SAFEGAURDING IN OBS&GYNAE Flashcards
What is female genital mutilation?
All procedures involving partial or total removal of the external female genitalia, or other injury to the female genital organs for nonmedical reasons
Why is FGM performed?
It’s a deeply held tradition and there are cultural beliefs around control of women, female chastity, hygiene (false), aesthetics and religion
Why is FGM performed?
It functions as a self-enforcing social convention or social norm.
It’s what people believe their community expects them to do. If they don’t respect the social rule, they will suffer social consequences such as derision, marginalization and loss of status
How many women and girls have undergone FGM?
More than 200 million women and girls
Number of women with FGM in the UK?
137,000
Continent where FGM is most prevalent?
Africa
>90% of women in Somalia, Egypt, Guinea
UK law on FGM?
Any form of FGM is against the law in the UK including refibulation after delivery
It carries a 14 year prison sentence
Female circumcision act 1985?
Made it criminal to excise, infibulate or otherwise mutilate the whole or any part of the labia majora, labia minora or clitoris of another person
Made it criminal to aid, abet, counsel or procure a girl to mutilate her own genitalia
Female genital mutilation Act 2003?
Added a further criminal offence to the female circumcision act 1985:
Aid, abet, counsel or procure another person who is not a UK national to mutilate a girl’s genitalia outside the UK
FGM and cultural sensitivity?
Freedom of religion and right to participate in cultural life are protected by international law
International law also dictates this freedom may be limited to protect the freedoms and fundamental rights of others
But
FGM is recognised as a form of torture by the UN
Type 1 FGM?
Clitoridectomy - partial or total
Type 2 FGM?
Excision of clitoris, labia minora with or without excision of the labia majora
Type 3 FGM?
Infibulation - removal of clitoris, Labia minora and then narrowing or the vaginal opening
Type 4 FGM?
Others e.g. stretched labia
Complications of FGM?
Severe pain
Bleeding
Shock
Injury to neighbouring organs - commonly urethral scarring
Urinary retention
Infection
Death
Dysmenorrhea
Abscess
Delayed healing
Scarring/keloid formation
Obstruction to urinary flow
UTI
Pelvic infection
Haematocolpus
Where is type 3 FGM most commonly from?
Sudan and Somalia
Long term complication software FGM?
Dysparuenia
Infertility
Risk for HIV due to traumatic intercourse
Lack of trust in carers - often dont attend or take offence
Psychosocial trauma and flashbacks / PTSD
Obstetric complications of FGM?
Difficulty performing vaginal exam, catheterisation, foetal blood sampling and foetal scalp electrode application (mostly with type 3)
Increased risk of c-section, episeiomy and severe vaginal trauma e.g. fistula formation
Higher risk of PPH, extended hopsital stay, fear of child birth and increased risk of perinatal death
Antenatal care for FGM?
At booking ask about FGM “have you ever been subject to FGM, cutting etc”
Discuss complications with women for them and their child
Consider mental health
Manage as high obstetric risk except for women who have had previous pregnancies with uncomplicated vaginal deliveries
Indicators of FGM?
Difficulty sitting/walking/standing
Difficulty passing urine
Menstrual problems
Recurrent UTIs
Reluctance to be examined medically
Repeated absences from school
If a child is going on. A visit to her home country or an older woman from their home country comes to visit
How to refer FGM to?
Police
Female obstetrician
Mental health services
Named midwife for safegaurding - need to complete the FGM notification form online
Social services
Care in labour for women with FGM?
Care for them sensitively
Consultant led
May require intrapartum defibulation
Gain consent and make it clear reinfibulation is against UK law - definitely need a translator for this if English is not good
Pay extra attention to perineum with type 2/3 FGM
Perineal care advice following delivery
Documentation
Postnatal care for women with FGM?
Perineal care
Referral to social services if female infant - must happen
Referral to mental health services
Document all these discussions
Common female genital cosmetic surgeries (FGCS)?
Labioplasty
Revirgination
Vaginal rejuvenation “designer vagina”
What is the difference between FGM and female Genital cosmetic surgery?
FGM is non-consenting minors and is associated with great harm resulting in permenant damage to normal sexual function
FGM act stipulates that no offence is committed if an operation is deemed necessary for physical or metal health. This may include cosmetic surgery resulting from distress caused by perception of abnormality - some legal ambiguity around FGCS
Definition of domestic abuse?
Any incident or pattern of incidents controlling, coercive, threatening behaviour, violence or abuse between those aged 16 or over who are, or have been intimate partners or family members regardless of gender or sexuality
What does domestic abuse involve?
Coercive control
Psychological or emotional abuse
Physical abuse
Sexual abuse
Financial abuse
Harassment
Stalking
Online or digital abuse
Prevalence of domestic abuse?
A significant global health issue
35% of worldwide female population have experience some form of violence from their intimate partners or significant others
Implications of domestic violence?
High social and economic costs
Short and long term problems for survivors and their children - physical, mental, sexual and reproductive health
Higher rate of miscarriage, premature birth, LBW, foetal injury and death, premature labour and delivery, chorioamnionitis, maternal infections, poor weight gain
What proportion of domestic violence starts in pregnancy or the postnatal period?
1/3rd of cases
Risk factors for domestic violence in pregnancy?
Serious violence before pregnancy
Feelings of inadequacy
Jealousy and controlling behaviour
Partner IV drug abuse
Low social class
Poor education
Social deprivation
Complications of domestic abuse in pregnancy?
Higher rate of miscarriages
Premature birth and LBW
Foetal injury and death
Premature labour and delivery
Chorioamnionitis and maternal infections
Poor weight gain
Signs of domestic abuse in patients/
Late booker or poor attender
Repeat minor injury attendance
Unexplained admissions
Depression, anxiety, self-harm
Injuries of different stages
STD/UTI/vaginal infection
Poor obstetric history
Domineering partner
What proportion of children have lived with domestic violence?
1 in 7
Effect of domestic violence on children?
Anxiety and depression
Difficulty sleeping
Nightmares or flashbacks
Bed wetting
Temper tantrums
Inappropriate behaviour for their age
Alcohol/drug use
Self harm
Physical; Sx
Eating disorder
Feelings of anger, guilt, insecurity and powerlessness
Key points: Domestic violence, crime and victims act 2004
A piece of legislation that addresses various aspects related to domestic violence and crime
Domestic violence protection orders - provides protection to the victims e.g. prohibit the perpetrator from contacting the victim
Restraining orders can be imposed for any offence
Common assault is an arrestable offence
1857 the Rule of Thumb
It was legal and perfectly acceptable for a man to beat his wife providng the stick he uses is not thicker than his thumb
Curfew on wife beating 1895
City of London Byelaw: wife beating is prohibited between 22:00 and 07:00 because the noise keeps the neoughborus awake
When did it become a criminal offence for a husband to rape his wife?
1980s
Risk factors of significant harm or neglect to a child who may be born or is existing ?
Past or current circumstances that may lead to any child experiencing serious physical or psychological harm or neglect
Previous convictions related to harming children
Child protection measures taken regarding existing children, or violence/serious discord in the family environment
Past or current circumstances that are likely to lead to an inability to care throughout childhood for any child who may be born, or that are seriously impairing the care of an existing child of the family e..g mental/physical conditions, drug/alcohol abuse, medical history, etc
When there are concerns about the welfare of the child, how often should the unit request information from the GP?
When there has been a. Gap of 2 or more years in contact between clinic and pt
When there is a change of partner
When a child has been born to the pt since a previous assessment
Where the unit has reason to believe that there has been a significant change in the patient’s medical or social circumstances
What is an ecomap?
shows the network of people around the child or family through a diagram. The child is placed at the centre of the diagram; each person and organisation that forms a part of the child or young person’s network is named and placed within a circle.
What is the legal framework for child safegaurding?
Children Act 1989
Types of domestic abuse?
Physical abuse
Sexual abuse
Psychological abuse
Financial abuse
What is the cycle of abuse?
They identified abuse as being cyclical and there being 3 phases that are repeated over time. Each stage ;lasts a different amount of time, with the total cycle taking from just a few hours to over a year
The cycle commonly speeds up as time goes on
Tension builds -> abuse -> remorse and forgiveness
What is reproductive coercion?
This involves male attempts to control female fertility
In these cases long-acting contraception should be considered
What is The National Centre for Domestic Violence? (NCDV)
They try to identify early signs of domestic abuse, make decisions for a better life and make domestic abuse socially unacceptable
They created a service that provides asssistance, guidance and legal support to victims of domestic abuse . Helps them obtain protective orders such as Non-Molestation orders
They can also organise emergency assistance to those facing immediate danger
What is Refuge?
A service that provides safe temporary accommodation for women and children escaping domestic abuse, support in the community, help with advocacy and support to understand your rights, gender-based violence services, ‘one stop shop’ services
What is women’s Aid?
A service that supports domestic violence survivors, campaign for change, educate and inform, conduct research projects on key issues of domestic violence, raise awareness
