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Year 4 OBGYN > Contraception And Procedures > Flashcards

Contraception And Procedures Flashcards

1
Q

What is the fertility awareness method?

A

The awareness of the fertile period during a cycle, and either using a barrier method or abstaining during that time

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2
Q

State the four subtypes of Fertility Awareness

A

Standard Days
Cervical Mucous
Basal Body Temp
Sympothermal

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3
Q

Describe the ‘Standard Days’ subtype of Fertility Awareness

A

If your cycle is between 26 and 32 days long then days 8-19 are the most fertile

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4
Q

Describe the Cervical Mucous subtype of Fertility Awareness Method

A

Just prior to ovulation, oestrogen levels increase, making mucous thin and stretchy

Also affected by intercourse/breast feeding/ female hygiene products

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5
Q

Describe the Basal Body Temperature subtype of Fertility Awareness

A

Temperature increase of at least 0.2 degrees with an increase of Progesterone
Fertility peaks a few days before this, so not very efficient

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6
Q

Describe the ‘Sympothermal’ subtype of fertility awareness

A

Combines Cervical Mucous and Basal Body Temperature

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7
Q

Describe the lactational Amenorrhoea subtype of Fertility Awareness Method

A

Full Breast feeding (Atleast 3-4 hourly)
<6 months PP
Menses not returned

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8
Q

Describe the pathophysiology of Lactational Amenorrhoea

A

Prolactin supresses GnRH release from Hypothalamus
Reduces FSH and LH, and therefore Oestrogen

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9
Q

What is the difference between Diaphragms and Caps?

A

Diaphragms should lie diagonally between pubic bone and posterior fornix
Caps sit directly over cervix and left in place for 6-8 hours

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10
Q

What is the pathophysiology of COCP?

A

1)Suppresses FSH and LH hence decreasing ovulation
2)Thickens Cervical Mucous

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11
Q

Describe two types of COCP

A

Monophasic - each pill contains the same amount of oestrogen/progesterone
Phasic - levels of hormones vary across the pills (important they’re taken in order)

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12
Q

What cancers does the COCP decrease the incidence of, and what do they increase the incidence of?

A

Reduced Ovarian/Uterine/Colon

Increased Breast and Cervical

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13
Q

Give three drug interactions of the COCP

A

Rifampicin
Anticonvulsants (such as Carbemazapine)
Antiretrovirals

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14
Q

Describe the pathophysiology of the Progesterone Only Pill

A

Thickens cervical mucous

Thins endometrium

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15
Q

State two benefits of POP

A

Can be used when breast feeding

Avoids CVS risks of oestrogen

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16
Q

State three disadvantages of POP

A

Amenorrhoea/Breakthrough bleeding

Has to be taken at same time >27h it’s ineffective

Increased risk of Ovarian Cysts and Breast Cancer

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17
Q

State three benefits of Nexplanon

A

Lasts for three years

Can be used in Breast Feeding or High BMI

Decreases risk of Endometrial Cancer

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18
Q

State three disadvantages of Nexplanon

A

Irregular bleeding

Painful

Increased Risk of Breast Cancer

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19
Q

Describe three Progesterone Only Injections

A

Depo- Provera (12 weeks)
Sayana Press (13 weeks)
Noristerat (8 weeks)

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20
Q

A benefit of PO Injections is that there are no contraindications . State 5 disadvantages

A

Weight Gain

Decreased Bone Mineral Density

Persistent Bleeding

Delayed Return in Fertility

Increased Breast Cancer Risk

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21
Q

What is the IUD?

A

AKA Copper Coil

Creates inflammatory reaction within the endometrium, rendering it unfavourable for the fertilised egg

Effective immediately

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22
Q

What is the IUS?

A

AKA Mirena Coil
First Line for Menorrhagia

Levonorgestrel releasing, thinning endometrium

Effective after 7 days

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23
Q

Give 5 Contraindications to the Coil

A

Infection

48h - 4w Post Partum

Uterine Structure Abnormalities

Copper Allergy

Gynae Malignancy

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24
Q

Give three advantages to the coil

A

Good non hormonal option

Can be used when breast feeding

Fertility returns to normal

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25
Q

Give 3 disadvantages for the coil

A

Risk of infection (PID within first 20d)

Perforation

Irregular bleeding for up to 6 months

Increased proportion of ectopic pregnancy

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26
Q

Give two pill options for Emergency Contraception

A

Levonorgestrel (able to be used 72hrs)

Ulipristil Acetate (able to be used 120 hrs)

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27
Q

Where is Nexplanon inserted?

A

Subdermally, non dominant arm

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28
Q

How does the Depo-Provera and Nexplanon provide contraception?

A

Inhibits Ovulation

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29
Q

How long does it take POP to be effective?

A

2 days

30
Q

What are the Fraser Guidelines?

A

Specific guidelines to providing contraception to under 16s without parental involvement

31
Q

Describe the Fraser Guidelines

A

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

32
Q

What is Amniocentesis and when is it carried out?

A

Used to sample a small amount of Amniotic Fluid from Foetus

After 15 weeks

33
Q

Describe the Amniocentesis procedure in three steps

A

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

34
Q

Give two indications for Amniocentesis

A

High risk result from first trimester screening
Previous pregnancy affected by genetic condition

35
Q

Give four complications of Amniocentesis

A

1% risk of miscarriage
Infection
Rhesus Sensitisation
Increased risk of club foot

36
Q

If a patient didn’t want an Amniocentesis, what three alternatives could you offer?

A

Chorionic Villus
Nuchal Translucency
Maternal Serum Markers for HCG and PAPP-A

37
Q

What is the Nuchal Translucency Investigation?

A

The nuchal pad at the nape of the neck

Quite specific for Downs (thickened)

38
Q

What is the Chorionic Villus test?

A

Prenatal Diagnostic Procedure carried out between 11 and 13+6

39
Q

Describe the procedure of a Chorionic Villus

A

Most commonly a trans abdominal approach although can be transcervical
Placental tissue grasped via cannula aspiration or biopsy forceps

Anti D Prophylaxis given afterwards

40
Q

Give three indications for Chorionic Villus

A

Identified as at risk through Antenatal Screening
Known carrier status
Abnormal USS

41
Q

Give four complications of Chorionic Villus

A

Miscarriage - risk slightly higher than Amniocentesis
Vaginal Bleeding (1 in 10)
Rhesus Sensitisation
Mosaic Result (normal and abnormal cells are found)

42
Q

What is a Total Hysterectomy

A

Removal of Uterus and Cervix

43
Q

What is a Subtotal Hysterectomy?

A

Removal of uterine body only (leaving cervix behind)

44
Q

What is a Total Hysterectomy and Bilateral Salpingo-oophorectomy?

A

Removal of Uterus/Cervix/Fallopian Tubes/Ovaries

45
Q

What is a Radical Hysterectomy?

A

Removal of Uterus/Cervix/Parametrium/Vaginal Cuff/ Part or all of Fallopian Tubes
Ovaries may be removed or left behind

46
Q

What are the three approaches to a Hysterectomy?

A

Abdominal
Laproscopic
Vaginal

47
Q

Name three ligaments that have to be divided/tied in a Hysterectomy

A

Round Ligament
Infundibulopelvic
Uterosacral

48
Q

In a Laproscopic Hysterectomy, where is the specimen removed?

A

Through the Vagina

49
Q

Give 5 complications of Hysterectomy

A

-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

50
Q

Endometrial Ablation is a potential treatment method for abnormal Uterine Bleeding. What are the four methods?

A

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

51
Q

Give two contraindications to Endometrial Ablation

A

Women who want to retain their fertility

Diagnosis of Endometrial Malignancy

52
Q

Name three complications of Endometrial Ablation

A

Fluid Overload
Uterine Perforation
Inflammation & Scarring (Pain etc)

53
Q

Tension Free Vaginal Tape is a synthetic tape placed around urethra. What is the indication?

A

Stress Incontinence

54
Q

Give four contraindications for TVT

A

Bladder Perforation
Damage to Pelvic Blood Vessels
Tape Erosions
Groin/Suprapubic Pain

55
Q

If a patient didn’t want a TVT procedure, what could you offer them?

A

Open Colposuspension
Bulking Agents

56
Q

Describe the procedure of a Coil Insertion

A

1) Bimanual Examination and Speculum Insertion
2) Cervical Dilator passed through Cervix
3) Small T shaped device pushed through into uterus where it remains

57
Q

When should you double the dose of Levonorgestrel Emergency Contraception?

A

BMI>26 or Weight >70Kg

If vomited within 3 hours, requires another dose

57
Q

Give four general advice points for the COCP

A
  • 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
58
Q

Describe the advice you would give a patient if they have missed ONE pill (COCP)

A

Take two pills the next day

59
Q

Describe the advice you would give a patient if they have missed TWO OR MORE pills (COCP)

A

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

60
Q

Describe the UKMEC classifications for COCP

A

1) No contraindications
2) Advantages > Disadvantages
3) Disadvantages > Advantages
4) Absolute contraindication

61
Q

Name four UKMEC3 contraindications for the COCP

A
  • > 35y and smoking <15 a day
  • VTE in first degree relative
  • Immobility
  • BRCA1/BRCA2
62
Q

Give four UKMEC4 contraindications for COCP

A
  • Personal VTE risk
  • > 35y and smoking >15 a day
  • Migraine with aura
  • Breast Cancer
63
Q

What could you give Women having the Depot injection before starting?

A

Trial with POP first to test Progestrerone SE

64
Q

When does a Vasectomy become effective?

A

After sperm analysis at 16 and 20 weeks indicates

65
Q

When is Contraception needed Post Partum?

A

After 21 days

66
Q

What are the contraceptive options for PP women?

A

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

67
Q

When do menopausal women no longer require contraception?

A

After one year of no periods in >50y

After two years of no periods in <50y

68
Q

What contraceptive options can be used in Women >50y

A

IUS
Implant
POP

69
Q

What is the contraceptive choice for Lamotrigine?

A

Any Progesterone

COCP is contraindicated

70
Q

What is the choice of Contraceptive for Phenytoin/Carbemazepine/Barbiturates/Topirimate?

A

Depot/IUD/IUS

Year 4 OBGYN (15 decks)

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