GTPAL System Used to Document Pregnancy History

Focusing on women’s health:
Name and describe the components and rationale of the gynecological health history.
Define and describe each component of the GTPAL system used to document pregnancy history.
Following the guidelines of the United States Preventive Service Taskforce (USPSTF) what screening recommendations would you do to G.R. a 66-year-old female patient who visits you at the office for the first time (last visit to her PCP 5 years ago) with only positive health history of hysterectomy 10 years ago due to fibroids.
A 35-year-old women with a BMI of 40 comes in asking about combined hormonal contraception’s. You explain the contraindications for hormonal contraception include (name more than 4 contraindications).
Submission Instructions:

Include at least two references in your post.
Provide a minimum of 2 substantive responses to your peers’ postings.
Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.)

Components and Rationale of the Gynecological Health History

A comprehensive gynecological health history is essential in assessing a woman’s overall health and identifying potential issues. The main components and their rationale include:

1. Menstrual History:
   • Components: Age at menarche, cycle length, duration and flow of periods, and any associated symptoms (e.g., dysmenorrhea, PMS).
   • Rationale: Provides insights into hormonal function and reproductive health. Abnormalities can indicate conditions like PCOS, endometriosis, or thyroid disorders.
2. Obstetric History:
   • Components: Number of pregnancies, outcomes (live births, miscarriages, stillbirths), complications (e.g., preeclampsia, gestational diabetes).
   • Rationale: Helps assess risks for future pregnancies and current health. Complications in past pregnancies can indicate risk factors for chronic conditions.
3. Sexual History:
   • Components: Sexual activity, number of partners, use of contraception, history of sexually transmitted infections (STIs).
   • Rationale: Identifies risk for STIs, need for contraception, and potential sexual dysfunction or trauma.
4. Contraceptive History:
   • Components: Current and past methods of contraception, satisfaction with methods, side effects.
   • Rationale: Guides counseling on suitable contraceptive options and identifies any adverse effects from previous methods.
5. Gynecological Conditions and Surgeries:
   • Components: History of gynecological conditions (e.g., fibroids, ovarian cysts), surgeries (e.g., hysterectomy, oophorectomy).
   • Rationale: Essential for understanding current health status and planning future care, including screening and preventive measures.
6. Screening History:
   • Components: Last Pap smear, mammogram, bone density scan, and results.
   • Rationale: Ensures appropriate screening is up-to-date and identifies any need for follow-up or additional testing.
7. Family History:
   • Components: Family history of gynecological cancers, hereditary conditions (e.g., BRCA mutations).
   • Rationale: Identifies genetic risks and informs personalized screening and prevention strategies.

GTPAL System for Documenting Pregnancy History

The GTPAL system is used to provide a detailed obstetric history:

1. G (Gravida): Total number of pregnancies a woman has had, regardless of the outcome.
2. T (Term births): Number of pregnancies that were carried to term (37 weeks or more).
3. P (Preterm births): Number of pregnancies that resulted in a preterm birth (20 to 36 weeks).
4. A (Abortions): Number of pregnancies that ended in miscarriage or elective abortion before 20 weeks.
5. L (Living children): Number of living children.

Screening Recommendations for G.R., a 66-Year-Old Female

According to the USPSTF guidelines, the following screenings are recommended:

1. Breast Cancer Screening:
   • Mammography every two years for women aged 50 to 74.
2. Colorectal Cancer Screening:
   • Colonoscopy every 10 years, or annual fecal immunochemical test (FIT), for adults aged 50 to 75.
3. Osteoporosis Screening:
   • Bone density screening for women aged 65 and older.
4. Hypertension Screening:
   • Annual blood pressure measurement.
5. Diabetes Screening:
   • Screening for type 2 diabetes in adults aged 35 to 70 who are overweight or obese.
6. Lipid Disorders:
   • Lipid screening every 5 years.

Given G.R.’s hysterectomy, cervical cancer screening is not required if she has no history of a high-grade precancerous lesion or cervical cancer.

Contraindications for Combined Hormonal Contraceptives in a 35-Year-Old with BMI of 40

Combined hormonal contraceptives (CHCs) are generally contraindicated in the following situations:

1. History of Thromboembolic Disorders:
   • Increased risk of venous thromboembolism, especially in women with obesity.
2. Hypertension:
   • CHCs can increase blood pressure, posing a risk for women with hypertension.
3. Migraine with Aura:
   • Elevated risk of stroke in women who experience migraines with aura.
4. Liver Disease:
   • Impaired liver function can affect the metabolism of hormones.
5. Breast Cancer:
   • Current or past history of breast cancer, as CHCs can influence hormone-sensitive tumors.
6. Smoking and Age Over 35:
   • Increased cardiovascular risk, especially for women who smoke.
7. Diabetes with Complications:
   • CHCs can worsen cardiovascular and microvascular complications in diabetic women.

References

• U.S. Preventive Services Task Force. (2022). Screening Recommendations. Retrieved from USPSTF website.
• Hatcher, R. A., Trussell, J., Nelson, A. L., Cates, W., Kowal, D., & Policar, M. (2018). Contraceptive Technology (21st ed.). New York: Ardent Media.