Contraception Flashcards
Tiers ?
1-Top Tiers :Sterilization IUD Implants
2- Second Tiers :Hormonal
3-Third Tiers :Physiological and Barrier
4-Fourth Tiers :Spermicidales
What is the physiological
1- coitus interruptus
2- safe period
3- lactation
Coitus interruptus
(4)
1-Withdrawal when ejaculation,
2-one of the oldest techniques,
3-not effective as the pre-ejaculatory fluid have sperms,
4-better coupled with safe period.
Safe period
(4)
1-Intercourse is protected or prevented in the period of ovulation, 10 to 18 days from menstruation, while the rest of the cycle is free.
2-It’s useful in intellectual couples and regular cycles.
3-It’s effective
4- it can be more accurate and effective when doing BBT and urinary LH kits
Lactation
(2)
1-60% of lactating women in the first 6 months d have amenorrhea and anovulation due to high P-R-L
2-efficacy is 50% alone. As the prolactin can decrease in unpredictable periods of time, leading to ovulation, thus amenorrhea, but not because of the lactation, because of the pregnancy.
Waht is barrier
Physical
- condom
- vag diaphragm
- cervical cap
Chemical
Spermicide
Talk about ads and dis of barrier
•Easy to initiate and discontinue.
•No effects on future fertility.
•No effects on lactation.
•No side effects.
•Can prevent STDs. (Condom)
•May be applied incorrectly, thus unuseful. •Affects pleasure.
•Sometimes requires partner participation.
•Less effective than other moderate methods.
Talk about condoms
(4)
1-The most commonly used barrier.
2-High success rate, 97%.
3-Medical benefits :Prevent STDs, HCV, treat premature ejaculation.
4-Side effects can be torn or slips out.
Talk about spermicide
(3)
1-Nonoxynol-9.
2-Forms :tablets, gel, cream, or sponge applied 10 minutes before intercourse.
3-Side effects. Allergic vaginitis ,not effective alone.
Talk about iud
(4)
1-The most commonly used in developing countries.
2-Made of polyethylene that make it radio-opaque in x-ray.
3-Used for long-term contraception, especially in multi-parous
4-Two nylon threads are present from the lower stem till the cervix. It acts as a marker for presence in place and to facilitate the removal.
Moa
Types
Of iud
Moa
-General :
•mechanical interference
•local foreign body inflammatory reaction.
-Copper :
•decreases carbonic anhydrase and alkaline phosphatase activity
• induces anti-sperm phagocytic activity
-LNG
•atrophic endometrium
•tubal motility interfere
•hostile cervical discharge.
Types
-Copper:
• the most commonly used
•7 to 10 years.
-Copper silver:
• silver is bought to reduce fragmentation of Cu.
-LNG :
•3 to 5 years
ايه ملاحظاتك ف insertion
(4)
1-Time of insertion :postmenstrual, within the drops to ensure
•no pregnancy
•Cervical dilatation, thus no anesthesia.
- 4;6 w after preg
- 3:4 w after abortion
2-No infection
3-no uterine abnormalities
4- following up with TAS, TVS.
Ads of iud
(6)
1-Provides long-term contraception.
2-Doesn’t rely on compliance
3-Doesn’t affect future fertility.
4-Doesn’t affect lactation.
5-Doesn’t affect sexual pleasure.
6-Low failure rate.
Problems of iud
(8)
1-Bleeding
•Post-insertion
-Spotting
-first Few days.
-Recovers spontaneously.
-If persistent, give anti-fibrolytics.
•Menorrhagia.
- due to +surface ,prostaglandins and fibrolytic activity.
-Manage:
~Give NSAIDs
~Give anti-fibrolytics.
~Remove IUD if displaced or discovered to cause a pathology.
~Put IUD-LNG.
2-Pain.
•During insertion:
~Normally due to forcible insertion.
~Give NSAIDs.
•Post-insertion :Displaced.
•Acute abdominal pain :Perforation.
3-Infection.
•Chronic cervicalitis and cervical erosions.
Give antibiotics if persistent. Removal.
•PID is more common in the presence of IUD.
•Ascending method is more common. Due to threads causing endometritis. Salpingites. Give antibiotics if persistent. Removal.
4-Vaginal discharge.
•If infection :mucopurulent fowl discharge.
•Pelvic congestion :Leukorrhea.
5-Expulsion :Due to menstrual contraction or Displaced from the start.
6-Perforation :
•At the time of insertion
•Symptoms: Sharp acute pain with persistent vaginal bleeding.
•Signs :No threads are seen or felt.
•Management :Missed IUD.
7-missed iud :
•Threads can’t be felt or seen due to perforation or expulsion.
•US. If in place~>👍🏻. If not in place~>X-ray. If not found ~>expulsion. If it’s found ~>laparotomy or laparoscopy is done to remove it from the pelvic cavity.
8-Pregnancy.
•Endometrial:
-Due to displacement
-Management.
~If threads are felt, then remove it. Pregnancy is continued. Abortion rate is 25%. (Expulsion)
-If threads are not felt, continue pregnancy. Abortion rate is 50% with higher incidence of septic abortion. ( perforation)
•Ectopic pregnancy: +++ lng
Contra of iud
-Undiagnosed AUB
-uterine anomalies
-PID
-uterine pathology
-increased incidence of ectopic pregnancy.
Talk about
Hormonal , types
- most commonly used in developed
- combined or prg only
Talk about combined
-moa
- types
1-
•E2 :negative feedback mechanism on LH, FSH, (Most potent)
•PRG :
-negative feedback mechanism, but less effective.
-Acts mainly on hostile cervical discharge
-atrophic endometrium
-tubal motility interfere
-prevents E2 from endometrial hyperplasia and carcinoma.
2-
-Pills : from d3 for 21 days, then free week.
-Patches 3 in 1 package. Weekly for 3 weeks, then 1 week free.
-Injects monthly.
-Vaginal ringfrom d3 for 3 weeks, then 1 week free.
Ads of cocp
Disease associated risk
1-
•Contraceptive ADS
1-the most efficient method as the failure rate 0.1 to 1 is due to patient fault, not the method fault.
2-Regulate the cycle very well,
3-no side effects on future fertility,
4-no effects on sexual pleasure.
•Non-contraceptive ADS
1-treats dysfunctional AUB
2-treats spasmodic dysmenorrhea
3-postpone menstruation whenever wanted.
2-
Disease-associated risk
-increased risk of chronic ischemic heart disease,
-breast cancer in pre-disposed.
Se of cocp
4 دم + dm , htn + dvt + 2l
Major
1- Spotting :Irregular intake
2-Breakthrough bleeding :Continuous intake
3-Hypomenorrhea :PRG Effect
4-Amenorrhea :
-Continuous intake
-Vigorous and combined intake~> post-pill amenorrhea
-Pregnancy should be excluded
5- DM :Impairing carbohydrate metabolism
6-HTN :PRG Causing water and salt retention
7-DVT :Synthetic E2 + LDL, - HDL
8-Not taken in lactation as synthetic E2 interfere with prolactin, thus POPs is taken
9- Transient liver impairment as they are metabolized in liver
Minor
1- PMS-like syndrome :
-Irritability and depressed mood
-Migraine
-Weight gain
-Breast tenderness
-Decreased libido
2-Nausea and vomiting
3- Skin pigmentation acne
4- Eye symptoms
Absolute and relative contra of cocp
•Absolute contra (5)
1-DVT or اي حاجة زيه or any history of it.
2Breast cancer or any history of it.
3-Malignancy of female genital tract.
4-AUB (may be preg)
5-Liver impairment.
•Relative contra (10)
1-Age above 35
2-High BMI
3-Smoker
4-Recompency after operation or any cause.
( predisposing to dvt)
5-History of liver impairment.
6-DM
7-HTN.
8-Migraine.
9-Superficial thrombophlebitis.
10Varicose vein.
Talk about prg contraception
1-POPs (4)
-taken continuously non-stoppable
-Indications : whom contraindicated of CoCPs, especially lactation. حبوب الرضاعة
-MOA :mainly on Hostile Cervical Discharge, Endometrium Atrophy, Tubal Motility Interferes, Inhibition of Ovulation in 60% of cases
-Side Effects :Irregular Menstruation, +Presence of Ectopic Pregnancies
2-Injectables (4)
-Every 3M
-DMPA
-MOA :Inhibition of Ovulation
-Side Effects :Spotting at the beginning, then Amenorrhea at the end of the first year
3-Implants (3)
-for 3 years
-MOA :Inhibition of Ovulation
-Side Effects :20% have Amenorrhea, up to 50% have Prolonged and Frequent Cycles.
Sterilization
•Female (4)
-tubal ligation
-
~laparoscopy :most commonly diathermy,
~laparotomy
~vaginal
-side effects :pelvic congestion, causing post-ligation syndrome, menorrhagia, 2ry dysmenorrhea,leucorrhea
-IVF if want to be pregnant (مش هفتح تاني لان مش هيفيد هيبقى عندها adhesions )
male
-surgical bilateral vasectomy or ligation of vas deferens
-medical glossypol ,inhibits spermatogenesis.
Contraception in lactation
كل حاجة ماعدا اي حاجة فيها e2 -
-Safe period as she does not have regular period
Emergency or post coital contraception
1-Within 48 hours( time when Fertilized ovum enters the UT)
Contraceptive pills
4 tablets~> 12 h~>then 4 tablets~> withdrawal
-PRG :0.75 ~> 12h~> 0,75
-COCPs
If low dose: 4 tablets ~>12 h~> 4 tablets
If high dose :2 tablets ~>12 h~> 2 tablets
2-within 4-5 days (time of implantation )
IUD.
دكتور نسيت اخد الحباية / الحبايتين
لحد حبايتين تقدري تاخديهم اول ماتفتكريهم وبعد كدة خدي الحباية الجديدة ف وقتها عادي
لكن لو ٣ هنعيد من اول تاني
