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Obstetrics & Gynaecology > Contraception > Flashcards

Contraception Flashcards

1
Q

Typical use vs. perfect use effectiveness rates of natural family planning:

A

25% vs. 1-9%

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2
Q

Typical use vs. perfect use effectiveness rates of the pill (both combined and progesterone only):

A

8% vs. 0.3%

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3
Q

Typical use vs. perfect use effectiveness rates of the injection:

A

3% vs. 0.3%

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4
Q

Typical use vs. perfect use effectiveness rates of the implant:

A

0.05% both

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5
Q

Typical use vs. perfect use effectiveness rates of the copper IUD:

A

0.8% vs. 0.6%

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6
Q

Typical use vs. perfect use effectiveness rates of the IUS:

A

0.1% both

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7
Q

Typical use vs. perfect use effectiveness rates of condoms:

A

15% vs. 2%

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8
Q

Typical use vs. perfect use effectiveness rates of withdrawal:

A

27% vs. 4%

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9
Q

What is the name of the criteria which are the conditions under which breastfeeding can be used safely and effectively as a contraceptive method?

A

LAM criteria

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10
Q

What are the LAM criteria?

A
  1. Amenorrhoea
  2. Fully or nearly fully breastfeeding
  3. <6 months postpartum
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11
Q

What are the positives of POPs?

A
  1. Independent of SI
  2. May be suitable in those whom are not suitable for COCP
  3. Decreases the risk of endometrial cancer
  4. No evidence of WL, lower libido, or depression
  5. Return of normal fertility on discontinuation of use
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12
Q

What are the negatives of POPs?

A
  1. Pills must be taken at the same time every day
  2. Menstrual irregularities = common
  3. Except Cerazette, may be less effective in women >70kg
  4. Functional ovarian cysts
  5. Nil STI protection
  6. Small increased risk of ectopic pregnancy
  7. Small increased risk of breast cancer
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13
Q

When is a Cerazette pill considered ‘missed’?

A

> 12 hours late

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14
Q

What is a non-Cerazette pill considered ‘missed’?

A

> 3 hours late

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15
Q

What are the C/I’s to COCP?

A
  1. > 35 and smoking >15 cigarettes
  2. Current breast cancer
  3. Migraine with aura
  4. Multiple RFs for CVD - e.g. HTN, DM, smoking
  5. Inadequately controlled HTN
  6. SLE with antiphospholipid Abs
  7. PMHx or high risk of VTE
  8. PMHx of TIA/CVA
  9. PMHx of ischaemic HD
  10. Breastfeeding and less than 6 months postpartum
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16
Q

What are the positives of the COCP?

A
  1. Independent of SI
  2. Menstrual bleeding is lighter and less painful
  3. Decreased risk of cancer of the ovary, uterus and colon
  4. Decreased acne
  5. Return to normal fertility upon discontinuation
17
Q

What are the negatives of the COCP?

A
  1. Increased BP
  2. Temporary adverse effects - e.g. headaches, nausea, mood changes, breast tenderness
  3. Small increased risk of MI and stroke
  4. Increased risk of STI
  5. Increased risk of VTE
  6. Increased risk of breast and cervical cancer
18
Q

What are the positives of transdermal patches?

A

In addition to those of COCs:

  1. Only need to be changed once weekly
  2. Efficacy unaffected by D&V, unlike a pill
19
Q

What are the negatives of transdermal patches?

A

In addition to those of COCs:

  1. Patch may irritate the skin
  2. Patch may detach from skin
  3. Less effective in women >90kg
  4. VTE risk may be greater
  5. Delay in return to normal fertility following discontinuation
20
Q

What are suitable patch sites?

A
  1. Upper outer arm
  2. Upper torso (NOT breast)
  3. Buttock
  4. Lower abdomen
21
Q

After what period of patch detachment should a new patch cycle be started and barrier protection used for the next 7 days?

A

> 48 hours

22
Q

What are the disadvantages of the vaginal ring?

A
  1. Increased frequency of vaginal infection/discharge
  2. Foreign body sensation in the vagina
  3. Breakage or expulsion from the vagina, compromising efficacy
  4. Dyspareunia
  5. Delay in return of normal fertility following discontinuation
  6. Very rarely, inadvertent insertion into the urethra + migration into the bladder
23
Q

How long should a vaginal ring be left in-situ?

A

3 weeks, followed by a 7 days ring-free period, before replacing with a new ring

24
Q

May the ring be removed for intercourse?

A

Yes, uncomfortable, but for no more than 3 hours

25
Q

What should the patient do if the ring is expelled in weeks 1 or 2?

A

<48 hours? - efficacy not compromised. Re-insert
>48 hours? - efficacy expelled. Re-insert, use condoms for 7 days, consider emergency contraception if unprotected SI has taken place in the last 5 days

26
Q

What should the patient do if the ring is expelled in weeks 3?

A

<48 hours? - efficacy not compromised. Re-insert
>48 hours? - follow instructions as with weeks 1 and 2, OR insert new ring and miss ring-free week OR have a withdrawal bleed and reinsert a new ring no more than 7 days post- the date of expulsion

27
Q

How often should the depo-provera injection be given?

A

Every 12 weeks

28
Q

What is a long-term complication of depo-provera?

A

Loss of BMD - therefore avoid in adolescents and women with RFs for osteoporosis

29
Q

What are the RFs for osteoporosis?

A
  1. Long term treatment with corticosteroids
  2. BMI <19
  3. FHx of maternal hip fracture before the age of 75
  4. Conditions associated with prolonged immobility
  5. Medical disorders independently associated with bone loss - IBD; RA; hyperthyroidism; coeliacs
30
Q

At what point in a cycle should depo-provera be given?

A

Day 1-5. At any other time int he cycle it will be necessary to use condoms for 7 days

31
Q

What is the difference between nexplanon and implant?

A

Nexplanon is radio-opaque and so can be located by x-ray. It also comes in a preloaded applicator to reduce errors during insertion

32
Q

What are the +ve’s of nexplanon?

A
  1. Lasts 3 years
  2. Can be used when breast feeding
  3. Normal fertility returns post-discontinuation
  4. Can be used by those for whom CHC is unsuitable
  5. Effective in women of all BMIs
33
Q

What are the -ve’s of nexplanon?

A
  1. Bleeding patterns are likely to be, and remain, irregular
  2. Fitting and removing is a minor surgical procedure ( and carry the risks of such)
  3. May slightly increase the risk of breast cancer
  4. Rare complications fo abscess, scarring and migration
34
Q

For how long is the Mirena IUS licensed for contraceptive use?

A

5 years

35
Q

What is the lifetime failure rate of vasectomy?

A

1/2000

36
Q

What is the lifetime failure rate of female sterilisation?

A

1/200

37
Q

What are the different methods of sterilisation?

A
  1. Filshie clip occlusion
  2. Tubal ligation
  3. Fallopian implants
  4. Hysterectomy
38
Q

What forms of emergency contraception may be used within 5 days post- unprotected SI?

A

Ulipristal acetate

39
Q

What forms of emergency contraception may be used within 3 days post- unprotected SI?

A

Levonorgestrel

Obstetrics & Gynaecology (14 decks)

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