Contraception Flashcards
When does pregnancy occur?
Implantation
What is the pearl index:
Measurement of contraceptive effectiveness. It measures the n. of pregnancies that occur when 100 women use a certain contraception for 1 year.
e.g. 3/100 in 1 yr = P.I. 3.0
What is LARC?
Long-acting reversible contraceptions.
UK MEC: describe the 4 stages.
1(A): Always can give
2(B): Benefits > risks
3(C): caution risks > benefit - need specialist
4(D): Don’t think about it: unacceptable health risk
Contraceptive consultation:
What is the patient/HCP perspective
pt perspective Side effect: - bleeding, weight, pain? Risks: - future fertility How effective it is How it works
HCP
- patinent choice
- dangerous patients
- compliance (method/user failure) & (understanding)
What differents between different OCP
the progesterone (monophasic, biphasic, triphasic)
Mode of action of OCP
- inhib ovulation
- EE ↓ FSH
- Progesterone prevents LH surge
- Cervical mucus effects
Drug interactions of COC
CYP450 inducers
Antibiotics:
- Rifampicin
-Rifabutin
Antidepressants: - St. John’s Wort Antiepileptics: -Carbemazepine -Oxcarbazepine -Phenytoin, Primidone, Topiramate,Phenobarbitol
Antifungals:
- Griseofulvin,
- ?Imidazoles & Triazoles
Anti-retrovirals(HIV Rx)
Other
Bosentan, Modafinil, Tracolimus
these can reduce efficacy of COCP (as can D&V)
Other benefit of OCP
Reduction in menstrual disorders ¯ functional ovarian cysts x 92% ¯ menorrhagia, irregular bleeding x 50% ¯ dysmenorrhoea x 40% ¯ PMS ¯ Iron deficiency anaemia x 50% ¯ PID x 50% ¯ Ectopic pregnancy x 90% ¯ Fibroids x 30% ¯ Benign breast disease x 50 - 75% Symptomatic relief / treatment of endometriosis ¯ Climacteric symptoms/ ↑ protection from osteoporosis ¯ Rheumatoid arthritis x 50% ¯ Endometrial cancer x 50% ¯ Ovarian cancer x 40% ¯ Colorectal cancer x 20%
How many conceptions are unplanned?
How many women request a TOP? How many per yr in UL
50%
33%, >200,000
TOP:
upper gestational limit:
How many medical practitioners?
24 weeks
2 registered
If patient has unplanned pregnancy:
OSCE station
- confirm pregnancy by PT
- Arrange USS: viability, gestational age, singleton/multiple, exclude molar/ectopic
Counselling
non directive/non judgemental
Discuss both options:
- continuation
- termination: tell of all options medical or surgical
- adoption if >24wks
Allow time for decision
Risk of STI: STI
discuss future contraception,
written/website info for both options.
Follow up appointment
What are they 3 stages/gestations of medical TOP
< 9 weeks: Early medication abortion (EMA):
9-12 weeks: Late Early medical abortion
12-24 w: Mid trimester medical abortion
What & when can u use surgical TOP methods
Manual vacuum aspiration: 9-12weeks: avoid if < 7 weeks, ↑ risk of failure.
Surgical evacuation under GA: 7-15
dilatation/evacuation GA 15-18
Surgical with fetocide (KCL into heart) 22-24wks
What drugs are used for medical
Mifipristone (anti progesterone) 200mg PO
24-48hrs later
Misoprostol (prostaglandin) 800mg PO/PV
allowed home for 2nd drug.
24 hr help
follow up in 4 weeks for PT
headache on pill
ensure not migrant (if so, stop): auras, photo sensitive
headache, could ↓ dose, take packs back to back or stop
missed pill
take as soon as you remember
if > 2 use condoms for 7 days,
if had sex emergency contraception and PT in 3 weeks
starting pill
if in first 5 days of cycle- covered straight away
7 days COP
2 day: mini pill
always give leaflets
girls comes had unprotected sex 2 days ago, would like a pregnancy test.
- give emergency contraception (120hr window) & come back in 3 weeks for PT. No point giving PT.
implant: what warning to give
bleeding irregularly 3-6months
can have combined pill to stop this or can have it removed. Similar to spotting.
same with EPO injection
Main warning for DEPO
can delay fertility 3-6 months, plan ahead stop earlier
which form of contraception is not effected by enzyme inducers
DEPO injection
Ellaone (ulipristal) emergency contraception interacts with what
how long is it effective for after unprotected sex
- Pill- effects ella one
- 5 days- does not get less effective with time
What options are there for emergency contraception
Emergency Pill
- Ulipristal (ellaOne): 5 days
- Levonorgestrel (Levonelle): 72 hours
Copper coil (can’t use if STI)
Q’s before emergency
Have you had emergency c. before? When?
LMP, on time? regular?
What is normal cycle length.
When did she have sex?
Questions according to UKMEC about IUD.
- How long postpartum can IUD be fitted?
- Current breast cancer or >5 year
- Known prolonged QT interval
- What must be excluded before insertion
- 4 weeks (3 before 4 weeks)
- For IUS 4 for current, 3 for > 5 years
- Cervical stimulation can induce vasovagal. Bradycardia can increase risk of cardiac event in those with long QT interval.
- Exclude pregnancy and PID before insertion
When are COC graded 4
- Migrane with aura: 2-4 times risk of CVA
- Breast feeding <6w post-partum
- Smoke > 15 a day
- BP >160/95
- Abnormal cardiac function
- SLE
- Major surgery or immobilisation
