gynecological 2 Reproductive Health

Clinical Guidelines for Female Reproductive Health

• Patient Modesty and Communication

  • Importance of protecting patient modesty during examinations.

  • Regular assessments should not include unnecessary vaginal examinations, especially for young patients (e.g., 13-year-olds).

  • Certain situations, like nearing delivery during pregnancy, may require visualization of the vagina for assessment (e.g., crowning).

• Pregnancy Considerations

  • Questions to ask:

  • "Is there any chance that you could be pregnant?"

  • "Do you use any form of birth control?"

  • Clarify meanings and interpretations of these questions.

  • Complete abstinence or surgical interventions (e.g., hysterectomy, vasectomy) are definitive ways to rule out pregnancy:

  • Hysterectomy: Removal of the uterus, sometimes including ovaries; can be partial or total.

  • Vasectomy: Surgical procedure for males to cut the vas deferens, preventing sperm from entering the ejaculate.

• Understanding Birth Control

  • Different types of birth control methods include:

  • Condoms

  • Diaphragms (barrier methods)

  • Potential complications include missed periods or irregularities due to hormonal birth control.

  • Importance of follow-up questions for sexual activity if pregnancy is ruled out.

• Assessment of Menstrual Health

  • Understanding menstrual cycles and signs of abnormality (e.g., unusual bleeding, pain, discharge).

  • Assessment methods include checking for abdominal distension, palpating abdomen for rebound tenderness, checking for psoas sign, and considering conditions like appendicitis.

  • Inquiry about menstrual bleeding:

  • Type of products used (pads, tampons), frequency of changing, amount and duration of menstrual flow.

  • Normal tampons absorb about five mL of blood; fully absorbed tampons may handle around one tablespoon, indicating a small volume in context.

  • Heavily soaked pads or tampons should be interpreted carefully to avoid misdiagnosing hemorrhage.

• Pregnancy History Terms (GTPAL)

  • Gravida: Total number of pregnancies.

  • Para: Number of births after 20 weeks, including live and stillbirths.

  • Important to clarify information accurately:

  • Gravida 1, Para 0: First-time pregnancies without live births.

  • Gravida 5, Para 0: Multiple pregnancies ending in miscarriages.

  • GTPAL Definition:

  • G: Total number of pregnancies

  • T: Term deliveries (37 weeks or more)

  • P: Preterm deliveries (20-37 weeks)

  • A: Abortions (spontaneous or elective)

  • L: Living children

• Terminology in Obstetrics

  • Prima gravida: First-time pregnancy (Gravida 1, Para 0).

  • Multigravida: More than one pregnancy.

  • Abortion: Includes both miscarriage and elective abortion; significant to delineate in communication.

• Medications Relevant to Pregnancy

  • Mifepristone / Misoprostol: Considered abortion pills that influence uterine contractions and may lead to cramping and bleeding.

  • Symptoms of concern include fever and signs of infection (potential endometritis).

• Causes of Vaginal Bleeding

  • Common causes include trauma, tumors, infections (vaginitis, cervicitis, endometritis), and complications related to pregnancy (placenta previa, placenta abruptio).

  • Ovarian Cysts: Can lead to abdominal pain, and spontaneous rupture can cause internal bleeding, though bleeding is typically rare.

• Endometriosis Awareness

  • Characterized by the growth of uterine tissue outside the uterus, leading to chronic pelvic pain and dysmenorrhea (painful periods).

  • Distinction of painful periods: Dysmenorrhea strictly refers to increased pain, irrespective of the amount of bleeding.

• Uterine Anatomy and Conditions

  • Uterine Prolapse: Occurs when the uterus protrudes into the vagina, often due to a weak pelvic floor.

  • Interventions: Need for support and possible reversion during delivery; do not pull on the umbilical cord.

• Ectopic Pregnancy

  • Definition: Fertilized egg implants outside the uterus, most commonly in the fallopian tubes.

  • Life-threatening condition usually indicates acute abdominal pain, sometimes accompanied by vaginal bleeding.

  • Risk factors: IUDs, previous pelvic inflammatory disease (PID), history of ectopic pregnancies.

  • Confirmation often by HCG levels; normal pregnancy tests can yield positive due to retained hormone production from ectopic tissue.

• Treatment and Response

  • Sudden abdominal pain in women of childbearing age should prompt evaluation for ectopic pregnancies or ruptured ovarian cysts.

  • Priority treatments: Transport, supportive care, management for shock if required.

• Medications and Procedures for Complications

  • D&C (Dilation and Curettage): Surgical procedure for removing tissue from the uterus after miscarriage or abortion.

  • Awareness of potential infection post-D&C or due to retained products from miscarriage is critical.

• Clinical Vignettes and Assessments

  • Clinical significance of presenting symptoms, appropriate questioning regarding pregnancy history, and physical findings in assessing female reproductive health.

  • Importance of being sensitive and cognizant of language when discussing reproductive health with patients.