Contraception & Family Planning CH 58

Question 1

Coitus Interruptus

Answer 1

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

Question 2

Postcoital douche

Answer 2

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

Question 3

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

Answer 3

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

Question 4

Male condom (latex) use and conjunction methods

Answer 4

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

Question 5

lamb skin condom disadvantage

Answer 5

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

Question 6

female condom

Answer 6

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

Question 7

vaginal diaphragm

Answer 7

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

Question 8

how long to use vaginal diaphragm

Answer 8

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

Question 9

vaginal diaphragm disadvantages

Answer 9

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

Question 10

cervical cap

Answer 10

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

Question 11

cervical cap disadvantages

Answer 11

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

Question 12

spermicidal preparations

Answer 12

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

Question 13

periodic abscence

Answer 13

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

Question 14

calendar method

Answer 14

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

Question 15

temperature method

Answer 15

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.

Question 16

combined temperature and calendar method

Answer 16

uses both methods for more effectiveness

Question 17

cervical mucus (billings) method

Answer 17

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

Question 18

symptothermal method

Answer 18

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)

Question 19

oral contraception , most common combined

Answer 19

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.

Question 20

extended use regimen of oral contraception

Answer 20

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

Question 21

benefits of oral contraceptive

Answer 21

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

Question 22

disadvantages of oral contraceptive

Answer 22

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

Question 23

Contraindications for oral contraceptive

Answer 23

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

Question 24

Progestin (minipill) exs and what they do

Answer 24

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

Question 25

advantages of progestin pill

Answer 25

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

Question 26

how does progestin pill work

Answer 26

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

Question 27

disadvantages of progestin pill

Answer 27

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

Question 28

emergency contraception, why is it used

Answer 28

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

Question 29

methods of emergency contraception

Answer 29

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

Question 30

how does levonorgestrel/progestin emergency contraception work

Answer 30

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

Question 31

side effects of hormonal emergency contraception

Answer 31

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

Question 32

how does IUD emergency contraception work

Answer 32

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

Question 33

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

Answer 33

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

Question 34

DMPA mechanism of action

Answer 34

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

Question 35

benefits of using DMPA

Answer 35

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

Question 36

risks associated with DMPA

Answer 36

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

Question 37

contraceptive implant

Answer 37

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

Question 38

vaginal ring

Answer 38

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

Question 39

transdermal patch

Answer 39

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

Question 40

side effects of transdermal patch

Answer 40

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

Question 41

T 380A (paraguar)

Answer 41

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

Question 42

IUD mechanism of action

Answer 42

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

Question 43

levonorgestrel releasing intrauterine device (LNG) IUD

Answer 43

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

Question 44

LNG IUD mechanism of action

Answer 44

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

Question 45

LNG advantages

Answer 45

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

Question 46

contraception over 40

Answer 46

sterilization, IUD, and hormone intrauterine systems

Question 47

induced abortion

Answer 47

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

Question 48

suction curettage- what is it

Answer 48

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

Question 49

suction curettage- how is it done?

Answer 49

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

Question 50

surgical curettage

Answer 50

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

Question 51

medical abortion meds

Answer 51

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

Question 52

medical abortion complications

Answer 52

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

Question 53

process when giving methotrexate and misoprostol

Answer 53

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.

Question 54

contraindication for medical abortion

Answer 54

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

Question 55

induction of labor by intra-amniotic instillation procedure

Answer 55

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

Question 56

complications of intra-amniotic instillation

Answer 56

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

Question 57

induction of labor with vaginal prostaglandins

Answer 57

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

Question 58

disadvantage of induction of labor with vaginal prostaglandin

Answer 58

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

Question 59

Dilatation and evacuation

Answer 59

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

Question 60

complications of dilation and evacuation

Answer 60

hemorrhage, perforation, infection, retained tissue

Question 61

hysterotomy and hysterectomy for induced abortion

Answer 61

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

Question 62

Menstrual regulation

Answer 62

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

Question 63

RU 486

Answer 63

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

Question 64

Complications of RU 486

Answer 64

failure to terminate pregnancy, incomplete abortion, significant uterine cramping

Question 65

Follow up after induced abortion

Answer 65

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

Question 66

long term sequelae of abortion

Answer 66

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.