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Notes on reproductive problems including cancers, cystocele, rectocele. Changes that occur during menopause, and types of abortions.
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UNIT 11 “FEMALE REPRODUCTIVE PROBLEMS” PART 4p. 1392-1401
Abortion = the loss or termination of a pregnancy before the fetus has developed to a state of viability.
Miscarriage = unintended loss of a pregnancy or a spontaneous abortion
There are 2 Classifications of Abortion:
1) Spontaneous Abortion
= Natural loss of pregnancy before 20 weeks of gestation
Causes:
o Fetal chromosomal anomalies (common cause before 8 weeks)
o Endocrine abnormalities
o Maternal infection
o Acquired anatomical abnormalities ie. endometriosis, uterine fibroids
o Immunological factors
o Environmental factors
Indicator: Uterine cramping and vaginal bleeding = admission to the hospital
If there is vaginal bleeding and no cramping, it’s usually caused by other conditions ie. polyps
Reliable Pregnancy Indicators:
1) Serum beta-human chorionic gonadotropin hormone (Beta-hCG)
2) Vaginal ultrasonography of the pelvis
Treatment to prevent possible spontaneous abortion is limited, and usually cannot be prevented
1. Bed rest and avoiding vaginal intercourse is recommended (there is no evidence supporting these)
2. Woman is told to report any bleeding to the HCP
If products of conception do not pass completely or bleeding becomes excessive you can:
Dilation and Curettage (The D&C) procedure = involves dilating the uterine cervix and scraping the endometrium to
empty the contents of the uterus. It is indicated when bleeding, cramping becomes excessive or the products of
conception do not completely pass
At the hospital:
Vital signs and EBL are monitored
Providing company for emotional support ie. spouse, friend, family
2) Induced Abortion
= An intentional or elective termination of a pregnancy done for either personal or medical reasons (more common among
women in their 20’s).
As a result of mechanical or medical intervention
, Choosing the technique depends on the gestational age (length of pregnancy), patient’s condition and preference
Techniques:
1. Menstrual evacuation
2. Suction curettage – most common (90%), can be performed up to 14 weeks of gestation
3. Dilation and evacuation (D & E) procedure – in the 2nd semester
4. Drug therapy – must be given within first 49 days (day 1 being the 1st day of last menstrual period)
Once the decision is made for an abortion:
o Woman and significant other need support and acceptance
o Prepare her for what to expect physically and emotionally (grief and sadness)
o Pt needs to understand the procedure (instructions for before & after treatment)
Follow up care:
o Signs and symptoms of complications
ie: abnormal vaginal bleeding, severe abdominal cramping, fever, foul drainage
o Avoid intercourse, tampons, douching until examination in 2 weeks
o Contraception can be started the day of the procedure or next visit
METHODS FOR INDUCING ABORTION
PREMENSTRUAL SYNDROME (PMS)
= A symptom complex related to the luteal phase of the menstrual cycle that resolves with menstruation (20-30% of
premenopausal women)
There are many symptoms associated with PMS so it is hard to define clinically
The symptoms always occur cyclically during the luteal phase before menstruation onset, and not present at other
times of the month.
Symptoms can be severe enough to impair interpersonal relationships or usual activities
Premenstrual dysphoric disorder (PMDD) = a type of PMS that have a severe mood disorder with marked
depression and anxiety on top of PMS
Pathophysiology is not well understood:
, a) Biological trigger with compounding psychosocial factors
b) Possible neurotransmitter involvement ie. serotonin
c) Genetic predisposition to PMS
d) Hormone & nutritional imbalances
CLINICAL MANIFESTATIONS
Varies between women and cycles
Note that abdominal bloating and breast swelling is due to fluid shifts, not weight gain. This is because total body
weight does not change.
o Breast discomfort, swelling
o Peripheral edema
o Abdominal bloating
o Sensation of weight gain
o Episodes of binge eating (can confirm)
o Migraine headache
o Anxiety, depression, irritability, mood swings
DIAGNOSTIC STUDIES
PMS can be diagnosed only diagnosed once ALL other alternatives have been ruled out
Focused health history and Physical exam can help determine underlying conditions (may include thyroid
dysfunction, uterine fibroids, depression)
No definitive test available for PMS
Use a symptom diary to record her symptoms prospectively for 2-3 menstrual cycles = Diagnosis is based on an
evaluation of the reported symptoms
COLLABORATIVE CARE
CONSERVATIVE APPROACH
o Stress management
ie. relaxation techniques, yoga, meditation, imagery, biofeedback
o Diet changes
ie: high fiber, food rich in b6low carb, low caffeine decreases autonomic nervous system arousal
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