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MB3 Obstetrics and Gynaecology > Contraception/abortion > Flashcards

Contraception/abortion Flashcards

1
Q

what percentage of pregnancies are unplanned?

A

30-50%

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2
Q

what poor outcomes may result from continuation of an unplanned pregnancy

A 
later and less frequent antenatal care
increased preterm birth and low birth weight 
increased postpartum depression 
reduced breastfeeding 
decreased bonding 
increased rates of neglect and abuse 
poorer long term developmental outcomes
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3
Q

how many unplanned pregnancies end in abortion

A

30-40%

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4
Q

what law allows for pregnancy termination in the UK

A

Abortion act 1967

recently NI extension to 11+6 wks and beyond 12wks in specific circumstances

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5
Q

what legal document is required for abortion and who needs to sign it

A

HSA1 - green form

2 doctors

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6
Q

what does clause C of the HSA1 allow

A

abortion allowed up to 23+6 weeks

continuance of pregnancy leads to greater risk than if it was terminated

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7
Q

what does clause E of the HSA 1 allow

A

abortion up to full term justified if there is risk the child born with a mental or physical abnormality leading to severe disability

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8
Q

true/false - in an emergency one doctor can sign a HSA1 form

A

true

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9
Q

healthcare professionals can refuse to participate in abortion care with select exceptions. what are these?

A

doesnt apply if emergency/life threatening
should not delay or prevent patient access to care
should not affect indirect tasks associated with abortion

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10
Q

what is the time aim from referral to initial termination consultation

A

5 days

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11
Q

what time aim is given between referral for termination and procedure

A

2 wks

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12
Q

methods of abortion?

A

medical

surgical

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13
Q

clinical assessment of gestation?

A

palpable uterus in >12wks

LMP and date of +ve UPT

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14
Q

USS assessment of gestation?

A

abdominal USS or transvaginal if <6wks

only given really for risk ie symptoms or risk of ectopic, uncertain dates or STOP

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15
Q

how may a MTOP be given <12 weeks

A

at home

mifepristone followed by misoprostol 24-48 hours later

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16
Q

in a patient who had MTOP <12 weeks with no bleed what do you do

A

<10wks - further dose of misoprostol if not bleeding within 4 hours
>10 wks to 11+6 - 3 further doses misoprostol

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17
Q

how long are MTOP available for

A

in scotland up to 19+6 before needing travel to england
theoretically in clause E to full term
to clause C - 23+6

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18
Q

what is an EMAH and what is contained in an EMAH pack

A 
early medical abortion at home 
mifepristone 
misoprostol 
antiemitic 
analgesia 
Abx 
6/12 POP 
patient info and contact info sheet 
LSUPT
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19
Q

how may MTOP be performed >12wks

A

inpatient procedure

dose mifepristone and repeated doses of PV misoprostol

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20
Q

how may STOP be performed <14 wks

A

electric vacuum aspiration under general anaesthetic

manual vacuum anaesthetic by local anaesthetic but only up to 10wks

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21
Q

how may STOP be performed >14 wks

A

dilatation of cervix and evacuation

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22
Q

complications of medical abortion

A

haemorrhage
failed/incomplete termination
infection

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23
Q

complications of STOP

A 
haemorrhage 
failed/incomplete 
infection 
uterine perforation 
cervical trauma
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24
Q

in who is Abx prophylaxis given for termination and what is given

A

medical abortion at high STI risk
all those undergoing STOP
doxy 7 days

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25
Q

in who is rhesus iso-immunisation given and why

A

women at risk who are Rh-ve
anti-D Ig
abortion can be sensitising to lead to development of anti-D Ab
can cross placenta in future pregnancies and leaf to destruction of Rh+ve foetal cells

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26
Q

what is given as VTE prophylaxis and for how long

A

risk assess
if high risk then LMWH 1 week post abortion
if very high risk then LMWH before abortion and considered up to 6 weeks after

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27
Q

can contraception be started right after abortion?

A

yes

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28
Q

is contraception fully effective after abortion

A

yes, if started within 5 days, if not then will take 2 days for POP or 7 for CHC, DMPA, SDI, LNG-IUS

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29
Q

when would you avoid use of an intrauterine method of contraception following termination

A

post abortion sepsis

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30
Q

when can barrier methods be used following termination

A

any time
avoid FAM until regular periods
sterilise consider after time as there is risk of regret or failure
diaphragm cannot be used after 2nd trimester TOP

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31
Q

follow up following EMAH?

A

low sensitivity UPT at least 2 weeks after

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32
Q

most effective emergency contraceptive? terms of use

A

copper IUD

fit within 5 days of early possible day ovulation or 5 days after single episode of sex

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33
Q

true/false - oral methods of contraception are not affected by liver induding drugs

A

false- they are affected by them

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34
Q

mechanism of action of levonorgestrel, terms of use

A

large dose progestogen to inhibit ovulation
need double dose if >70kg
best if in 24hrs but up to 72
good for needing quickstart contraceptive

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35
Q

mechanism of action of ulipristal acetate, terms of use and caveat of use for POP

A

progesterone receptor modulator to block progesterone receptor
5 days post unprotected sex
prevents LH surge
licensed for 5 days
POP cannot be used 5 days before or after

36
Q

what forms of contraception prevent ovulation

A

most hormone methods except hormone coil
suppress FSH/LH
emergency to delay

37
Q

what forms of contraception prevent fertilisation

A

condom, diaphragm, spermicide, sterilisation, IUS/IUD

38
Q

what forms of contraception prevent implantation

A

hormonal
IUD as a secondary
copper coil as emergency

39
Q

risk of pregnancy in withdrawal method in 1y

A

20%

40
Q

factors to consider in contraception use

A 
experience 
age 
child protection 
consent 
frequency/sex
relationship status 
pregnancy risk and STI 
future plans 
lifestyle and compliance 
weight
blood pressure 
PMHx
breastfeeding 
SHx
side effects 
procedure 
non hormonal effect??
migraine
41
Q

what child protection concerns may arise with contraceptive advice

A

sex <13
age gap >2yrs in <18
power imbalance
drug/alcohol use or grooming

42
Q

non-contraceptive benefits of hormonal contraception

A 
period pain 
heavy bleed
irregular bleed
ovulation pain 
PMS 
cyclical breast tenderness
cysts 
endometriosis 
ovarian cancer 
acne/hirsutism
43
Q

reasons for condom failure

A 
too late
wrong lube 
wrong technique 
wrong size 
inconsistent use 
wrong storage 
damage on opening 
expired
44
Q

reasons for diaphragm failure

A 
too late
removed early 
wrong technique 
inconsistent 
no damage check
45
Q

reasons for CHC, POP, DMPA failure

A 
inconsistent use 
late injection 
wrong storage 
late replacement 
drug interaction
46
Q

reasons for iatrogenic contraception failure

A 
poor counselling 
no extra precaution recommended 
drug interaction 
malposition or expulsion 
incorrect insertion
47
Q

how long does IUD/IUS last

A

3-10 years

48
Q

complications of IUD/IUS insertion

A

perforation, PID, expulsion

invasive and pain

49
Q

how long can copper coil be used

A

up to 10yrs

if inserted >40 then can be kept up to menopause

50
Q

what is the only method of contraceptive that mahy be reliable post breast cancer

A

copper IUD

51
Q

side effects of copper IUD

A

can make periods longer, heavier and more painful esp in first 3m

52
Q

true/false - hormonal IUS is more effective than copper coil

A

true

53
Q

side effects of IUS

A

irreg spotting, bleeding in first few months then side effects low

54
Q

alternative indication for mirena coil

A

heavy periods, HRT, hyperplasia or endometriosis

55
Q

what is the most effective contraceptive

A

SCI

56
Q

how long does SCI last

A

3yrs

57
Q

how long does SCI take to work

A

7 days

58
Q

what side effect can happen with SCI

A

prolonged bleeding

59
Q

what score category can be used for contraceptive eligbility

A

UKMEC

60
Q

how does CHC act, what are the failure rates

A

prevent ovulation

0.3% perfect use, user failure 8%

61
Q

how to take CHC

A

start if first 5 days period or any time when not pregnant and use condoms for 7 days
take 21 days with 7 day break
can tricycle with 7 days off after
or take continuously until bleed, come off 4 days and start

62
Q

factors affecting effectiveness of CHC

A

impaired absorption in GI conditions
increased metabolism, liver enzyme induction, drug interaction
compliance

63
Q

risks associated with CHC

A 
venous or arterial thrombosis 
adverse effect cancers 
systemic HTN 
migraine with aura 
age >35
breast and cervical cancer
64
Q

benefits associated with CHC

A 
reduced ovarian and endometrial cancer 
benefit on acne 
reduced PCOS 
lesser PMS 
lesser intense bleeding
65
Q

side effects of CHC

A 
breakthrough bleed
breast tenderness 
worsening acne 
nausea 
all major risks
66
Q

risks of cervical cancer with CHC

A

increased after 5 years
reduced after 10yrs
condom use and HPV vaccination
cervical screens

67
Q

risks of breast cancer with CHC

A

increased but reduces 10 years off

68
Q

risk of age >35 with CHC

A

UKMEC 2
risk but benefit outweighs
consider other risks as they can be contraindication

69
Q

risk of systolic HTN and management with CHC

A

small increase
check 3m
needs to be <140/90

70
Q

risk of arterial thrombosis with CHC

A

increased risk MI or stroke

particularly in smoking or HTN

71
Q

risk of venous thrombosis with CHC

A

depends on dosage
prescribe with lowest risk involved
discuss signs and symptoms

72
Q

risks of migraine with aura and CHC

A

ABSOLUTE CONTRAINDICATION
UKMEC 4
increases stroke risk
need to establish true aura - change 5-20 mins before headache
scotoma, altered sensation, taste, smell or hemiparesis

73
Q

types of POP and mechanism

A

desogestrel, non-desogestrel

desogestrel acts to inhibit ovulation and all others thicken cervical mucus

74
Q

how to take POP

A

taken day 1-5 period or any time if not pregnant and use condoms 7 days

75
Q

absolute contraindication for POP

A

breast cancer

76
Q

side effects POP

A

headache
bleeding
nausea
acne

77
Q

missed POP?

A

take at same time
if late only matters if >12hrs
if >12hrs then wont work for 2 days

78
Q

how does depot provera or sayana press work

A

lowers oestradiol and suppresses FSH

isnt affected by enzyme affecting drugs so good for epilepsy

79
Q

side effect sayana press/ DMPA

A 
weight gain 
nausea 
acne 
headache 
bleeding
80
Q

discuss bone health and depot

A

can cause issues with peak bone age if given in teens
can be given if absolutely necessary but avoid
cannot be used in poor Ca absorption or strong FHx
try to avoid in menopause

81
Q

how to use diaphragm/cap

A

use spermicide

put in before sex and take out after 6 hours

82
Q

uses of diaphragm/cap

A

not wanting UID
family spacing
not good for absolute avoidance
71-88% effective

83
Q

true/false - female sterilisation works better than male sterilisation

A

false

84
Q

how effective is natural family planning

A

76%

only really if wanting something natural

85
Q

counselling for vasectomy

A

weight up risk and benefit
regret?
consider other options

86
Q

effectiveness of male sterilisation?

A

very low failure, very effective and can be hard to reverse

87
Q

complications of vasectomy

A 
pain 
anaesthetic 
infection 
bleeding 
haematoma 
failure - semen analysis needed

MB3 Obstetrics and Gynaecology (12 decks)

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