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 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
