Contraception and Unplanned Pregnancy Flashcards

Question

Name 2 other factors that can reduce the effectiveness of the COCP?

Answer 1

``` impaired absorption (GI conditions) being on enzyme inducing drugs e.g. carbamazepine ```

Answer 2

risk of VTE slightly increased but only really a problem in those already with risk factors of VTE (risk increased in higher oestrogen pills) COCP can increase BP May be increased risk of MI and ischaemic stroke small additional risk of breast cancer and cervical cancer

Answer 3

as it can increase BP you need to get BP taken initially, at 3 months and then annually

Answer 4

COCP increases risk of arterial disease so if older and have risk factors like smoking then even more at risk

Answer 5

COCP increases risk of ischaemic stroke in those with migraine with aura so is contraindicated (although important to check migraine with aura diagnosis is correct as many misdiagnosed)

Answer 6

there is a small additional risk of breast cancer but this goes back to baseline in 10 years of stopping small risk of cervical cancer with use of more than 5 years so important to talk about HPV etc there is actually 20% reduction in ovarian cancer for every 5 years on the pill used to a max of 50% after 15 years 20-50% reduction in endometrial cancer benefit for both ovarian and endometrial cancer reduction may last decades after stopping

Answer 7

12% decrease in all cause mortality and no overall increase in cancer risk

Answer 8

shown to be beneficial for acne, also decreased and more regular bleeding, fewer functional ovarian cysts, decreased PMS

Answer 9

nausea, worsening of acne, breakthrough bleeding, breast tenderness

Answer 10

desogestrel which inhibits ovulation (older pills not used but they worked by thickening cervical mucus)

Answer 11

when COCP is not suitable

Answer 12

days 1-5 of period for immediate protection or anytime if not pregnant plus condoms for 2 days the pill has to be taken at the same time every day and if more than 12 hours late the pill won't work

Answer 13

current breast cancer

Answer 14

POP doesn't carry the same risks of VTE, arterial disease etc

Answer 15

same as COCP but generally get irregular bleeding

Answer 16

a progesterone injection, lasts for 3 months

Answer 17

those with epilepsy as it isn't affected by enzyme inducing drugs

Answer 18

hormonal side effects similar to COCP and after 3 injections hope for amenorrhoea also weight gain and can affect bone mass due to oestradial suppression so tend not to give to teens (when building bone mass) or close to menopause (when losing bone mass)

Answer 19

it is a barrier inserted by the female with spermicide put into the vagina before sex and must be left 6hrs after and then washed with soapy water a good option if want to space out pregnancies but not bothered if got pregnant a bit early

Answer 20

very effective but need counselling, involves operation, reversals dont always work also sometimes sterilisation doesn't work, do post vasectomy seminal analysis at 7 months, if still motile sperm then it hasn't worked

Answer 21

fail rates are relatively high usually try and encourage use of another method

Answer 22

IUS – mirena coil, IUD DMPA also can use barrier methods

Answer 23

Copper IUD Ella one Levonelle

Answer 24

copper IUD

Answer 25

has to be fitted with 2 important criteria? has to be within 5 days of earliest possible date of ovulation or 5 days after a single episode of sex (have to be sure no embryo implanted already) although most effective it's not always practical and people may not want an IUD fitted

Answer 26

ullipristal acetate- a progesterone receptor modulator that blocks progesterone receptors stopping LH surge so delays ovulation

Answer 27

5 days after unprotected sex

Answer 28

if taken within 24 hrs it's 90% effective but as time goes on efficacy goes down

Answer 29

because it blocks progesterone you cant have just taken progesterone or take it after (unable to quick start contraception in young people and cant give it to someone who wants emergency contraception because theyve missed their pills)

Answer 30

a big dose of progesterone hormone aiming to inhibit ovulation

Answer 31

72 hours after unprotected sex | if used in 24hrs it's 90% effective

Answer 32

it doesn't work as well as ella one and if > 70kg need a double dose however can take contraception with progesterone straight after if wanted

Answer 33

in the second half of the cycle when ovulation has already taken place

Answer 34

Abortion is permitted under the 1967 abortion act but in NI this has only in 2020 come in line with rest of UK Rather than making abortion legal the Act includes exceptions to the 1861 offences against the person act where abortion had previously been a punishable offence

Answer 35

It is certified under a specific indication (5 clauses A to E) and certified on a HSA1 form (certificate A) and signed by 2 doctors There are 2 emergency clauses (F and G) that only need signed by 1 doctor in situations to save the mothers life or prevent grave or serious injury

Answer 36

CMO via abortion notification form

Answer 37

Most abortions (98%) in UK certified under Clause C which has gestational limit of 24 weeks “Continuing the pregnancy would involve risk of injury to the physical or mental health of the pregnant women or her existing children/family (greater than if the pregnancy were terminated)” The next most common certification is Clause E (1-2%) which has no gestational limit “There is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped”

Answer 38

Clause within the 1967 Abortion Act allowing HCPs the right to refuse to participate in abortion care Limits of CO: Does not apply in emergency or life-threatening situations Should not delay or prevent a patient’s access to care Does not apply to ‘indirect’ tasks associated with abortion e.g. administrative, supervision of staff etc

Answer 39

can be done clinically by estimating LMP +/- date of +ve UPT if someone has a palpable uterus they are likely more than 12 weeks ultrasound done in some people (used to be everyone but now cause COVID they risk assess), TV if under 6 weeks if not abdominal US is done

Answer 40

Involves 2 medications MIFEPRISTONE 200mg PO MISOPROSTOL 800mcg PV/SL (24-48 hours later) < 12 weeks gestation Can self-administer mife/miso at home 2nd 1/2 dose misoprostol if >10 weeks or if don’t experience any bleeding in the first four hours of taking the initial dose > 12 weeks (late or mid-trimester) Inpatient procedure Repeated doses of PV misoprostol: 800mcg PV then 400mcg 3-hourly PV/PO/SL (up to 4)

Answer 41

because it takes a while for HCG to fall so high sensitivity ones might pick up the low levels of HCG and think the person is pregnant even if the abortion has worked

Answer 42

1/200 procedures can fail or person won't pass the whole pregnancy

Answer 43

Removal of pregnancy via surgical procedure (usually under anaesthesia) Cervical priming via misoprostol or osmotic dilators (Makes it easier to pass instruments through cervix associated with fewer complications) For later surgical abortion greater extent of cervical dilation is required ``` < 14wks Electric vacuum aspiration (GA) Manual vacuum aspiration (up to 10wks; LA) > 14wks Dilatation and evacuation ```

Answer 44

abortion is generally a safe procedure small risk of haemorrhage, failed or incomplete abortion and infection in surgical abortions also small risk of uterine perforation or cervical trauma risks are lower in early abortion

Answer 45

antibiotic prophylaxis is given to those undergoing STOP and some MTOP if increased risk of STI or have been unable to perform screening usually 7 days doxycycline if rhesus neg and STOP or late MTOP may give anti-D to reduce the chance of sensitising event VTE prophylaxis as LMWH may be given to those identified as at risk

Answer 46

fertility returns quickly after abortion- ovulation occurs in > 90% in 1st month as early as 8 days with early MTOP should discuss contraception at the time almost all methods can be started at the time or soon after abortion immediately effective if started on day otherwise time till effective depends on method