of Hypo and Hyperglycemia.

Prepared and approved by the Clinical Management Unit of Obstetrics and

Gynecology
Version 01-2013
 • Blood Pressure Measurement.
• Heart Rate Measurement.
• Obtaining Urine Culture in Continent Patients, Autonomous and
Non-Autonomous.
• Obtaining Sputum for Culture.
• Obtaining Feces for Culture.
• Urine collection in 24 hours.
• Prevention of Pressure Ulcers.
• Treatment of Pressure Ulcers.
• Nursing History Preparation
• Protection of Patient Rights.
• ECG records.
• Suture Removal.
• Rectal Probing.
• Sampling with Vacuum System.
• Temperature Taking.
• Isolation protocols. Device Change for Ostomy Patients
• Assistance to urgent
surgical processes
(Caesarean sections,
Curettages, Uterine
Cerclages,
Bartholinitis...)
• Ca Standardized Care Plan. from Mom.
Surgical and
Obstetric- • Assistance to scheduled gy • Ca Standardized Care Plan. of Cervix and Uterus.
Gynecological Laparoscopic and Open • Standardized Care Plan Reception of the patient in
Emergency Area Surgery Surgical gya, • Operating room.
processes related to the oh • Care Plan for Normal Childbirth.
specialties: Gynecology,
General Surgery,
Urology, Pediatrics. river
• Pregnancy-Birth-Puerpe
Care Process
• Local Preco Registration z of the patients undergoing surgery: Follow-up of wounds, cures
Management.
• Prevention of to. Health Education (face-to-face classes)
Lymphedema or the Ectopic Pregnancy and Hydatidiform Mole protocols;
• Application and
monitoring βHCG of Gynecological Oncological Pathology (Cervical Cancer, and have
monitoring been subjected to surgical procedures and are still discharged from
Day hospital • Attention/monitoring hospital.
Gynecological Endometrium and treated in the gynecological emergencies of our hospital that collect
Vulva) that need further analytical results (cultures, group and Rh, ..).
care consultations derived from other units of the Hospital to patients with
• Patient follow-up remains gynecological, oncological or breast pathology.
pending for the implantation of IUDs with Levonorgestrel and icos implants,
• Attention to the Intercon coordinating with Primary Care the achievement of these
they require an
evaluation
•• Reference
Appointment
consultation
management.
• Information to patients. cas.
• Request for clinical
External stories
• Stories Archive. Orias.
Consultations.
• Hist completion
• Replacement of
consumables.
• Material control.
• Consultation preparation. risk

Prepared and approved by the Clinical Management Unit of Obstetrics and

Gynecology
Version 01-2013