Best practice in post-abortion contraction 2022 Flashcards
Explained 4 categories of medical eligibility criteria (MEC)
- A condition for which there is no restriction for the use of the contraceptive method
- A condition for which the advantages of using the method usually outweigh the theoretical or proven risks
- A condition for which the theoretical or proven risks usually outweigh the advantages of the method
- A condition that represents an unacceptable health risk if the contraceptive method is used
UK Mec 4 for COCP
Stroke (history of cerebrovascular accident, including transient ischaemic attack (TIA)
* Current and history of ischaemic heart disease
* Vascular disease
* History of, or current venous thromboembolism (VTE)
* Major surgery with prolonged immobilisation
* Complicated valvular and congenital heart disease (e.g., pulmonary hypertension)
* Cardiomyopathy with impaired cardiac function
* Atrial fibrillation
* Known thrombogenic mutations
* Systolic blood pressure ≥160 mmHg or diastolic ≥90–99 mmHg
* Migraine with aura
* Smoking ≥15 cigarettes/day after age 35 years
* Severe decompensated liver cirrhosis
* Benign hepatocellular adenoma
* Malignant hepatocellular carcinoma
* Positive antiphospholipid antibodies
* Systemic lupus erythematosus (SLE) with positive antiphospholipid antibodies
* Current breast cancer
UK Mec 4 LNG-IUD and Cu-IUD
- Unexplained vaginal bleeding
- Post-abortion sepsis
- Awaiting treatment for cervical cancer
- Endometrial cancer
- Gestational trophoblastic disease with persistently elevated human chorionic
gonadotrophin (hCG) levels or malignant disease - Current pelvic inflammatory disease
- Current symptomatic chlamydia
- Current gonorrhoea or purulent cervicitis
- Pelvic tuberculosis
- Current breast cancer
Is any contraceptive contraindicated in HIV?
No
Which enzyme inducing drugs can interfere with POP and COCP
Anticonulsants: Carbamazepine, phenytoin, topiramate
Antiretrovirals: emtricitabine, efavirenz
Anti-TB Rifampixin
Herbal: St Johns Wart
Which contraceptives work by thickening cervical mucus?
POP and LNG-IUD
Which contraceptives work by preventing ovulation>
COCP
Injection, implants
Drospirenone POP
Which contraceptives work by preventing fertilisation
Cu-IUD
Effectiveness of typical use for
- Progesterone injection
- COCP
- POP
- Progesterone injection 94%
- COCP 91%
- POP 91%
Perfect use >99%
Typical use and perfect use diaphragm
Perfect 94%
Typical 88%
Typical use and perfect use condon
98%
83%
Typical use and perfect use fertility awareness
99%
88%
Typical use and perfect use withdrawal
96%
73%
Disadvantages LNG-IUD
Inserted and removed by a healthcare provider
Insertion can be painful
1:1000 risk of perforation
1:20 risk of expulsion
1:100 risk of infection for 3 weeks after insertion
Light, unpredictable vaginal bleeding is common for 3–6 months after insertion
Disadvanatges POP injection
Repeat every 2-3 months
Can delay return fertility for up to 1 year
Erratic bleeding is common initially
4% loss bone denisty, reversible on stopping
Risk COCP
Need to remember take correctly
Many medical CI
Small increased risk VTE and breast cancer whilst taking
How long does contraceptive patch and ring work?
Patch 1 week
Ring 3 weeks
Risk VTE per 10,00
- Not preg or hormonal therapy
- CHC with levonorgestrel/norgestimate/NET
- Vaginal CHC ring/patch
- CHC with desogestrel/gestodene/drospirenone
- Pregnancy
- Immediately postpartum
If 2nd trimester miscarriage what UKMEC is progesterone and Cu IUD
2
Offer progesterone implant
If following a septic miscarriage miscarriage what UKMEC is progesterone and Cu IUD
1 week
