225/226 - Pregnancy Prevention and Termination Flashcards

1
Q

Do IUDs prevent ovulation?

A

No

(wild)

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2
Q

What must be done before a surgical abortion is considered complete?

A

Check products of conception

Does not require pathology as long as the provider knows waht they are looking for - frond-like material

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3
Q

What kind of pain management is used during a surgical abortion?

A

Paracervical block w/lidocain

Usually do not need general anesthesia

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4
Q

Which method of emergency contraceptrion can be used within 72 hours (3 days) of exposure?

Which can be used wtihin 120 hours (5 days)?

A
  • 72h
    • High dose levonorgestrel (Plan B)
  • 120h
    • Anti-progestin: Ulipristal acetate
      • Requires prescripion
    • Copper IUD
  • Delays or alters ovulation, may impede tubal transport*
  • Anti-progestin alters endometrial lining*
  • NOT considered an abortion*
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5
Q

What is the difference in MOA of a progestin-releasing IUD vs a copper IUD?

How does each IUD alter the menstrual cycle?

A
  • 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
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6
Q

Which drugs are used for medical abortion?

What are their MOAs?

A

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

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7
Q

How OCPs prevent pelvic inflammatory disease?

A

Chlamydia and gonorrhea can infect, but they cannot ascend due to thickened cervical mucous

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8
Q

How many visits does a medical abortion usually take?

Surgical abortion?

A

Medical = usually 2 visits, complete after 24h

Surgical = can be done in 1 visit, takes 5-10min

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9
Q

What is the most commonly performed gynecologic surgery performed in the USA?

A

Abortion

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10
Q
A
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11
Q

Is a medical or surgical abortion more likely to result in bleeding and cramping after?

A

Medical

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12
Q

List the contraindications to medical abortion (7)

A
  • 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
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13
Q

Which methods of contraception are safe for a woman with a hx of pulmonary embolism (after the acute phase)?

A
  • Copper IUD
  • Progestin-releasing IUD
  • Progestin only formulations
    • Oral, implants, injections

  • Anything with estrogen is contraindicated*
  • Only copper IUD is safe during acute phase*
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14
Q

What are the contraceptive effects of OCPs on each of the following:

  • Cervical mucus:
  • Endometrial lining:
  • Ovulation:
A
  • 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
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15
Q

How does surgical abortion differ in the first vs. second trimester?

A

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

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16
Q

What is the MOA of the progestin IUD?

A

Endometrial atrophy

Thickened cervical mucous prevents sperm migration

Does not prevent ovulation

17
Q

What is the difference between progestin and progesterone?

A

Progestin = hormone used in birth control

Has gone through many “generations,” but basically it has a longer half life than endogenous progesterone