Contraception and termination of pregnancy Flashcards by Molly Richard

For how long do ovum and sperm survive in the female genital tract?

Ovum survives for up to 24 hours

Sperm survives for up to 5 days

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What factors are monitored for natural family planning?

Basal body temperature 
Cervical mucous 
Cervical position 
Standard/ fertile days 
Breastfeeding

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How can basal body temperature be used to monitor fertility?

Taken before rising in the morning

Increase of >0.2 sustained for at least 3 days after at least 6 days of lower temp indicates ovulation

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Describe the position of the cervix when fertile vs when infertile

Cervix is high in the vagina, soft and open when fertile

Cervix is low in the vagina, firm and closed when less fertile

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What days of the menstrual cycle are the most fertile?

8 to 18

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What criteria must be met for breastfeeding to be considered an effective method of contraception?

Exclusively breast feeding

Less than 6 months post natal

Amenorrhoeic

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What methods of contraception are combined hormonal methods and which contain progesterone only?

Combined:
COC, patches, vaginal ring

Progesterone only:
POP, implant, depo injection

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What methods of emergency contraception may be available to patients?

Copper IUD

Oral medications: UPA or LNG

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What is the most effective method of emergency contraception?

Copper IUD

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When can a copper IUD be installed for emergency contraception and what is the reason for this?

5 days after UPSI or up to 5 days after the earliest expected date of ovulation

This is because pregnancy doesn’t implant within the first 5 days - so this is a safe time to insert

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What are the differences between UPA and LNG, the two oral methods of emergency contraception?

UPA
Anti progestogen
Can work during the LH surge but not after the peak
Up to 5 days post UPSI

LNG
High dose progestogen
Works until just before the LH surge
Up to 3 days post UPSI

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In which circumstances should UPA, an oral emergency contraceptive NOT be used?

If hormonal contraception has been used in the last 7 days

If the patient has severe asthma, uncontrolled on oral steroids

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How do combined methods of contraception, such as the pill, patch or ring work?

Contain both oestrogen and progestogen which act by negative feedback on the pituitary gland to inhibit ovulation, make cervical mucus thick and sticky and make the endometrium thinner

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At what body weight would the combined hormonal patch not be recommended?

> 90kg

This is because there is possible decreased efficacy

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Which method of contraception has the lowest failure rates?

The contraceptive implant

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Which methods of contraception are considered short-acting and which are considered long-acting?

SHORT ACTING
Combined hormonal contraception

LONG ACTING 
Contraceptive implant 
Depo injection 
IUS 
Cu IUD

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What are some of the risks associated with methods of combined hormonal contraception?

Venous thrombosis

Arterial thrombosis

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What is the treatment for acne and hirsutism which contains a high does of oestrogen and therefore also acts as a contraceptive?

Cyproterone acetate

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How should a patient on CHC be reviewed?

Check BP at 3 months then either 6 monthly or annually

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What is the cut off limit for BP for patients taking a combined hormonal method of contraception?

140/90

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Migraine with aura is a contraindication for the use of which contraceptive?

Combined oral contraceptive pill

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What are the risks and protective benefits for cancers associated with combined hormonal contraception?

Increased risk of breast cancer and cervical cancer

Protection against ovarian and endometrial cancers

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The combined hormonal contraceptive is associated with being of benefit for which conditions?

Acne

PCOS

Premenstrual syndrome

Ovarian and endometrial cancers

When can the CHC, POP, subdermal implant or DMPA all be started?

Within the first 5 days of regular menstruation or anytime in the cycle but should use condoms for the first 7 days

When can IUS or Cu-IUD be started?

At anytime in the cycle if there has been no IPSI in the past 3 weeks or since the last period

How often is the depo injection given?

Every 13 weeks

What are some of the risks of the depo injection?

Increased risk of poor bone mineral density in people who already have bone problems VTE Interaction with liver enzyme inducers

What may be some of the contraindications to the use of the depo injection?

Age <18 years or >45 years BMI <20 Malabsorption Hyperthyroidism Amenorrhoea

How does IUS work?

Effects implantation and mucus

How does the Cu-IUD work?

Copper is toxic to the joining of egg and sperm Inflammatory response in the endometrium

Why are failure rates with the Cu-IUD slightly higher than with other methods of contraception?

Because it doesn't contain any hormones and is dependent on its position in the uterus

What are the risks associated with IUS and the Cu-IUD?

Infection Perforation Risks to pregnancy when in situ Expulsion

What is the major risk of clipping someone for female sterilisation?

If the patient is already pregnant it could cause an ectopic pregnancy

What is meant by conscientious objection?

Doctors have the right to opt out of certain procedures because of personal beliefs and values

The highest rates of termination of pregnancy are seen in which age group?

20-24

What year was the abortion act?

1967

What is the general law in Norther Ireland for when abortion can be performed?

Only if there is serious risk of harm to the mother

What is the 'Gillick competence' used for?

To assess whether a young person can consent to TOP

What are the general gestation limits for social termination of pregnancy?

23 weeks 6 days

What are the gestation limits for termination of pregnancy for reasons of fetal anomaly?

Any gestation

What are the NHS Tayside limits for surgical and medical termination of pregnancy?

Surgical termination up to 12 weeks | Medical termination up to 18 weeks and 6 days

What weeks are considered early, late and mid trimester termination of pregnancy

Early is up to 9 weeks Late 9-12 weeks Mid trimester 12-24 weeks

What is the 2 stage process for medical termination of pregnancy?

1) Oral mifepristone (anti-progesterone) | 2) Vaginal or oral prostaglandin e.g misoprostol

Medical termination of pregnancy is a 2 stage process, what can/ is done differently for early or late termination of pregnancy?

Early - option to complete the 2nd part at home Late/ mid-trimester - repeated doses of prostaglandin (stage 2) given 3 hourly

What method of surgical termination of pregnancy is used in Scotland?

Vacuum aspiration

When can a vacuum aspiration for termination of pregnancy be performed?

6-12 weeks

What are some of the possible complications of termination of pregnancy?

Pain Haemorrhage Infection Uterine perforation and rupture Cervical trauma Anaesthetic complications

What aftercare is offered to patients following termination of pregnancy?

Uterine pregnancy test at 2-3 weeks (higher sensitivity than community tests as pregnancy hormones may still be elevated) Anti D Counselling CONTRACEPTION

A 35-year-old woman seeks contraception. She has heavy and painful periods. She smokes 10 cigarettes daily. Her BMI is 33 and BP 128/70. She is taking a drug for epilepsy that is a liver enzyme inducer. What would be the best contraceptive for this woman?

intrauterine system (IUS)

What is the single best method of contraception for a 46 year old with a BMI of 42. She is in a stable relationship. She smokes 20 cigarettes/day . She also has history of pelvic inflammation due to diverticular disease in the past. She also has multiple fibroid uterus including intramural and submucous fibroid.

Progesterone only pill Given her previous history sterilisation will be risky. Difficult to fit Mirena and Hysteroscopic sterilisation with fibroid uterus.COCP Contraindicated in women age 40+ and with high BMI.

A 40 year old woman seeks contraception. She smokes 30 cigarettes a day. Her BMI is 40 and she has heavy menstrual periods. She is sexually active. Her uterus is retroverted and normal size. What is the best contraceptive option?

Mirena IUS

What factors may cause a woman to regret sterilisation procedures?

Performed at time of abortion Young age (<30yrs) Few or no children Not in a relationship o a mutually faithful relationship Coercian by a partner or medical personnel

The efficacy of which methods of contraception is reduced by liver enzyme inducing drugs?

Combined oral contraceptive Progesterone only pill Subdermal implant (not the IUS or IUD)

What method of contraception is generally best for patients who are taking carbamazepine?

IUS or IUD | this is because it won't be affected by enzyme induction

What are the different time scales for when contraception becomes effective if it it not started on day 1 of the patients period?

Instant : IUD 2 Days : POP 7 Days : COC, Injections, Implant, IUS