• Focusing on women's health: o Name and describe the components and rationale of the gynecological health history. o 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).
Sample Answer
Women's Health Assessment and Screening
1. Gynecological Health History
The gynecological health history is a focused and critical part of the overall medical history, used to assess reproductive health, sexual history, and risk factors for gynecological diseases and cancers.
GTPAL System
The GTPAL system is a standardized method used to document a woman's comprehensive obstetric history using five components:
G (Gravida): The total number of pregnancies a woman has had, regardless of the outcome or duration. This includes the current pregnancy.
Example: A woman currently pregnant with twins who had one prior miscarriage and one prior term birth is G3.
T (Term Births): The number of pregnancies delivered at 37 weeks 0 days gestation or later (full term).
P (Preterm Births): The number of pregnancies delivered after 20 weeks 0 days, but before 37 weeks 0 days gestation.
A (Abortions): The total number of pregnancies ending before 20 weeks 0 days gestation. This includes spontaneous miscarriages and induced abortions.
L (Living Children): The number of children currently living. This is the only component counted in terms of individual children, not number of pregnancies.
Note: In the case of multiple births (twins, triplets), the T, P, and A counts remain 1 for that single pregnancy event, but L is counted by the number of babies.
3. USPSTF Screening Recommendations for G.R. (66-year-old female)
G.R. is a 66-year-old female with a health history only positive for a hysterectomy (removal of the uterus and cervix) 10 years ago due to fibroids. She has not seen a PCP in 5 years. Based on USPSTF guidelines, the following screenings are recommended:
Screening
Recommendation
Rationale Based on USPSTF
Cervical Cancer (Pap Smear)
Screening is not recommended.
USPSTF recommends against screening for women older than 65 who have had adequate prior negative screening results and are not otherwise at high risk. Furthermore, G.R. had a hysterectomy, meaning she has no cervix, and if the hysterectomy was for a benign condition (fibroids), screening is discontinued.
Breast Cancer (Mammography)
Screening is recommended.
USPSTF recommends biennial (every 2 years) screening mammography for women aged 50 to 74 years (Grade B recommendation). G.R. is 66, fitting squarely within this age group.