Womens Health Flashcards
Difference between sex and gender?
Sex is the biological classification of male or female through external genitalia and chromosomal makeup
Gender is social and/or cultural conformities and individual ideology
main types of gynaecological malignancies?? (4)
Vulval
Cervical
Endometrial
Ovarian
Risk factors for vulval cancer
- VIN
- Melanoma or lichen sclerosis
- Recurrent HPV infections
- Paget’s disease
Cervical cancer RFs?
Smoking
CIN
Recurrent HPV
Immunocompromised (immunosuppressants, HIV, transplants)
COCP - due to no use of condom
Endometrial cancer RFs?
Obesity, T2DM, HTN
Smoking, alcohol, bad diet
Family history
Previous history with other gynaecological cancers or breast cancers
Early menarche - late menopause
Ostrogen only HRT
Nulliparous
Ovarian cancer RFs
Smoking obesity
Family history
Breast cancer or tamoxifen use
Nulliparous
Early menarche-late menopause
Age
Talcum powder pre 1975 and asbestos exposure
Cervical Screening explained
Introduced 1988
Women aged 25-64
25-49 = every 3 years
50-64 = every 5 years
HIV/CIN +ve = annually
Rescheduled if:
- PID
- Bleeding
- Less than 12 weeks postpartum
Don’t need if:
- cancer referral required
- virgin
Process:
1. Speculum and HSV brush
2. Swab placed in liquid
3. Microbiologist take look if +ve —> cytology
4. If dyskaryosis seen on cytology then colposcopy and biopsy
figures around the effects of cervical examinations?
4,500 lives saved per year, 5% abnormalities found, stats dropped between 1988-1999
Who’s included in a gynaecological MDT
MDT coordinator
- GP
- Gynaecologist/consultant
- radiologist
- histopathologist
- specialist nurse
Extended:
- OT
- dietician
- palliative care if needed
- chaplain if needed
- social worker if needed
What is the 5 main purposes of an MDT
- Discuss new cases/diagnoses
- Make management plan for patient and communicate
- Options for support in terms of dedicating specialist nurses to patients
- Review guidelines and audit
how many antenatal visits should be done?
10 or 7 if previous babies have been had
Describe the calendar of antenatal screens/checks in an “average” woman
8-10 weeks = booking visit (mental health, PMHx, SHx, gynae and obstetric and surgical Hx THEN drug history - following vitamin D and folic acid, blood test for Hep B, HIV, blood group, rhesus factor, anaemia)
BP, WEIGHT AND URINAnalysis is done pretty much all the time to screen for bacturia
12 weeks = USS
11-13+6 = combined test
16 weeks = USS to discuss test and FBC for anaemia for oral iron tablets
18+ anomaly scans (14-20 = triple or quadruple tests)
What is in a combined test
Nuchal translucency (USS)
PAPPA & free floating b-hCG (bloods)
What is in a triple test?
Free floating b-hCG
Serum oestriol
Alpha-feta protein
What is in a quadruple test?
Alpha-feta protein
Free floating b-hCG
Inhibin A
Serum oestriol
Benefits of antenatal screen?
- Allows patients to educate themselves and feel fully informed moving forward
- Allows advanced preparation if keeping baby (household changes etc)
- Allows support group connections
- Reassurance for those at risk or low risk
Negatives of antenatal screening
Just a screening test = could be false positive
Miscarriages
Results for downs on antenatal tests?
HIGH = beta h-CG & inhibin
LOW = PAPPa& alpha-fetoprotein & serum oestriol
>6mm NT
Supplements for pregnant women?
400mcg of folic acid 3 months prior-12 weeks gestation
5mg of folica acid 3 months prior - 12 weeks gestation
10mcg vitamin D daily through pregnancy and post
Iron tablets if Hg <11
Vitamin A = teratogenic caution
What is FGM
Female genital mutilation act 2003
What is the FGM act?
Illegal in uK
Illegal to aid and abet in uK
Illegal to send over for FGM
Labioplasty only if preserves mental and phsyical health of a child/woman
4 types of FGM
1 - clitoral removal
2 - clitoral and labial removal
3 - closure
4 - burning stitching or piercing of clitoris
IVF on the NHS?
Offered for 3 cycles if meet specific criteria:
- <40 if 40-42 or 40 mid treatment only 1 cycle done
- 2 years of trying without contraception
- 12 cycles of alternative fertility treatment clomifene done
Some CCGs look at weight smoking and drinking status too
Still birth?
Rates 4.6 - death of a baby antenatally or within 24 hours of life
Perinatal
Life of baby antenatally - 7 days post
Neonatal death?
2.6 UK death of newborn within first year
Low birth weight?
<2.5kg/2500g
How are quality of womens health services assessed?
Donabedians:
1. Structure (patient;staff ratio, working contracts/hours)
2. Process (long patient waiting lists, hand hygiene, recording of incidents)
3. Outcome (acquired hospital infections, emergency’s, near miss/major incidents, longer hospitalisations, patient experiences)
What is the human fertilisation and embryology act 1990
Women shouldn’t be supported in fertility treatment if the welfare of the child wasnt in their best interest and if not supported by a father (now supported pretending 2008)
What is the human fertilisation and embryology authority?
Board of academics that are in control of standardising and checking in on iVF artificial fertilisation clinics in the UK looking at the correct storage of eggs sperm and embryos.
Issues with the human fertilisation and embryology act?
- Welfare isn’t defined
- Welfare isn’t predictable
- Fertile couples don’t undergo this scrutiny
- Why is a father needed?
abortion act 1967 (1990)
It is not illegal to have an abortion if 2 medical practioners have certified is as best interest for mother or baby
If <24 weeks = medical abortion and needs to be in interest of mothers mental and physical wellbeing and if baby may struggle if born due to handicap
If >24 weeks = surgical and pregnancy needs to pose significant risk to mother or baby mental or physical health
If <16 abortion can go ahead with practitioner consent
What are the pro life arguments
Justice - for the foetus, seen as human status = human rights to live
Justice - for the mothers who would like to adopt, robbing them of an opportunity
Non-maleficence - harming the foetus
Non-maleficence - medical and mental health future complications
What are the pro abortion arguments?
Justice = will allow teenagers to live long fulfilled life
non-maleficence = harm to baby maybe but what about harm to mother?
Non-maleficence = women shouldn’t be placed with emotional burden of rape
Beneficence = contraceptive failure/mistake and their life shouldn’t be impacted by this people make mistakes
Autonomy = own body own choice
HPV epidemiology etc..
High risk HPV can be caused by strains 16 and 18
90% of warts are strains 6 and 11
Warts are subcutaneous manifestations of the HPV strain that look brown/red in colour can itch and burn and bleed
Topical lotions or ablations are used for treatment
Pubic Lice epidemiology…
1-3mm in size tan/grey in colour and can live in coarse hair such as eyebrows eyelashes abdomen hair back hair armpit hair and pubic hair
Leave red lesions and blue lesions in some cases
Treatment is insecticides, good personal hygiene and familial treatment
Can be transmitted through sexual activities or close contact
Herpes epidemiology…
HSV1 = cold sores
HSV 2 = genital
Starts with febrile prodromal phase, neuralgia, lower abdomen pain and ulcers
Can be active or latent
Treatment is not often acyclovir unless severe
Valid argument?
Conclusion is logical to the premise
Sound argument?
True premise that is factual and correct
What can be 2 issues of an argument?
The premise is incorrect
Anything regarding morality as it cant be justified
Can an argument be valid but not sound?
Yes
If it has an incorrect premise or moral content
What is a straw man fallacy
Misrepresentation of person A’s initial argument portrayed as a weaker more frivolous argument that is more likely to be viewed negatively or rejected
What is ad hominem fallacy
Discredited an argument based of the person who made it (youre a kid you know nothing)
What is begging the question fallacy
Circular reasoning, where conclusion matches the premises without any evidential backing
What is appealing to emotion
Using feelings within the argument
What is argument from fallacy
Discredited and debunking an argument because its initial premise is false/incorrectt
What is euthanasia?
Euthanasia is the deliberate ending of someone’s life usually due to stop suffering
What is assisted suicide
Deliberately assisting or encouraging one to commit suicide
Active euthanasia?
Directly delivering the treatment to end someone’s life
Passive euthanasia?
With-holding life-prolonging treatment which patients can consent to to eventually kill them
Voluntary euthanasia?
Patient consents
Non-voluntary euthanasia
When a person is dying cant consent but usually is through statement of wishes
what is involuntary euthanasias
Patient does NOT consent = murder
Arguments for euthanasia? (3)
- Autonomy, patients should be able to decide when they die and how they die
- DNACPR exists and palliative care with high level sedation for suffering exists why cant others have that treatment
- If a patietn is in pain doctors are not being BENEFICENT and acting in their best interest if they want to end life
Arguments against euthanasia?
- Only god can end life
- Questions the attitudes towards human life - squanders research
- Violates non-maleficence = lack of respect for terminally ill
- Detracts from improving end of life care
What is the doctrine of double effect
Is where an action is put in place to achieve a morally good outcome even if a potentially morally bad side effect may be produced (this can be foreseen or not)
what is an example of the doctrine double effect principle?
Giving a drug to a terminally ill patient to relieve symptoms but knowing that this could shorten their lives
What are 4 terms of doctrine double effect?
- No other option than giving or doing the action youre doing
- The action needs to have a good intention, can’t just be a bad intention (drug to kill)
- The action needs to be proportional for helping (cant be too large of a dose to kill just to relieve)
- Action must be relevant (correct drug to relieve symptoms)
Problems with doctrine double?
- Unforeseen side effects may occur (quicker death)
- Death isn’t alwasy a problem for some
- Must take responsibility for both as intention isn’t alwasy enough
What is the teenage pregnancy prevention framework 2018?
Idea to implement:
- promotion of good quality relationships
- education
- friendly contraceptive providers
Issues with teenage pregnancies
- Lower birth weight increased mortality for baby
- Lower socioeconomic status, less education and work = worse outcome for mother and baby
What are 2 reasons for teenage pregnancy
Low socioeconomic groups = less education
Failing of contraception
Western countries
What does MBRRACE-UK stand for?
Mothers and babies reducing risk through audits and confidential enquiries across the UK
What is reported to MBRRACE-UK
Perinatal and maternal mortality (death)
What is maternal mortality
Death of the mother either up to 42 days or LATE (post 42 days-year)
What can cause maternal mortality?
- Indirect (pre existing condition thats worsened, condition that developed during pregnancy)
- Direct (allergy to medication, infection/sepsis, haemorrhage, VTE, eclampsia)
- Late can include either of these
What are influencing factors to maternal mortality ?
Pre-existing conditions - obesity/diabetes etc
Low Socio-economic class - poor education (not attending appts.), no access to healthcare (no momey to drive or public transport), lower groups (smoking, alcohol and drugs), poorer living conditions (nutrition and housing)
obstetric problems - (IVF, Twins and age)
What is the main cause of indirect maternal mortality
Cardiac death
What is still birth?
Death of a foetus >24 weeks up to 24 hours post delivery (4.1 in UK)
What is early neonatal death
Death of new born first 7 days
What is death of neonatal?
Death of newborn up to 28 days
What is death of post neonatal?
28-365 days
What are the main causes of neonatal death?
- Prematurity
- Congenital risk
- Obstetric problems
- Infections
What is perinatal mortality include
Still births and early neonatal deaths
What is the main cause of infant death
Death in first year of life - 61% die in first year
- prematurity and congenital abnormality
What are the trends of infant mortality?
- Higher rates of teenage pregnancy
- Higher rates in lower socioeconomic groups
- Higher rates in primps
- Higher rates in ethnic minorities
Risk factors for still birth
- Smoke
- Obesity
- Lower socioeconomic background
- Foetal IUGR
- Multiple pregnancies
- Ethnic problems
- Geographical location
- Congenital abnormalities
Epidemiology of STIs
More men than women and easier to diagnose in men
Recent rise in syphilis
15-24
What is the most common STIs
Chlamydia - warts - herpes - gonorrhoea -
3 reasons why increasing sTI rates
- More condom less sex
- More testing
- More gay sex
Who should be targeted for sexual health promotion
- Gay men
- Young adults
- Prison inmates
- Sex workers
- HIV
- Ethnic communities
What 3 things should be educated about for promoting sexual health awareness
- Use and correct use of condoms
- Sexual education in schools
- Clinics and support group s available
- Screenign tests
Incidence meaning
New cases
Prevalance meaning
Existing cases
What are 3 forms of criminal HIV transmission
- Accidental (unaware)
- Intentional (directly infecting them with intent)
- Reckless (not intentional but careless)
