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Gynaecology, Obstetrics and Sexual Health > Contraception and termination of pregnancy > Flashcards

Contraception and termination of pregnancy Flashcards

1
Q

What is the failure rate of both the combined hormone contraceptive pill and the progesterone only pill with typical and perfect use?

A 
Typical = 9% failure rate
Perfect = 0.3%
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2
Q

What is the failure rate of the injectable contraception (e.g. DepoProvera)?

A 
Typical = 6%
Perfect = 0.2%
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3
Q

What is the failure rate of the copper intrauterine device?

A 
Typical = 0.8%
Perfect = 0.6%
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4
Q

What is the failure rate of the levonorgestrel intrauterine system (e.g. Mirena)?

A

0.2%

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5
Q

What is the failure rate of the implant?

A

0.05% - lowest failure rate of the options available to females

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6
Q

What is the failure rate of female sterilisation?

A

0.5%

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7
Q

What is the failure rate of male sterilisation?

A

0.05%

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8
Q

What forms of combined hormone contraception exist?

A 
Oral pill (e.g. Microgynon, Marvelon, Glaira)
Dermal patch (e.g. Evra patch)
Vaginal ring (e.g. NuvaRing)
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9
Q

What are absolute contraindications to using Combined Hormone Contraception?

A

Smoker > 35 years, < 6 weeks postpartum, breast-feeding, HTN, current or past VTE Hx, migraine with aura, CVD, current breast Ca, liver cirrhosis

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10
Q

Which type of drugs will reduce the efficacy of CHC?

A

Enzyme-inducing drugs such as antiepileptics, antiretrovirals, Rifampicin, sulfonylureas

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11
Q

What is the mode of action for CHC?

A

Suppression of ovulation is the main mechanism of action. Also, thins endometrium and thickens cervical mucus.

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12
Q

What is the treatment course of CHC methods?

A

3 weeks ‘on’ - using the contraception (daily pill/weekly patch/3-weekly ring) then 1 week ‘off’ - not using any contraceptive methods. Still covered during this interval

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13
Q

Side effects of CHC?

A

Nausea, headaches, mood changes, acne, (weight gain), blood clots, increased risk of breast/cervical cancer, raised BP, increased risk of VTE.

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14
Q

What are some non-contraceptive benefits of using CHC?

A

Lighter, less painful bleeds, regularity of bleeds. Reduces risk ovarian and endometrial cancer

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15
Q

When should CHC be started?

A

Start on day 1 of menstrual cycle, (up to day 5).

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16
Q

What are the rules with regards to missing the COCP?

A

If missed one, take forgotten pill immediately even if with next one. If next one on time, it’s fine.
If missed 2+ consecutive pill, take one pill immediately and will need to use condoms for 7 days.

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17
Q

What is the mode of action of the Progesterone only pill (POP) a.k.a. mini-pill?

A

Thickens cervical mucus and thins endometrium

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18
Q

What is the treatment course for the POP?

A

Take at same time every day, no pill-free intervals.

3 hour window rule for traditional POP e.g. levonorgestrel. 12 hour window rule for newer POP e.g. cerazette

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19
Q

What side effects may be elicited by using Progesterone contraception?

A

Headaches, acne, mood changes, weight gain.

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20
Q

When should POP be started?

A

Day 1 of the menstrual cycle

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21
Q

What are the rules with regards to missing the POP?

A

Take ASAP, even if with next one. But if > 3 hours late or > 12 hours late for cerazette, use condoms for next 2 days and consider emergency contraception if had sex in the 2-3 days before the missed pill or had sex since the missed pill

22
Q

What is the mechanism of action of the copper intrauterine device?

A

The copper is directly toxic to sperm and the coil provides a hostile environment for implantation.

23
Q

How long does the copper coil last?

A

5-10 years

24
Q

What an important negative to be aware of when using the copper coil as contraception?

A

May make periods heavier and more painful.

Also, slightly increased risk of ectopic pregnancy

25
Q

What is the mechanism of action of Intra-uterine Systems such as Mirena or Jaydess?

A

Thickens cervical mucus, thins endometrium, prevents ovulation in some women’s cycles.

26
Q

How long does the IUS last?

A

5 years for Mirena

3 years for Jaydess

27
Q

What effect does the IUS have on a woman’s menstruation?

A

Initially, irregular bleeds but then much lighter/less painful bleeds or some women may not have any bleeds at all.

28
Q

What are some risks when inserting either the IUD or IUS?

A

Infection in the first 3 weeks, bleeding, perforation (1 in 1000), expulsion (1 in 20), vasovagal faint (1 in 10)

29
Q

When should the IUD or IUS be inserted?

A

Put in any time if not had sex since period or within first 5 days of period

30
Q

How long does the progesterone implant (e.g. Implanon) last?

31
Q

How long does the progesterone injection (e.g. Depo-Provera) last?

32
Q

What are some contraindications to fitting an IUD?

A

Pregnancy, Undiagnosed bleeding, Cervical/uterine cancer pre treatment, Active PID,
Asymptomatic chlamydia, Uterine abnormality, Gestational trophoblastic neoplasia, Long QT syndrome

33
Q

When should F/U be arranged for a man having a vasectomy to check it’s success?

A

Sperm sample at 8 weeks, then again 2-4 weeks later (both must be negative).
Can take up to 3 months for remaining sperm to be used up therefore condom should be used for at least 12 weeks post vasectomy or until azoospermia confirmed.

34
Q

Is reversal of sterilisation available on the NHS?

A

No.

Even when attempted, reversal is not always successful.

35
Q

What 3 options exist for emergency contraception?

A

Levonorgestrel 1500mcg (aka Levonelle)
Ulipristal acetate 30mg (aka EllaOne)
Copper IUD

36
Q

What is the mode of action of Levonorgestrel?

A

Acts by inhibiting ovulation.

It’s less effective when unprotected sexual intercourse (UPSI) occurs around ovulation.

37
Q

Up to how long after UPSI is levonorgestrel licensed for as an emergency contraceptive?

A

72 hours post UPSI.

Not effective if already ovulated

38
Q

What should a woman do if she has vomited less than 2 hours after taking levonorgestrel as emergency contraception?

A

Repeat dose

39
Q

What should a women do if she wants to use levonorgestrel as EC but is taking enzyme inducing drugs?

A

Double dose

40
Q

What options does a woman wishing to take oral EC have if she is over 70kg or BMI > 26?

A

Double the dose of levonorgestrel or use Ulipristal

41
Q

What is the mode of action of Ulipristal?

A

Inhibition/delay of ovulation.

Effective even if LH levels have begun to rise

42
Q

Up to how long after UPSI is levonorgestrel licensed for as an emergency contraceptive?

43
Q

What should a woman do if she has vomited less than 3 hours after taking Ulipristal as emergency contraception?

A

Repeat the dose

44
Q

Why should Ulipristal be avoided as the form of EC if progesterone has been taking in the past week?

A

This reduces the effectiveness of the Ulipristal

45
Q

How long is the copper IUD effective for as a form of EC?

A

Within 120 hours or UPSI
OR
within 5 days of earliest calculated ovulation

46
Q

Is oral emergency contraceptive effective after ovulation has occurred?

47
Q

Up to how many weeks gestation is termination of pregnancy legal?

48
Q

What surgical options are there for termination of pregnancy?

A

Up to 14 weeks: Vacuum aspiration. If < 7 weeks, examination of aspirate required to confirm complete abortion.
Up to 24 weeks: Dilatation and evacuation. Preceded by cervical preparation (using misopristol 400mcg pv 3 hours before surgery if < 14 weeks or using osmotic dilators if > 14 weeks).

49
Q

What is the medical method of termination of pregnancy for early pregnancies (=< 63 days)?

A

=< 49 days: 200mg mifepristone then 24 hours later 400mcg misopristol
=< 63 days: 200mg mifepristone then 24 hours later 800mcg misopristol. If no abortion within 4 hours, give 400mcg misopristol

50
Q

What is the medical method of termination of pregnancy for early pregnancies (=< 63 days)?

A

9-13 weeks: 200mg mifepristone then 36 hours later 800mcg misopristol PV. Can add up to 4 doses of misopristol 400mcg PO if needed
13-24 weeks: Same as above but if still no abortion after 4 further doses, give additional mifepristone dose

51
Q

What prophylaxis against infection is given for both surgical and medical management of termination of pregnancy?

A

1g azithromycin and 800mg metranidazole

Gynaecology, Obstetrics and Sexual Health (6 decks)

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