224/225: Pregnancy Prevention and Termination Flashcards
Do IUDs prevent ovulation?
No
IUDs kill sperm, keep sperm out (thicken cervical mucus) and prevent implantation
(wild)
What must be done before a surgical abortion is considered complete?
Check products of conception
Does not require pathology as long as the provider knows waht they are looking for - frond-like material
What is the most common pain management used during a surgical abortion?
Paracervical block w/lidocaine
But lots of variation between providers (general, local + IV. local only)
Which method of emergency contraceptrion can be used within 72 hours (3 days) of exposure?
Which can be used wtihin 120 hours (5 days)?
- 72h
- High dose levonorgestrel (Plan B)
- 120h
- Anti-progestin: Ulipristal acetate
- Requires prescripion
- Copper IUD
- Anti-progestin: Ulipristal acetate
- Delays or alters ovulation, may impede tubal transport*
- Anti-progestin alters endometrial lining*
- NOT considered an abortion*
What is the difference in MOA of a progestin-releasing IUD vs a copper IUD?
How does each IUD alter the menstrual cycle?
- Progestin-releasing IUD
- Local progestin -> endometrial atrophy; zygote cannot implant
- Results in lighter periods, less cramping
- Copper IUD
- Endometrial inflammation -> prevents sperm from fertilizing
- Results in heavier, more painful menstruation
Which drugs are used for medical abortion?
What are their MOAs?
Mifepristone followed by misoprostol
- Mifepristone = anti-progesterone; terminates pregnancy
- Misoprostol = prostaglandin analog; aids expulsion
Mifepristone given in clinic
Pt self-administeres misoprostol 24-48h later
How OCPs prevent pelvic inflammatory disease?
Chlamydia and gonorrhea can infect, but they cannot ascend due to thickened cervical mucous
How many visits does a medical abortion usually take?
Surgical abortion?
Medical = usually 2 visits, complete after 24h (1 visit to get meds, 1 for follow-up in 2 weeks, insure abortion is complete)
Surgical = can be done in 1 visit, takes 5-10min
What is the most commonly performed gynecologic surgery performed in the USA?
Abortion
Is a medical or surgical abortion more likely to result in bleeding and cramping after?
Medical
Women can manage at home (could be pro/con depending on person)
List the contraindications to medical abortion (7)
- Ectopic pregnancy
- IUD in place
- Corticosteroid use (if long term)
- Hemorrhagic disorders
- Anticoagulant use (if concurrent)
- Adrenal failure (chronic)
- Allergy to mifepristone, misoprostol, or other prostaglandin
Which methods of contraception are safe for a woman with a hx of pulmonary embolism (after the acute phase)?
- Copper IUD
- Progestin-releasing IUD
- Progestin only formulations
- Oral, implants, injections
- Anything with estrogen is contraindicated*
- Only copper IUD is safe during acute phase*
What are the contraceptive effects of OCPs on each of the following:
- Cervical mucus:
- Endometrial lining:
- Ovulation:
- Cervical mucus:
- Progestin thickens the mucus, thus preventing sperm migration
- Endometrial lining:
- Constant progestin -> atrophic endometirum; zygote cannot implant
- Estrogen is not anti-contraceptive, but it prevents breakthrough bleeding
- Ovulation:
- Suppression by progestin (and a little bit by estrogen
- Progestin decreases GnRH pulse frequency, which suppresses LH and LH surge
- Estrogen suppresses FSH and contributes to LH surge inhibition
How does surgical abortion differ in the first vs. second trimester?
Abortion in the second trimester requires cervical preparation
Osmotic dilator and/or chemical ripening agents
In first trimester, dilate curvix, suction products of conception; do not need cervical preparation
What is the MOA of the progestin IUD?
Endometrial atrophy
Thickened cervical mucous prevents sperm migration
Does not prevent ovulation
