Women’s health

8 Women’s health



Anatomy at a glance 1

Physiology you need to know

Major conditions

Interruptions to pregnancy

Abortion

Ectopic pregnancy

Tumours of the ovary

Carcinoma of the cervix

Breast cancer

Ten top tips


ANATOMY AT A GLANCE


The female reproductive system may be divided into an external and an internal component.


The external organs have the collective name of the vulva, and are shown in Figure 8.1.


image

Figure 8.1 Female external genitalia.


The internal organs consist of the


image Vagina: a tubular structure running backwards at an angle of 45 degrees to the vertical situated between the bladder and the rectum.

image Uterus: a hollow muscular organ which is shaped like a pear 7.5 cm long and 5 cm wide with relatively thick walls (2.5 cm). The cervix is that part of the uterus that protrudes into the vagina.

image Uterine (Fallopian) tubes: extend from the uterus towards the ovaries where they terminate in finger-like projections known as fimbriae which lie adjacent to the ovaries.

image Ovaries: each ovary is approximately 3 cm long and 2 cm wide. Surrounding the medulla is the cortex containing ovarian follicles in various stages of development, each of which contains an ovum.

The relationship of these organs is shown in Figure 8.2.


image

Figure 8.2 Median sagittal section of the female pelvis.



PHYSIOLOGY YOU NEED TO KNOW


The main functions of the female reproductive system are:


image To produce the female sex hormones oestrogen and progesterone.

image To ripen ova for fertilization.

image To facilitate the fertilization of ova.

image To incubate the fetus and deliver it into the outside world when it is ready to continue its growth and development as an infant.

Although at birth there are approximately two million oocytes present in the ovaries only 400–500 will develop to ovulation during adult life. Ovulation occurs when an ovarian follicle matures, ruptures and releases the ovum that it contains into the peritoneal cavity. Follicle-stimulating hormone (FSH) is responsible for the maturation process of the follicle (it also leads to the secretion of oestrogen, which stimulates the endometrium lining the uterus, preparing it for receiving a fertilized ovum). The anterior pituitary releases FSH, and it also releases another hormone known as luteinizing hormone (LH), which stimulates the cells lining the follicle (after ovulation) to develop into the corpus luteum. This will produce progesterone.


Two fates may befall the ovum. If it is fertilized it embeds itself in the wall of the uterus where it continues to develop, producing human chorionic gonadotrophin in the process. This hormone continues to stimulate the corpus luteum to produce progesterone for the first three months of the pregnancy. If the ovum is not fertilized, the corpus luteum decays and a new menstrual cycle will commence about 14 days after ovulation with menstruation.


Reproductive function ceases at around age 50, the menopause, when menstruation stops. On average, therefore, women live for some 30 years in this post-menopausal state. The menopause is a time in a woman’s life when her hormonal balance is severely disrupted as oestrogen levels fall dramatically. Hot flushes are one very pronounced symptom associated with low oestrogen levels and pulses of LH. The woman experiences acute physical discomfort as she feels very hot and her skin reddens, particularly around the face and neck. Episodes are unpredictable and sudden in onset, although they gradually decline in frequency as the now postmenopausal hormonal balance is established.



MAJOR CONDITIONS


There are many health problems related to the female reproductive tract. This chapter concentrates only on those that account for the maximum amount of treatment required, particularly as in-patients. You are encouraged to read and study much further afield to understand the full picture of women’s health. Do remember the sociological dimension to women’s health, and how women’s role in society plays such a big part in determining health.



INTERRUPTIONS TO PREGNANCY (P797)




ABORTION



PATHOLOGY: Key facts


Abortion is defined as the cessation of pregnancy before the 24th week of pregnancy. This can occur spontaneously or may be induced for therapeutic reasons. Spontaneous abortion usually results from:


image Problems with the fetus due to chromosomal or developmental abnormalities which are incompatible with life.

image Maternal problems such as a severe infection of the mother, side effects of drugs or hormonal imbalances.

image Environmental factors such as trauma or nutritional deficits affecting the mother.

Therapeutic abortion is performed for either medical or social reasons, and is controlled by legislation in the UK and many other countries. Despite this, criminal abortions are still performed, which can have disastrous consequences for the woman.



WHAT TO LOOK OUT FOR


Vaginal bleeding during pregnancy is abnormal and the woman should be seen by a midwife or doctor immediately as this may indicate a threatened abortion. At this stage it is still possible to save the pregnancy. Severe bleeding and pain usually indicate that an inevitable abortion has occurred, however, and the pregnancy cannot be saved.


Sometimes the woman experiences a missed abortion, in which there may be a brownish discharge early in the pregnancy accompanied by a weak pregnancy test. The classic early symptoms of pregnancy may have ceased sooner than expected. The obstetrican will usually evacuate the remains of the pregnancy about 2 weeks after the estimated death of the fetus. This eliminates the risk of disseminated intravascular coagulation, and reduces the distress the woman probably experiences from knowing that she is carrying the remains of her dead fetus within the uterus.



MEDICAL MANAGEMENT


Retained products of conception pose a major infection hazard; therefore, after inevitable abortion, such products must be fully removed. This may have to be done as an emergency procedure on the ward using swabs, sponges and forceps with a speculum. In less urgent situations, dilation of the cervix and evacuation of the uterus may be performed. All products of conception should be saved for histology.


Therapeutic abortions may be performed surgically by suction, dilatation and curettage as a day case. They are best performed before 12–14 weeks of gestation. Alternatively, a medical abortion may be induced by giving a single 600 mg oral dose of mifepristone followed by 1 mg of gemeprost (a prostaglandin preparation) by vagina. This is most effective in the first 9 weeks of pregnancy.


Later terminations, after 12–14 weeks, require different techniques. Prostaglandins may be given IV, regulated by infusion pump to induce labour. The fetus dies and is expelled with assistance of oxytocin. Alternatively, gemeprost can be given as a vaginal pessary 1 mg every 3 hours to induce a late abortion (maximum dose 5 mg) after treatment with mifepristone.



PHARMACOLOGICAL FOCUS


Mifepristone is an anti-progesterone agent. A pregnancy requires progesterone to prevent uterine contractions, therefore reducing progesterone levels makes it easier to induce uterine contractions with prostaglandins, and so expel the fetus.



PRIORITIES FOR NURSING CARE


If the woman has a threatened abortion, rest and close observation are essential. It will be a very anxious time, and a lot of support is needed to help the woman cope with the fear of possibly losing her pregnancy.


If a therapeutic abortion is carried out, or the abortion becomes inevitable, the patient needs close observation and regular monitoring of vital signs. The abortion may well involve labour pains that will be particularly distressing to the woman. Analgesia and support are essential. Patient education prior to discharge is a vital nursing role, concentrating on the following key points:


image Resume normal activity gradually.

image Intermittent menstrual-like discharge is to be expected for the next 2 weeks but it should not be bright red in colour; sanitary pads should be used. She should abstain from sexual intercourse while the discharge is present.

image Some cramping is to be expected, but severe discomfort or fever should be reported immediately to the doctor.

Related posts:

  1. Caring for the patient with a haematological disorder
  2. Caring for the patient with a disorder of the gastrointestinal system
  3. Caring for the patient with a disorder of the endocrine system
  4. Caring for the patient with a disorder of the liver, biliary tract and exocrine pancreas

Stay updated, free articles. Join our Telegram channel
Tags:
Feb 3, 2017 | Posted by in NURSING | Comments Off on Women’s health

Full access? Get Clinical Tree
Get Clinical Tree app for offline access