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Dip GUM > Contraception / Abortion > Flashcards

Contraception / Abortion Flashcards

1
Q

Which COCP may also help with acne

A

Cyproterone acetate based COCP - Dianette - shouldn’t be used only for contraception due to higher VTE risk

Drospirenone based COCP - Yasmin / Angeliq

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2
Q

Typical failure rate of COCP per 100 women years

A

9%

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3
Q

Typical Failure rate of POP per 100 women years

A

9%

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4
Q

Failure rate of mirena per 100 women years

A

0.2%

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5
Q

Failure rate of depo prova per 100 women years

A

6%

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6
Q

Failure rate of condom per 100 women years

A

17-21%

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7
Q

Mechanism of action of COCP

A

Inhibition of ovulation
Atrophic endometrium
Thickened cervical mucus

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8
Q

Absolute CI to COCP use

A

0 to <6 weeks postpartum + breastfeeding
0 to <3 weeks postpartum + other VTE risk
Age ≥35 years + 15 cigarettes / day
Hypertension ≥160 / 100
Vascular disease / impaired cardiac function
Hx of DVT / PE / stroke / IHD
Major surgery with prolonged immobilisation
Migraine with aura
Current breast cancer
Viral hepatitis / decompensated cirrhosis / liver tumours
Thrombogenic mutations / Positive antiphospholipid antibodies

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9
Q

SE of COCP

A 
altered mood - no causal relationship with depression
Mood swings
Headache 
Loss of libido  - no causal relationship
Nausea
percieved weight gain - no causal relationship
Bloatedness
Breakthrough bleeding
Vaginal discharge 
Breast pain
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10
Q

Benefits of COCP

A 
Lighter less painful periods 
Regular bleeds
Improved pre-menstrual syndrome
Reduced risk of PID
Protect against ovarian and endometrial cancer
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11
Q

Mechanism of action of progestogen only methods

A

Thickened cervical mucus

Thin endometrium

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12
Q

Common SE of progestogen only methods

A

Irregular / absent menstrual bleeding
Simple ovarian cysts
Breast tenderness
Acne

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13
Q

Risk of depo provera

A

Reversible loss of bone mineral density
Weight gain
Delay in return of fertility
Irregular / absent menstruation

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14
Q

Mechanism of action of copper IUD

A

Toxic to egg and sperm

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15
Q

SE of copper IUD

A

Heavier periods
Increased menstrual pain
Increased spotting

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16
Q

Duration of action of depo, implant, mirena, copper coil

A

Depo = 12 weeks
Implant = 3 years
Mirena = 5 years
Copper coil = 10 years

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17
Q

CI to intrauterine contraception (UKMEC 4)

A

Symptomatic chlamydia or gonorrhoea - for initiation
PID
malignant trophoblastic disease
trophoblastic disease with persistently elevated hCG levels
Unexplained vaginal bleeding - initiaiton
Endometrial cancer - initiation
Cervical cancer - awaiting treatment - initiation
Copper allergy

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18
Q

Methods to calculate the fertile window

A

Change in basal body temp
Change in cervical mucus
Track cycle days
Combination of above

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19
Q

Types of emergency contraception

A

Levonelle - levonorgestrel
EllaOne - ulipristal acetate
Copper IUD

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20
Q

Early medical termination - drugs used + gestation

A

Mifepristone oral + misoprostal orally
+ analgesia
4 - 9weeks

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21
Q

Later medical termination - drugs used + gestation

A

Mifepristone oral + misoprostal PV every 3-6 hours
+ analgesia
12 - 24weeks

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22
Q

surgical termination - technique used + gestation

A

MVA up to 9 weeks
Suction under GA unto 12-14 weeks
Dilation and evacuation >12 - 24weeks

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23
Q

Possible Complications of termination

A 
Incomplete abortion 
Endometritis and resultant tubal damage
Uterine perforation 
cervical trauma
Psychological SE
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24
Q

Factors decreasing fertility

A 
Increasing age
Smoking
Less frequent sex
Alcohol
Obesity
NSAIDs
Chemotherapy
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25
Q

Presentation of ectopic pregnancy

A 
\+ve pregnancy test
Abdo / adnexal pain
Vaginal bleeding
Cervical excitation
fainting
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26
Q

Investigation of ectopic pregnancy

A 
UPT
physical obs - BP, HR, RR, temp
Hb
Group + save
Beta-HCG
TVUSS
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27
Q

Management of ectopic pregnancy

A

Either IM methotrexate
Or
laparoscopy - salpingectomy / salpingotomy

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28
Q

Define threatened miscarriage

A

Vaginal bleeding

Os closed

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29
Q

Define inevitable miscarriage

A

Vaginal bleeding

Os open

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30
Q

Define incomplete miscarriage

A

Vaginal bleeding
Os open
products of conception seen in os or on USS

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31
Q

Define complete miscarriage

A

Pain and bleeding resolved
os closed
No retained products on USS

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32
Q

Define missed miscarriage

A

Fetal pole present on USS - no heart beat
Or Gestational sac present but no fetal pole

No pain or bleeding

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33
Q

Management of miscarriage

A

Expectant
Medical - misoprostal
Surgical - SMOM

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34
Q

Define cervical ectropion

A

Benign condition
Columnar epithelium on vaginal aspect of cervix.
Transforms to squamous epithelium

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35
Q

Define nabothian follicle

A

Mucus filled cyst within the ectocervix - not significant - no tx needed

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36
Q

COMMON causes of cervical ectropion

A

Puberty
COCP
Pregnancy

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37
Q

Causes of cervical stenosis

A

Usually iatrogenic
Cervical cone biopsy / LLETZ
Endometrial ablation devices

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38
Q

What is asherman’s syndrome

A

Endometrial cavity fibrosis and adhesion

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39
Q

What is a uterine fibroid

A

Benign tumour of uterine smooth muscle = leiomyoma

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40
Q

Risk factors for uterine fibroids

A

Nulliparity
Obesity
Family history
Black African / Caribbean ethnicity

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41
Q

Symptoms of uterine fibroids

A

Pelvic mass
Menstrual disturbance - often HMB
Pressure symptoms - urinary frequency

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42
Q

Management of fibroids

A 
Conservative
Medical tx for heavy menstrual bleeding
Uterine artery embolisation
Myomectomy
Hysterectomy
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43
Q

Cell types of endo and ecto cervix

A 
Endocervix = canal = columnar glandular epithelium
Ectocervix = external = squamous epithelium
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44
Q

Symptoms and causes of acute cervicitis

A 
Irritation, mucus / pus discharge 
Dyspaerunia
Post coital bleeding
Inter-menstrual bleeding
STIs
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45
Q

Cell type of cervical polyp

A

Endocervical = columnar (glandular) epithelium

46
Q

symptoms of cervical polyp

A

Asymptomatic
Intermenstrual bleeding
Post coital bleeding
Rarely >1cm

47
Q

What is cervical dysplasia

A

Cervical intraepithelial neoplasia.

Atypical cells in the squamous epithelium

48
Q

If untreated what % of CIN develop cancer over 10 years

A

1/3 with CIN II or III

CIN Commonly regresses - can progress to CIN II or III

49
Q

What age is CIN most common

A

90% <45yo

Peak incidence 25-29

50
Q

Aetiology of cervical cancers

A

HPV 16, 18, 31, and 33 most common.
HPV vaccine is for 16 and 18
Oral contraceptives
Smoking

51
Q

Biggest risk factor for the development of cervical cancer

A

Non-attendance for cervical screening

52
Q

Who is invited for cervical screening + how often

A

25-64
Every 3 years until 50
5 yearly from age 50 until 65.
Annually if HIV +ve

53
Q

Describe colposcopy

A

Speculum ex + microscope magnification 10-20x
Acetic acid stain + iodine
+ biopsy

54
Q

What is a LLETZ procedure + what’s it for

A

Large loop excision of the transformation zone

For CIN II or III

55
Q

Possible complications of LLETZ

A

Haemorrhage
Cervical stenosis
Slight increased risk of preterm delivery

56
Q

Peak incidence of cervical carcinoma

A

2 peaks - 30s and 80s

57
Q

Types of cervical carcinoma

A

90% squamous malignancies

10% adenocarcinomas (worse prognosis)

58
Q

What is Stress incontinence

A

Involuntary leakage of urine on effort / exertion /sneezing / coughing.
Due to an incompetent sphincter.
May be associated with genitourinary prolapse.

59
Q

What is Urge incontinence

A

Involuntary urine leakage
Accompanied by/ immediately preceded by urgency.
Due to detrusor instability or hyperreflexia leading to involuntary detrusor contraction.

60
Q

What is Mixed incontinence

A

Involuntary leakage of urine associated with urgency and exertion/effort/sneezing/ coughing.

61
Q

What is Overactive bladder syndrome (OAB)

A

Urgency with or without urge incontinence
+ usually frequency and nocturia.
+/- Incontinence

62
Q

What is Overflow incontinence

A

Due to chronic bladder outflow obstruction.
Often due to prostate disease in M.
Can be due to a neurogenic bladder.

63
Q

What is ‘True incontinence’

A

continuous urine leakage

May be due to a ureto/urethro/bladder-vaginal fistula

64
Q

What is tranexamic acid

A

Anti-fibrinolytic

65
Q

What is 3rd degree uterine prolapse?

A

Uterine descent with cervical protrusion beyond the introitus

66
Q

Is 3rd degree uterine prolapse painful?

A

Not usually

Unless ulcerated

67
Q

Does 3rd degree uterine prolapse cause difficulty defecating?

A

Yes by pressure on the anterior wall of the rectum.

68
Q

Can 3rd degree uterine prolapse cause urinary incontinence?

A

Yes.

Or retention

69
Q

Possible symptoms of endometriosis

A 
Ovulation pain
Mid cycle lower abdominal pain
Heavy menstruation
Dysmenorrhoea 
Dysparunia
Dysuria 
Haematuria
70
Q

What is the guidance on pregnancy tests before sterilisation

A

ALL women should have a UPT on the day of sterilisation to identify current pregnancies

71
Q

Failure rate of Cu-IUD per 100 women years

A

0.8%

72
Q

Failure rate of implant per 100 women years

A

0.05%

73
Q

% women becoming pregnant in the first year of using no method of contraception

A

80-85%

74
Q

Typical failure rate of FAM per 100 women years

A

24%

75
Q

Typical failure rate of the diaphragm per 100 women years

A

12%

76
Q

Typical failure rate of Female condom per 100 women years

A

20%

77
Q

Typical failure rate of Female sterilisation per 100 women years

A

0.5%

78
Q

Typical failure rate of vasectomy per 100 women years

A

0.15%

79
Q

UKMEC for Implant or POP post-partum at 0 - <3 weeks with or without risk factors for VTE

A

UKMEC for implant or POP - Post partum 0 - <3 weeks
with risk factors for VTE = 1
without risk factors for VTE = 1

80
Q

UKMEC for DMPA post-partum at 0 - <3 weeks with or without risk factors for VTE

A

UKMEC for DMPA - Post partum 0 - <3 weeks
with risk factors for VTE = 2
without risk factors for VTE = 2

81
Q

UKMEC for CHC post-partum at 0 - <3 weeks with or without risk factors for VTE

A

UKMEC for CHC - Post partum 0 - <3 weeks
with risk factors for VTE = 4
without risk factors for VTE = 3

82
Q

UKMEC for CHC post-partum at 3 - 6 weeks with or without risk factors for VTE

A

UKMEC for CHC - Post partum 3 - 6 weeks
with risk factors for VTE = 3
without risk factors for VTE = 2

83
Q

UKMEC for DMPA post-partum at 3 - 6 weeks with or without risk factors for VTE

A

UKMEC for DMPA - Post partum 3 - 6 weeks
with risk factors for VTE = 2
without risk factors for VTE = 1

84
Q

UKMEC for CHC post-partum at 6+ weeks

A

UKMEC for CHC post-partum at 6+ weeks

= 1

85
Q

UKMEC for CHC post-partum at 0-6 weeks AND breastfeeding

A

UKMEC for CHC post-partum at 0-6 weeks AND breastfeeding

= 4

86
Q

UKMEC for CHC post-partum at 6 weeks to 6months AND breastfeeding

A

UKMEC for CHC post-partum at 6 weeks to 6months AND breastfeeding
= 2

87
Q

UKMEC for CHC post-partum at >6months AND breastfeeding

A

UKMEC for CHC post-partum at >6months AND breastfeeding

= 1

88
Q

UKMEC for DMPA post-partum at 0-6 weeks AND breastfeeding

A

UKMEC for DMPA post-partum at 0-6 weeks AND breastfeeding

= 2

89
Q

UKMEC for IUD / IUS with post-partum sepsis

A

UKMEC for IUD / IUS with post-partum sepsis
= 4
may substantially worsen the condition

90
Q

UKMEC for IUD / IUS at 0-48 hours post-partum

A

UKMEC for IUD / IUS at 0-48 hours post-partum

= 1

91
Q

UKMEC for IUD / IUS at 48 - <4 weeks post-partum

A

UKMEC for IUD / IUS at 48 - <4 weeks post-partum

= 3

92
Q

UKMEC for IUD / IUS at >4 weeks post-partum

A

UKMEC for IUD / IUS at >4 weeks post-partum

= 1

93
Q

What are risk factors for VTE postpartum

A 
Immobility 
transfusion at delivery 
BMI >30
PPH
C/S delivery 
ART / IVF
multiple pregnancy
Hyperemesis
Current systemic infection
smoking
PET
Age >35
Parity >3
Varicose veins
94
Q

When can contraception be stopped after laparoscopic tubal sterilisation

A

Method dependant
If Cu-IUD / IUS - retain for 7/7 after procedure
If implant - retain for 7/7 after procedure
injection - procedure should be done within its 14 week licence
if CHC - can stop on day of surgery if taken correctly for 7/7 before, if in HFI restart and continue for 7/7
If POP - traditional - continue for 7/7, if desogestrel could stop on day of procedure

95
Q

Diagnostic criteria for migraine

A 
>/= 5x headache attacks - each lasts 4 - 72 hours
AND 2 or more features of:
 - unilateral 
 - pulsating 
 - inhibits or prohibits ADLs
 - aggravated by walking / stairs / routine movement
AND 1 or more of:
 - photophobia
 - nausea / vomiting
96
Q

Diagnostic criteria for migraine with aura

A

Diagnostic criteria for migraine
PLUS 2+ attacks with 3 of:
- aura symptom develops gradually over >4 mins or 2 symptoms in succession
- no aura symptom lasts >60 mins
- a fully reservable symptom of focal cerebral cortical for brain stem function
- headache follows aura with a free interval of >60 mins or both start simultaneously

97
Q

When is EC indicated for late / missed POP

A

Desogestrel = >12hr late (i.e. 36 hr after last)

Traditional = >3hr (i.e. 27 hr after last)

98
Q

When is EC indicated for late / missed COCP

A

> 2 pills missed
= 48 hours late

Or extension of the HFI by 48 hrs

99
Q

When is EC indicated for late / lost combined patch or ring

A

if patch detached / ring removed for >48 hours

Or extension of the HFI by 48 hrs

100
Q

If the hormone free interval is extended beyond 7 / 7 when can an IUD be offered

A

Em IUD can be offered upto day 13 after the start of the HFI

101
Q

What is the timeframe for interaction of hormonal contraception with ulipristal acetate EHC

A

UPA EHC efficacy may be decreased if
progestogen or combined hormone used in the:

7 days prior
and 5 days after

102
Q

How common is gestational trophoblastic disease?

A

Hydatidiform mole affects 1-3 in every 1000 pregnancies.

10% of those transform into malignant gestational trophoblastic disease

103
Q

What is hydatidiform mole

A

abnormal conceptions
with excessive placental development
and little or no fetal development

2 major types = complete and partial

104
Q

Types of gestational trophoblastic disease

A

Benign forms =

  • Partial hydatidiform mole
  • Complete hydatidiform mole

Malignant forms =

  • Invasive hydatidiform mole
  • Choriocarcinoma
  • Placental site trophoblastic tumour
  • Epithelioid trophoblastic tumour
105
Q

Presentation of gestational trophoblastic disease

A

Positive pregnancy test
+ vaginal bleeding or suspected miscarriage
+/- hyperemesis

USS - suspect diagnosis
histological diagnosis

106
Q

USS features of gestational trophoblastic disease made?

A

grape-like or hydropic changes

snowstorm-like appearance

107
Q

What is the difference between complete and partial molar pregnancies

A

Genetically distinct
But both over-express paternal genes

Complete hydatidiform moles = diploid, as a result of duplication without mitosis after monospermic fertilisation (or rarely, dispermic fertilisation of an anucleate oocyte)

Partial hydatidiform moles = triploid, as a result of dispermic fertilisation.

108
Q

most common site of metastatic gestational trophoblastic disease

A

The lung

associated with dyspnoea, cough, haemoptysis, and chest pain

109
Q

What contraception is safe following a diagnosis of GTD and when should it be commenced?

A

use barrier methods until hCG levels normalise

Then can use hormonal contraception (including COCP or POP)
IUCDs can be fitted once the hCG levels are normal - not before due to the risk of perforation

110
Q

Management of a molar pregnancy

A

Suction curettage is the method of choice of evacuation
Send to histology
UPT in 3/52
+/- Anti- D

If hCG normalises within 56 days then follow up is for 6 months from the date of evacuation.

If hCG normalises after 56 days follow-up is 6 months from normalisation of the hCG level

111
Q

When can women whose last pregnancy was a complete or partial hydatidiform molar pregnancy try to conceive in the future and what is the outcome of subsequent pregnancies?

A

Advised not to conceive until their follow-up is complete

Women who undergo chemotherapy for GTN are advised not to conceive for 1 year after completion of treatment

LOW risk of a further molar pregnancy (1/80)
> 98% of pregnancies following a molar pregnancy are not molar
no increased risk of obstetric complications

112
Q

What is the long-term outcome of women treated for GTN?

A

hemotherapy for GTN = earlier menopause likely

multi-agent chemotherapy including etoposide = increased risk of developing secondary cancers

Dip GUM (27 decks)

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