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Y5 Gynae & Obstetrics > Contraception and Abortion > Flashcards

Contraception and Abortion Flashcards

1
Q

What is a LARC?

A

Long Acting Reversible Contraception

Requires administration less than once per month

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2
Q

What are examples of LARC?

A

Implant:
- progesterone only implant

IU:

  • Cu IUD
  • LNG-IUS

Injection

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3
Q

Without contraception, what percentage of couples will conceive in a year?

A

85%

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4
Q

What criteria are used for suitability to contraception?

A

MEC criteria

Medical Eligibility Criteria

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5
Q

What are the MEC categories?

A

1 - no contraindication
2- benefit outweigh risk
3 - risk outweigh benefit
4 - ABSOLUTE CONTRAINDICATIPN

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6
Q

What are side effects to hormonal contraceptive methods?

A 
Unexpected bleeding 
Weight gain 
Headache 
Mood swing 
Loss of libido
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7
Q

What should you do if a woman has headaches in pill free week on COCP?

A

Tell her to run the packs together

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8
Q

What should you do if COCP causes migraines?

A

STOP AND CHANGE

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9
Q

What are formulations of combined hormonal contraception?

A

Pill
Transdermal patch
Vaginal ring

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10
Q

How do combined hormonal contraceptive methods work?

A

Inhibit ovulation via negative feedback of oestrogen and progestogen on the pituitary, causing suppression of LH, FSH

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11
Q

What is the main form of oestrogen contained?

A

ethinyl estradiol

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12
Q

What are most pill preparations like?

A

21 pills followed by 7 days pill free interval OR 7 placebo tablets

preparations are monophonic (same dose of hormone)

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13
Q

How does the patch / ring work?

A

Patch:; change every week for 3 weeks (21 days), then break for 7

Ring: keep for 21 days, then break for 7

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14
Q

What do you do if you missed ONE Pill?

A

Take it as soon as you remember

Continue remaining pills at usual time

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15
Q

What do you go if you missed TWO or MORE pills in 48h?

A

Take most recent one as soon as you remember, continue with the rest

If pills missed were in first week, you need EC
If pills were in last week, omit pill free interval and start the new pack right away

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16
Q

When should additional precaution be taken with the patch?

A

If patch was NOT APPLIED for 48h

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17
Q

When should additional precautions be taken with the ring?

A

If ring was NOT INSERTED for 3h

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18
Q

What is the cancer risk like for COCP user?

A

INCREASED breast cancer (for 10 years after stopping, then normal)

REDUCED colorectal, endometrial, ovarian cancer

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19
Q

What are two absolute contraindications for CHC?

A

> 35 years AND smoker

Migraine with aura

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20
Q

How does the progesterone only contraceptive methods work?

A

Desorgestrel: Inhibit ovulation

All others: thicken cervical mucous

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21
Q

How does the LNG-IUS work?

A

It causes endometrial atrophy (prevents endometrial proliferation and implantation)

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22
Q

How often does the POP need to be taken?

A

Every day, no breaks

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23
Q

What are side effects of the POP?

A

Irregular bleeding

Acne

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24
Q

What must you do if you forget to take the POP?

A

Emergency contraception

Use protection

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25
Q

What is the progesterone implant called?

A

Nexplanon

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26
Q

How long does Nexplanon last?

A

3 yearsq

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27
Q

Where is nexplanon inserted?

A

8cm above the medial epicondyle in the non dominant arm

SUBCUTANEOUS

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28
Q

What is the progesterone only injectable called?

A

IM depoprovera

SC Sayana press

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29
Q

What is the injection interval for progesterone only injectable

A

12-14 weeks

30
Q

What occurs if you want to have a baby right after the injectable?

A

DELAY in FERTILITY of up to 1 year after discontinuation

31
Q

What are SE of the progesterone only injectable?

A

Weight gain

Osteoporosis

32
Q

What is the LNG-IUS called?

A

Mirena

33
Q

How long does mirena last?

A

5 years

34
Q

What are side effects of mirena?

A

acne
breast tenderness
mood disturbance
headache

35
Q

What is a unique benefit of Cu IUD?

A

Can be used as CONTRACEPTION if within 5 days from UPS

36
Q

What is the bleeding pattern with LNG-IUS?

A

lighter, less painful

37
Q

What is the bleeding pattern with Cu-IUD?

A

heavier, painful

38
Q

What medication can you give to help reduce blood loss in Cu-IUD?

A

Tranexamic acid

39
Q

When must you remove an IUD if a woman is pregnant?

A

BEFORE 12 week gestation

40
Q

What are potential risks of IUD?

A

Perforation
Expulsion
infection

41
Q

What types of female sterilisation are available?

A

Laparoscopic sterilisation - occlude the Fallopian tubes using Filshie clips

Hysteroscopic sterilisation - expanding springs inserted in the tubal ostia via hysteroscope, infusing fibrosis

42
Q

What are the types of oral Emergency Contraception?

A

Levonorgestrel 1.5mg

Ulipristal 30mg

43
Q

How long after UPS is levonorgestrel used for?

A

72h

44
Q

How long after UPS is ulipristal used for?

A

5 days (120 h)

45
Q

WHAT IS THE effectiveness of oral EC methods?

A

2/3

Cu IUD is WAY MORE EFFECTIVEq

46
Q

What are the two medications given for a medical abortion?

A

Mifepristone (progesterone receptor modulator)

FOLLOWED BY

Misoprostol (prostaglandin analogue)

47
Q

How do mifepristone and misoprostol work?

A

Mifepristone increases uterine contractility and sensitises uterus to prostaglandins

Misoprostol causes the expulsion

48
Q

When is the effect of mifepristone maximal, so when should misoprostol be administered?

A

Mifepristone is max at 48 h

So give misoprostol at 24-48 h

49
Q

How does medical abortion change based on gestation?

A

<9 weeks: give medications at home with oral analgesia
will bleed for about 2 weeks

9-21 weeks: same drugs, but give misoprostol every 3 hours until expulsion occurs. Should be done in clinical setting as increased discomfort, bleeding, passage of larger foetus.

50
Q

How long is the average abortion time for medical abortion in second trimester?

A

7hours

51
Q

How do you abort a foetus medically after 21 weeks?

A

Intracardiac injection of potassium chloride

52
Q

What are methods of surgical abortion based on gestation period?

A

Vacuum aspiration < 14 weeks

Dilatation and evacuation > 14 weeks

53
Q

How does vacuum aspiration occur?

A

Consider pre-treatment misoprostol in nulliparous /adolescent / previous cervical cancer or past 12 week gestation

This will dilate the cervix

Then gently dilate the cervix with gradual dilators
Evacuate the cavity with gentle suction

54
Q

How long does vacuum aspiration take’

A

less than 10 mins

55
Q

Whart medication should you give after vacuum aspiration

A

Prophylactic antibiotics - reduce risk of postabortal infection

56
Q

How does dilatation and evacuation work?

A

Use osmotic dilators, misoprostol and mifepristone

Remove contents of uterus with aspiration and extraction of foetal tissues

Perform ultrasound to confirm evacuation

57
Q

What are complications of abortion

A

failure to end pregnancy
Incomplete abortion requiring evacuation
Haemorrhage
Infection

58
Q

How soon after abortion should you start postabortal contraception?

A

IMMEDIATELY

59
Q

Why does the. COCP cause a withdrawal bleed?

A

Oestrogen and progestogen cause a slight thickening of the endometrium

During the pill free week, the lack of progestogen causes the breakdown of th endometrium

60
Q

What are thee types of LNG-IUS

A

Mirena -52 mg progestogen
Jaydess - 13.5mg
Kyleena - 19mg

61
Q

How long do the three LNG IUS last for

A

Mirena: 5 years
Jaydess: 3 years
Kyleena: 5 years

62
Q

What is the benefit of Mirena over the other two?

A

High dose of progestogen

Good for PCOS, endometriosis, STIs

63
Q

How long can a Copper IUD last for?

A 
5 years (if copper only on stem - usual one) 
10 yrs (if copper also on arms )
64
Q

How does the Copper IUD work?

A

Copper causes aseptic inflammation of the endometrium, so implantation cannot occur
Inflammation however also means that blood vessels in the uterus become hyperaemic > increased bleeding

65
Q

What are the risks of perforation. of an IUD?

A

1:1000

66
Q

What are the kinds of infection that can be caused by an IUD?

A

Ascending infection
So if the patient has an STI in the Lower genital tract, insertion of the IUD will push it up into the upper genital tract

67
Q

What is advice you should give for emergency contraception=?

A

If vomiting/diahrroea within 2 hours, you need to take another one
Period could be delayed/anticipated by a week
If next menstrual period is delayed by >2 weeks take a pregnancy test

68
Q

What is the prandf name for levonorgestrel 1.5 emergency contraception?

A

Levonelle

69
Q

What is the brand name for Ulipristal 30mg emergency contraception?

A

EllaOne

70
Q

What are MEC3 criteria for the COCP

A 
>35 yo and smoker (<15xday)
migraine, no aura 
FH DVT/PE <45 
Controlled HTN 
Immobility e.g. wheelchair
71
Q

What are MEC4 criteria for COCP

A 
>35yo and smoker (>15xday) 
migraine with aura 
PMH DVT/PE <45
PMH stroke /IHD
Uncontrolled HTN 
Breast cancer 
Breast feeding & <6 weeks PP 
recent major surgery with prolonged immobilisation

Y5 Gynae & Obstetrics (34 decks)

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