WOMEN’S HEALTH WEDNESDAY

There are two short-hand systems of documenting obstetrical history: GPA and TPAL 

In GPA, the abbreviations stand for:

• Gravida = The number of times the patient has been pregnant, regardless of outcome, including the current pregnancy.
• Para = The number of births after 20 weeks. Twins/triplets only count as one. This includes stillbirths.
• Abortus = The number of induced abortions, miscarriages or ectopic pregnancies. 

So, a pregnant patient who has had one live birth and one miscarriage would be G3 P1 A1

TPAL is more specific. In this system, the Gravida is still listed first, and under Para there are four numbers, each standing for the following:

• Term = The number of pregnancies delivered after 37 weeks
• Pre-term = The number of pregnancies delivered between 20 - 37 weeks
• Abortus
• Live = The number of children currently alive

So, a pregnant patient who has had one child at full term, twins at 35 weeks, one miscarriage and one abortion would be G5 P1123

WOMEN’S HEALTH WEDNESDAY

The cervical cancer prevention process in three steps:

1 The Pap test/Pap smear. This is a screening for pre-cancerous and cancerous cells in the cervix. A speculum tool is used to allow a swab to collect a sample of cells for examination under a microscope. Common misconception: Pap is short for the doctor’s name who invented it (Paponikolaou), not human papilomavirus - which coincidentally can cause cancerous cell growth in the cervix. A Pap smear is performed annually in sexually active females and usually ever 5 years in post-menopausal women with no history of abnormal findings.

2 If suspicious cells are collected in the Pap, the next step is a coloscopy (not to be confused with a colonoscopy). In this procedure, a tool called a coloscope is used to illuminate and magnify the cervix and vaginal tissue (“scopy” = to look). It is usually paired with biopsy - cells are removed from cancerous or pre-cancerous lesions for further evaluation. A coloscope is also used to examine and collect evidence from rape victims. 

3 If it is determined that cervical dysplagia is evident, a LEEP procedure is performed (loop electrosurgical excision procedure). It is performed within an office and requires local or general anesthesia. The tool used simultaneously cuts and cauterizes the tissue as lesions are removed. 

TRICKY THURSDAY

This acronym helps you keep track of all you need to assess while caring for a mother, post partum (in no particular order):

Homan’s sign

Emotional state

Respiratory

Breasts

Uterus

Bladder

Bowel

Lochia

Episiotomy

WOMEN’S HEALTH WEDNESDAY

A hydatidiform mole aka molar pregnancy is a rare occurrence where a normal sperm fertilizes a “bum” egg and creates a benign tumor in the uterus. The placenta forms an abnormal, nonfunctioing mass of cysts. There is a complete molar pregnancy - no embryo and no normal placenta, or a partial molar pregnancy - a non-viable embryo which will not survive and some functioning placenta. It is NOT an ectopic pregnancy or normal miscarriage.

Symptoms include heavy bleeding or passing of grape-like cysts in the first trimester, and rapid uterine growth. Patients WILL test positive on a pregnancy test. Patients who have had molar pregnancies in the past are at high risk for occurrence - it is suggested to wait 6 -12 months before trying to conceive again to reduce risk. The molar tissue must be removed with a vacuum-type tool through the vagina. If it is not completely removed the patient is at risk for developing persistant gestational trophoblastic disease which can lead to a true cancer.