Contraception and OG Prescribing

Question 1

Copper IUD as emergency contraception?

Answer 1

Can be used up to 5 days after UPSI
Or if more than 5 days then up to 5 days after likely date of ovulation

Question 2

How can you work out day of ovulation in person to work out if can get copper IUD as emergency contraception?

Answer 2

The follicular phase is what varies, luteal phase is constant
So take cycle length e.g. 30 days and minus the luteal phase which is always 14 days to get day of ovulation, so in 30 day cycle it is day 16. If they are passed day 21 they cannot have copper IUD.

Question 3

IUD or IUS insertion after childbirth?

Answer 3

it can be inserted up to 48 hours after childbirth or wait 4 weeks

Question 4

COCP and POP postpartum?

Answer 4

POP can be started at any point
COCP got to wait 6 weeks due to increased risk of VTE

Question 5

Missed pill rules COCP?

Answer 5

missed pill counts as > 24 hours

If only miss one pill just take 2 that day - no other action necessary
If miss more than one pill need additional contraception for next 7 days

essentially if a woman has taken the pill for 7 consecutive days in a row she doesn’t need emergency contraception

Days 1-7: emergency contraception if UPSI in pill free interval or week 1
Day 8-14: if she’s taken it for 7 days in a row, no emergency contraception needed
Day 15-21: she should finish the pills in her current pack and start a new pack the next day; thus omitting the pill free interval

Question 6

After taking ulipristal acetate how long should women wait before restarting hormonal contraception?

Answer 6

5 days (ulipristal acetate can reduce the effectiveness of hormonal contraception cause it is a progesterone antagonist)

Question 7

When do you offer metformin in gestational diabetes?

Answer 7

omen should be offered a trial of changes in diet and exercise if they have a fasting plasma glucose level below 7 mmol/l at diagnosis. A further check is made in 1–2 weeks to assess the need for metformin. If above 7 at this time they get metformin

Question 8

Alternatives for doxycycline for chlamydia in a pregnant woman?

Answer 8

doxycycline = contraindicated

alternatives = amoxicillin or erythromycin

can also give azithromycin but BNF states to only give this if no other alternative