Contraception And Procedures Flashcards
What is the fertility awareness method?
The awareness of the fertile period during a cycle, and either using a barrier method or abstaining during that time
State the four subtypes of Fertility Awareness
Standard Days
Cervical Mucous
Basal Body Temp
Sympothermal
Describe the ‘Standard Days’ subtype of Fertility Awareness
If your cycle is between 26 and 32 days long then days 8-19 are the most fertile
Describe the Cervical Mucous subtype of Fertility Awareness Method
Just prior to ovulation, oestrogen levels increase, making mucous thin and stretchy
Also affected by intercourse/breast feeding/ female hygiene products
Describe the Basal Body Temperature subtype of Fertility Awareness
Temperature increase of at least 0.2 degrees with an increase of Progesterone
Fertility peaks a few days before this, so not very efficient
Describe the ‘Sympothermal’ subtype of fertility awareness
Combines Cervical Mucous and Basal Body Temperature
Describe the lactational Amenorrhoea subtype of Fertility Awareness Method
Full Breast feeding (Atleast 3-4 hourly)
<6 months PP
Menses not returned
Describe the pathophysiology of Lactational Amenorrhoea
Prolactin supresses GnRH release from Hypothalamus
Reduces FSH and LH, and therefore Oestrogen
What is the difference between Diaphragms and Caps?
Diaphragms should lie diagonally between pubic bone and posterior fornix
Caps sit directly over cervix and left in place for 6-8 hours
What is the pathophysiology of COCP?
1)Suppresses FSH and LH hence decreasing ovulation
2)Thickens Cervical Mucous
Describe two types of COCP
Monophasic - each pill contains the same amount of oestrogen/progesterone
Phasic - levels of hormones vary across the pills (important they’re taken in order)
What cancers does the COCP decrease the incidence of, and what do they increase the incidence of?
Reduced Ovarian/Uterine/Colon
Increased Breast and Cervical
Give three drug interactions of the COCP
Rifampicin
Anticonvulsants (such as Carbemazapine)
Antiretrovirals
Describe the pathophysiology of the Progesterone Only Pill
Thickens cervical mucous
Thins endometrium
State two benefits of POP
Can be used when breast feeding
Avoids CVS risks of oestrogen
State three disadvantages of POP
Amenorrhoea/Breakthrough bleeding
Has to be taken at same time >27h it’s ineffective
Increased risk of Ovarian Cysts and Breast Cancer
State three benefits of Nexplanon
Lasts for three years
Can be used in Breast Feeding or High BMI
Decreases risk of Endometrial Cancer
State three disadvantages of Nexplanon
Irregular bleeding
Painful
Increased Risk of Breast Cancer
Describe three Progesterone Only Injections
Depo- Provera (12 weeks)
Sayana Press (13 weeks)
Noristerat (8 weeks)
A benefit of PO Injections is that there are no contraindications . State 5 disadvantages
Weight Gain
Decreased Bone Mineral Density
Persistent Bleeding
Delayed Return in Fertility
Increased Breast Cancer Risk
What is the IUD?
AKA Copper Coil
Creates inflammatory reaction within the endometrium, rendering it unfavourable for the fertilised egg
Effective immediately
What is the IUS?
AKA Mirena Coil
First Line for Menorrhagia
Levonorgestrel releasing, thinning endometrium
Effective after 7 days
Give 5 Contraindications to the Coil
Infection
48h - 4w Post Partum
Uterine Structure Abnormalities
Copper Allergy
Gynae Malignancy
Give three advantages to the coil
Good non hormonal option
Can be used when breast feeding
Fertility returns to normal
Give 3 disadvantages for the coil
Risk of infection (PID within first 20d)
Perforation
Irregular bleeding for up to 6 months
Increased proportion of ectopic pregnancy
Give two pill options for Emergency Contraception
Levonorgestrel (able to be used 72hrs)
Ulipristil Acetate (able to be used 120 hrs)
Where is Nexplanon inserted?
Subdermally, non dominant arm
How does the Depo-Provera and Nexplanon provide contraception?
Inhibits Ovulation
How long does it take POP to be effective?
2 days
What are the Fraser Guidelines?
Specific guidelines to providing contraception to under 16s without parental involvement
Describe the Fraser Guidelines
1) The young person understands the advice given to them
2) The young person cannot be persuaded to have their parents informed
3) The young person is likely to have sexual intercourse anyway
4) Unless the person receives contraception, their physical or mental health will suffer
5) It is in their best interest
What is Amniocentesis and when is it carried out?
Used to sample a small amount of Amniotic Fluid from Foetus
After 15 weeks
Describe the Amniocentesis procedure in three steps
1) Local anaesthetic inserted today decrease pain for mother
2) Ultrasound guided needle passed through maternal abdominal wall into amniotic sac
3) Small amount of fluid is taken and foetal cells are taken for PCR/Karyotyping
If Rhesus negative give Anti D
Give two indications for Amniocentesis
High risk result from first trimester screening
Previous pregnancy affected by genetic condition
Give four complications of Amniocentesis
1% risk of miscarriage
Infection
Rhesus Sensitisation
Increased risk of club foot
If a patient didn’t want an Amniocentesis, what three alternatives could you offer?
Chorionic Villus
Nuchal Translucency
Maternal Serum Markers for HCG and PAPP-A
What is the Nuchal Translucency Investigation?
The nuchal pad at the nape of the neck
Quite specific for Downs (thickened)
What is the Chorionic Villus test?
Prenatal Diagnostic Procedure carried out between 11 and 13+6
Describe the procedure of a Chorionic Villus
Most commonly a trans abdominal approach although can be transcervical
Placental tissue grasped via cannula aspiration or biopsy forceps
Anti D Prophylaxis given afterwards
Give three indications for Chorionic Villus
Identified as at risk through Antenatal Screening
Known carrier status
Abnormal USS
Give four complications of Chorionic Villus
Miscarriage - risk slightly higher than Amniocentesis
Vaginal Bleeding (1 in 10)
Rhesus Sensitisation
Mosaic Result (normal and abnormal cells are found)
What is a Total Hysterectomy
Removal of Uterus and Cervix
What is a Subtotal Hysterectomy?
Removal of uterine body only (leaving cervix behind)
What is a Total Hysterectomy and Bilateral Salpingo-oophorectomy?
Removal of Uterus/Cervix/Fallopian Tubes/Ovaries
What is a Radical Hysterectomy?
Removal of Uterus/Cervix/Parametrium/Vaginal Cuff/ Part or all of Fallopian Tubes
Ovaries may be removed or left behind
What are the three approaches to a Hysterectomy?
Abdominal
Laproscopic
Vaginal
Name three ligaments that have to be divided/tied in a Hysterectomy
Round Ligament
Infundibulopelvic
Uterosacral
In a Laproscopic Hysterectomy, where is the specimen removed?
Through the Vagina
Give 5 complications of Hysterectomy
-Damage to Bladder/Uterus
-Damage to Bowel
-VTE
-Pelvic Abscess
-If Ovary preserved, menopause may occur 1-2 years earlier due to change in blood supply
Endometrial Ablation is a potential treatment method for abnormal Uterine Bleeding. What are the four methods?
Transcervical Resection of Endometrium (Using diathermy under GA)
Balloon Ablation (Cervix is dilated and balloon with heated fluid sits inside for 2-8 mins)
Microwave Energy
Bipolar Mesh
Give two contraindications to Endometrial Ablation
Women who want to retain their fertility
Diagnosis of Endometrial Malignancy
Name three complications of Endometrial Ablation
Fluid Overload
Uterine Perforation
Inflammation & Scarring (Pain etc)
Tension Free Vaginal Tape is a synthetic tape placed around urethra. What is the indication?
Stress Incontinence
Give four contraindications for TVT
Bladder Perforation
Damage to Pelvic Blood Vessels
Tape Erosions
Groin/Suprapubic Pain
If a patient didn’t want a TVT procedure, what could you offer them?
Open Colposuspension
Bulking Agents
Describe the procedure of a Coil Insertion
1) Bimanual Examination and Speculum Insertion
2) Cervical Dilator passed through Cervix
3) Small T shaped device pushed through into uterus where it remains
When should you double the dose of Levonorgestrel Emergency Contraception?
BMI>26 or Weight >70Kg
If vomited within 3 hours, requires another dose
Give four general advice points for the COCP
- Take at same time everyday
- Start within first 5d of new cycle for immediate protection
- Sex during pill free week is only safe if you start the next pill packet on time
- Not effective if vomiting within 2 hours
Describe the advice you would give a patient if they have missed ONE pill (COCP)
Take two pills the next day
Describe the advice you would give a patient if they have missed TWO OR MORE pills (COCP)
Take the last one that you have missed and finish the packet. Use barrier protection until you have taken 7 days of pills.
If Week 1 and unprotected sex in the pill free week, or first week of cycle, then take Emergency Contraception
If Week 3, start next packet without pill free break
Describe the UKMEC classifications for COCP
1) No contraindications
2) Advantages > Disadvantages
3) Disadvantages > Advantages
4) Absolute contraindication
Name four UKMEC3 contraindications for the COCP
- > 35y and smoking <15 a day
- VTE in first degree relative
- Immobility
- BRCA1/BRCA2
Give four UKMEC4 contraindications for COCP
- Personal VTE risk
- > 35y and smoking >15 a day
- Migraine with aura
- Breast Cancer
What could you give Women having the Depot injection before starting?
Trial with POP first to test Progestrerone SE
When does a Vasectomy become effective?
After sperm analysis at 16 and 20 weeks indicates
When is Contraception needed Post Partum?
After 21 days
What are the contraceptive options for PP women?
POP - can be used when breast feeding
COCP - can’t be used if breast feeding and less than 6 weeks PP (UKMEC4), May reduce milk production
IUD/IUS - can be inserted within 48h or after 4 weeks
When do menopausal women no longer require contraception?
After one year of no periods in >50y
After two years of no periods in <50y
What contraceptive options can be used in Women >50y
IUS
Implant
POP
What is the contraceptive choice for Lamotrigine?
Any Progesterone
COCP is contraindicated
What is the choice of Contraceptive for Phenytoin/Carbemazepine/Barbiturates/Topirimate?
Depot/IUD/IUS
