contraception

Question 1

how does mirena work?

Answer 1

Prevents endometrium proliferation

thickens cervical mucus

Question 2

how does implant, pop, depo work?

Answer 2

inhibits ovulation

thicken cervical mucus (main action of pop alone)

Question 3

which is the most effective emergency contraceptive?

Answer 3

IUD

can be used 5 days after ovulation/5 days after UPSI

Question 4

which contraceptive for high BMI?

Answer 4

ullipristal

can be used up to 5 days

Question 5

can you use the pill after using ullipristal?

Answer 5

not for 5 days
use condoms for 5 days after

effectiveness reduced if progestogen used in 7 days prior

Question 6

when would you not use ullipristal?

Answer 6

if missed pill

Question 7

what is used as prophylactic against infection following terminations?

Answer 7

1g azithromycin and 800mg metronidazole

Question 8

how is termination done?

Answer 8

mifepristone to sensitise myometrium to prostaglandins

misoprostol to stimulate uterine contractions

Question 9

when would feticide be given?

Answer 9

22 weeks to prevent live birth

Question 10

how is surgical termination done before 14w?

Answer 10

<14 weeks

dilation and suction

Question 11

how is surgical termination done after 14?

Answer 11

dilation and evacuation

Question 12

how is subfertility investigated?

Answer 12

1. semen analysis
2. serum progesterone 7 days before period
3. day 2-5 FSH and AMH
4. USS to count antral follicles (more is good)
5. prolactin level and pituitary MRI
6. PCOS - testosterone and USS ovaries
7. TVUSS for structural abnormality
8. tubal patency (hysterosalpingography or laparoscopy)

Question 13

what does low progesterone mean?

Answer 13

not ovulated

Question 14

what does low FSH mean?

Answer 14

good ovarian reserve

Question 15

is high amh good?

Answer 15

yes

ideally you want low FSH and high AMH

Question 16

what must be checked before hysterosalpingography?

Answer 16

chlamydia so you dont spread during procedure

Question 17

how is ovulation induced?

Answer 17

gnrh therapy
clomifene
letrozole

Question 18

what are the symptoms of ovarian hyperstimulation syndrome?

Answer 18

pain
bloating
n+v
ascites
oliguria
weight gain
pleural effusion

Question 19

how long does it take for cocp to be effective if started day 1-5?

Answer 19

immediately

Question 20

how long does pop take to work if started day 1-5?

Answer 20

immediately

Question 21

how long is preg test positive following termination?

Answer 21

4 weeks - check at this stage

if positive - retained products or persistent trophoblast