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4: Y4 - Gynaecology [8] > [29] Contraception - Emergency > Flashcards

[29] Contraception - Emergency Flashcards

1
Q

What is the purpose of emergency contraception?

A

Prevent pregnancy following sexual intercourse

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2
Q

How does emergency contraception differ from other forms of contraception?

A

It is used after sex, whereas other forms are used before or during sex

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3
Q

What are the indications for emergency contraception?

A
  • Sexual intercourse without contraception

- Contraceptive method has failed

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4
Q

Give an example of how a contraceptive might fail

A

Condom torn

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5
Q

When might women using POP or COCP need emergency contraception?

A

If they miss pills, depending on how many pills have been missed

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6
Q

What are the types of emergency contraception?

A
  • Emergency hormonal contraception (morning after pill)

- Intrauterine device

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7
Q

What are the types of morning after pill available in the UK?

A
  • Levonorgestrel

- Ulipristal acetate

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8
Q

What is the brand name for Ulipristal acetate?

A

EllaOne

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9
Q

What is levonorgestrel?

A

Synthetic progesterone

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10
Q

How does levonorgestrel work?

A

It delays ovulation by 5-7 days, after which any sperm will be non-viable

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11
Q

What is ulipristal acetate?

A

A progesterone receptor modulator

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12
Q

How does ulipristal acetate work?

A

It delays ovulation for 5-7 days, after which any sperm will be non-viable

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13
Q

How long after unprotected sex can levonorgestrel be used?

A

Within 72 hours of unprotected sex

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14
Q

How long after unprotected sex can ulipristal acetate be used?

A

Within 120 hours of unprotected sex

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15
Q

Do hormonal emergency contraceptives have an effect on implantation?

A

No

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16
Q

What is the copper intrauterine device usually used as?

A

A method of long-term non-hormonal contraception

17
Q

How long after unprotected sex can the copper coil be inserted to be used as emergency contraception?

A

Within 5 days

18
Q

How does the copper coil work as emergency contraception?

A

Toxic to sperm, and may induce a sterile inflammatory response within the uterus that makes implantation impossible

19
Q

How long does the copper coil provide contraception for if used as emergency contraception?

A

5-10 years (depending on type) as long as it remains in situ

20
Q

How effective is the copper coil as emergency contraception?

A

99% effective

21
Q

Who should the copper coil be offered to as emergency contraception?

A

All women presenting

22
Q

What are the absolute contraindications to levonorgestrel as emergency contraception?

A

None

23
Q

What reduces the efficacy of levonorgestrel as emergency contraception?

A
  • Diseases of malabsorption

- Enzyme inducing drugs

24
Q

Give an example of a disease of malabsorption

A

Crohn’s

25
Q

Give an example of an enzyme inducing drug

A

Rifampicin

26
Q

What should be done if a patient requiring emergency contraception who is on an enzyme inducing drug refuses the IUD?

A

Double dose of levonorgestrel, e.g. 3mg at once, may be taken.

Ulipristal acetate is absolutely contraindicated here

27
Q

What are the contraindications to ulipristal acetate?

A
  • Diseases of malabsorption
  • Hypersensitivity to ulipristal acetate
  • Severe hepatic dysfunction
  • Enzyme inducing drugs
  • Breast feeding
  • Asthma insufficiently controlled by corticosteroids
  • Drugs decreasing gastric pH
28
Q

How long after taking ulipristal acetate should breastfeeding be avoided?

A

7 days

29
Q

Give 2 examples of drugs reducing gastric pH

A
  • Omeprazole

- Ranitidine

30
Q

What are the contraindications to the copper IUD as emergency contraception?

A
  • Uterine fibroids with distortion of uterine cavity
  • Documented or suspected pelvic inflammatory disease
  • Documented or suspected STI, especially chlamydia or gonorrhoea
31
Q

What are the adverse effects of emergency hormonal contraception?

A
  • Nausea
  • Dizziness
  • Menstrual disturbance
  • Abdominal pain
32
Q

What are the adverse effects of IUD?

A
  • Pelvic infections
  • Expulsion of IUD
  • Bleeding
  • Pelvic pain
33
Q

In what forms should follow up advice be provided for emergency hormonal contraception?

A
  • Verbal

- Written

34
Q

What follow up advice should be given in a patient taking emergency hormonal contraception?

A
  • Seek help if vomiting occurs within 2 hours of taking levonorgestrel, or 3 hours of taking ulipristal, as the medication may not have been absorbed adequately
  • Effectiveness of hormonal methods decreases as the time since sexual intercourse increases
35
Q

What follow up advice should be given in a patient using copper coil is emergency contraception?

A

Increased relative risk of ectopic pregnancy following insertion of IUD

36
Q

What should the patient be alert to as signs fo ectopic pregnancy following IUD insertion for emergency contraception?

A

Next period is >5 days late with reduced bleeding, especially coupled with severe lower abdominal pain

4: Y4 - Gynaecology [8] (52 decks)

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