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AHN 548 Unit 3 > Contraception & Family Planning CH 58 > Flashcards

Contraception & Family Planning CH 58 Flashcards

1
Q

Coitus Interruptus

A

withdrawal of penis before ejaculation, demands self control by the man, failure rate high due to escape of semen before orgasm and deposition of semen on external genitalia near vagina

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2
Q

Postcoital douche

A

plain water, vinegar, or feminine hygiene products used as douche. method ineffective and unreliable

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3
Q

lactational amenorrhea, how does it work and how long does it last

A

highly effective for breastfeeding women. breastfeeding results in reduction of gnrh, LH, FSH, and dopamine. prolactin suppressed. results in amenorrhea and anovulation. must be exclusively breastfeeding for birth control and not as effective after 6 months

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4
Q

Male condom (latex) use and conjunction methods

A

covers penis during coitus to prevent deposition of semen. some have spermicide. highly effective and cheap. impervious to sperm and most bacterial and viral organisms that cause STIs and HIV. may be used in conjunction with contraceptive vaginal jelly or foam for more effectiveness

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5
Q

lamb skin condom disadvantage

A

not impermeable to bacterial and viral organisms that cause STIs and HIV

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6
Q

female condom

A

made of thin polyurethane with 2 flexible rings at each end (one for inside the vagina and one for outside). advantage- woman’s control. disadvantage- bulky, costly

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7
Q

vaginal diaphragm

A

mechanical barrier between vagina and cervical canal. circular ring that fits in vagina cul de sac. Contraceptive jelly is placed on cervical side (ineffective without it), then put additional jelly in after insertion. pregnancy rate 15-20 per 100 years

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8
Q

how long to use vaginal diaphragm

A

can be inserted up to 6 hours before sex and 6-24 hours after intercourse.

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9
Q

vaginal diaphragm disadvantages

A

requires fitting by physician or trained medical staff, and needing to anticipate intercourse. fit must be assessed yearly. may cause vaginal wall irritation. may dislodge if pt has irregularly shaped vagina or uterus

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10
Q

cervical cap

A

small cuplike diaphragm placed over cervix held in place by suction, must fit tight

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11
Q

cervical cap disadvantages

A

many women can’t reach cervix for proper placement, tailoring cap to fit is difficult

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12
Q

spermicidal preparations

A

act as toxic effect on sperm as well as mechanical barrier to sperm. all contain nonoxynol 9 (long acting surfactant). Some need time for dispersion. chemicals may irritate genitalia. frequent use associated with genital lesions linked to increase risk for HIV

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13
Q

periodic abscence

A

also called natural family planning or rhythm, requires that coitus be avoided during time of cycle when fertilizable ovum and motile sperm could meet. Fertile time is from time of ovulation to 2-3 days afterwards

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14
Q

calendar method

A

predicts day of ovulation using a formula based on menstrual pattern. fertile interval will be 2 days before ovulation and at least 2 days afterwards. least reliable form of period absence. have to have regular period

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15
Q

temperature method

A

done by recording basal bod temp vaginally or rectally upon awakening before any physical activity. slight drop in temp occurs 24-36 hours after ovulation, then rises abruptly 0.3-0.4 degrees Celsius (0.5-0.7 F) and remains there for remainder of cycle. 3rd day after temp rises is end of fertile period.

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16
Q

combined temperature and calendar method

A

uses both methods for more effectiveness

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17
Q

cervical mucus (billings) method

A

uses changes in cervical mucous secretions as affected by menstrual cycle hormonal alterations to predict ovulation. mucous is thin and watery days before and just after ovulation. other times mucous is thick and opaque. cannot evaluate mucous properly with vaginal infection

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18
Q

symptothermal method

A

most effective of all periodic abstinence. combines cervical mucous and temperature methods. adjuncts are bloating and vulvar swelling. (most accurate way is to test serum LH but this is impractical)

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19
Q

oral contraception , most common combined

A

pills containing estrogen and progestin taken every day for 21 days followed by 7 days of a placebo (pt will have withdrawal bleeding). recommend to still use another form of contraception in first week.

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20
Q

extended use regimen of oral contraception

A

84 days of active pills followed by 7 days free used to cause extended periods of amenorrhea. ethinylestradiol and drospirenone can be used for 126 days; ethinylestradiol/levonorgesterol can be used for 365 days

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21
Q

benefits of oral contraceptive

A

reduction of risk of ovarian and endometrial cancer, ectopic preg, PID, menstrual disorders, benign breast disease, acne and protection against bone mineral loss, development of colorectal dz, and progression of rheumatoid arthritis

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22
Q

disadvantages of oral contraceptive

A

increased risk for PE, VTE, MI, (smoking, htn, and high cholesterol increases risk), stroke

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23
Q

Contraindications for oral contraceptive

A

pregnancy, undiagnosed vaginal bleeding, prior hx of vte, mi, stroke, lupus, uncontrolled diabetes, htn, and smoking, active liver disease, breast cancer

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24
Q

Progestin (minipill) exs and what they do

A

norethindrone and levonorgestrel, provides good protection against pregnancy without suppressing ovulation

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25
Q

advantages of progestin pill

A

don’t have to worry about side effects associated with estrogen. Ideal for women for whom estrogen is contraindicated

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26
Q

how does progestin pill work

A

cervical mucous becomes less permeable to sperm and endometrial activity goes out of phase so that nidation is thwarted even if fertilization occurs.

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27
Q

disadvantages of progestin pill

A

must be taken every day promptly, even delay of 2-3 hours diminishes effectiveness for the next 48 hours. may cause irregular bleeding

28
Q

emergency contraception, why is it used

A

used to prevent unwanted pregnancy after unprotected intercourse or after failure to use contraceptive method appropriately.

29
Q

methods of emergency contraception

A

combination oral contraceptives containing the progestin levonorgestrel (yupze method), levonorgestrel tablets given alone, or copper T IUD

30
Q

how does levonorgestrel/progestin emergency contraception work

A

prevent pregnancy by delaying or inhibiting ovulation or by distributing the function of the corpus luteum. usual combo is 100 ethinyl estradiol and 500-600 levonorgestrel in several tablets administered twice 12 hours apart. must start within 72 hours of intercourse

31
Q

side effects of hormonal emergency contraception

A

nausea and vomiting, give anitemetic (meclizine) 1 hour before

32
Q

how does IUD emergency contraception work

A

IUD may inhibit implantation or possibly interfere with sperm function. T 380A must be inserted within 7 days

33
Q

Depot medroxyprogesterone acetate (DMPA), what is it, how is it given

A

long acting hormonal contraception, progesterone, given 150mg IM in gluteus maximus or deltoid every 3 months

34
Q

DMPA mechanism of action

A

suppression of ovulation by suppressing the surge of gonadotropins, thickening cervical mucous to impede ascent of sperm, and thinning of the endometrium such that implantation of a blastocyte is less likely

35
Q

benefits of using DMPA

A

lower risk of ectopic pregnancy, endometrial CA, sickle cell crisis

36
Q

risks associated with DMPA

A

reduction in bone mineral density, but improvement after discontinuation, irregular bleeding and abnormally long menstrual flow.

37
Q

contraceptive implant

A

not available in US,4 cm implant placed in arm. releases etonogestrel. works like DMPA

38
Q

vaginal ring

A

flexible ring that releases ethinyl estradiol and etonogesterol at fairly constant. worn for 3 weeks per month by can last for 14 more days. remains effective 3 hours after removal

39
Q

transdermal patch

A

delivers norelgestromin, and ethinyl estradiol for a 7 day period. patch free period for 7 days a month. application sites: buttock, lower abdomen, upper outer arm, and upper torso

40
Q

side effects of transdermal patch

A

headache, nausea, site reaction, breast symptoms, and dysmenorrhea, breakthrough bleeding and spotting

41
Q

T 380A (paraguar)

A

T shaped device that contains copper. two monofilament strings are attached to the vertical arm to ascertain placement in uterus. lasts for 10 years

42
Q

IUD mechanism of action

A

spermicidal activity, interference with normal development of ova or fertilization of ova, impede sperm migration, and promote sperm phagocytosis

43
Q

levonorgestrel releasing intrauterine device (LNG) IUD

A

T shaped frame with reservoir on the vertical arm that releases progestin (levonorgestrel) daily. lasts 5 years

44
Q

LNG IUD mechanism of action

A

thickening of cervical mucus to impede sperm, altering uterotubal fluid to interfere with sperm migration. sometimes causes anovulation, changes characteristic of endometrium

45
Q

LNG advantages

A

heavy and irregular bleeding for 3 to 4 months then significant decrease in menstrual flow and may become amenorrheic. used to treat menorrhagia

46
Q

contraception over 40

A

sterilization, IUD, and hormone intrauterine systems

47
Q

induced abortion

A

deliberate termination of pregnancy in a manner that ensures the embryo or fetus will not survive

48
Q

suction curettage- what is it

A

safest and most effective method for pregnancy termination of 12 weeks or less. most common in US

49
Q

suction curettage- how is it done?

A

cervix dilated with instruments or by hydrophilic laminaria tent, followed by insertion of suction cannula into uterine cavity. performed using paracervical block and local anesthesia. aspiration followed by curettage

50
Q

surgical curettage

A

same as suction curettage but more invasive. higher risk of bleeding, longer duration

51
Q

medical abortion meds

A

mifepristone (antiprogestin) plus misoprostol (should be done by 7 weeks), misoprostol alone, and methotrexate plus misoprostol. used in pregnancies in 1st trimester (<49 days).

52
Q

medical abortion complications

A

cramping, bleeding from incomplete abortion, and failure to evacuate the uterus necessitating completion by suction curettage

53
Q

process when giving methotrexate and misoprostol

A

give 50mg methotrexate orally, then 800 mg of misoprostol vaginally 3-7 days later. see patient 24 hours later for vaginal US (make sure there is no gestational sac), if not complete, repeat misoprostol, then follow up in 4 weeks. suction curettage needed if still not complete. follow up more frequent if cardiac activity noted.

54
Q

contraindication for medical abortion

A

active liver disease, active renal disease, severe anemia, acute IBS, anticoagulant therapy

55
Q

induction of labor by intra-amniotic instillation procedure

A

used after 1st trimester, used for initiating mid trimester abortion. consists of amniocentisis, aspiration of as much fluid as possible, and instillation of hypertonic or hyperosmolar (oxytocin or prostglandin) into amniotic sac. Ripen cervix with Laminaria tent. MUST be septic. monitor for bleeding and passage of fetus and placenta

56
Q

complications of intra-amniotic instillation

A

retained placenta (may be removed with forceps and curettes under local anesthesia), hemorrhage, infection (give high risk pts prophylactic antibiotics), cervical laceration, hypernatremia

57
Q

induction of labor with vaginal prostaglandins

A

vaginal suppositories containing 20 mg of prostaglandin used every 3 to 4 hours until abortion occurs. the presence or absence of labor determines whether prostaglandin should be stopped. Misoprostol (synthetic prostaglandin) also used

58
Q

disadvantage of induction of labor with vaginal prostaglandin

A

higher incidence of GI side effects, live abortion, and fever

59
Q

Dilatation and evacuation

A

modification of suction curettage. serial use of laminaria tents, larger suction cannulas, and special forceps used to extract tissue. paracervical block anesthesia and IV sedation used on pregnancies up to 18 weeks. outpatient and doesn’t require labor

60
Q

complications of dilation and evacuation

A

hemorrhage, perforation, infection, retained tissue

61
Q

hysterotomy and hysterectomy for induced abortion

A

used in special circumstances like cervical stenosis or other complications. unacceptably high rates of morbidity and mortality

62
Q

Menstrual regulation

A

aspiration of endometrium within 14 days after a missed menstrual cycle or within 42 days after the beginning of the last menstrual period. low suction done with small cannula. used back in the day before urine pregnancy tests were created

63
Q

RU 486

A

or mifepristone, is a synthetic drug. antiprogestational agent. given orally in conjunction with a prostaglandin (misoprostol) for first trimester abortion

64
Q

Complications of RU 486

A

failure to terminate pregnancy, incomplete abortion, significant uterine cramping

65
Q

Follow up after induced abortion

A

give human rho D immune globulin (rhogam) if patient is Rh negative unless male partner is known to be Rh negative. fevers and unusual bleeding should be reported by patient. no intercourse or tampon use for 2 weeks. discuss depression with pt. do pelvic exam and give contraception

66
Q

long term sequelae of abortion

A

2 or more induced abortion leads to higher risk of future midtrimester pregnancy loss. women who’ve had sharp curettage in 1st trimester have higher risk of baby with low birth rate.

AHN 548 Unit 3 (8 decks)

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