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Repro > Contraception LARC > Flashcards

Contraception LARC Flashcards

1
Q

every 2 seconds there are how many births and how many deaths

A

9 births

3 deaths

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2
Q

what happens to the basal body temp during a cycle

A

goes up after ovulation
increase by >0.2
has to be sustained for 3 days after at least 6 days of lower temp

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3
Q

cervical mucous before and after ovulation

A

post thick and sticky

after thinner, watery, stretchy

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4
Q

cervical position when fertile/less fertile

A

fertile - high in vagina soft and open

less fertile - low firm and closed

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5
Q

during a standard 28 cycle which days are the most fertile

A

8-18

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6
Q

criteria for breast feeding

A

exclusive VF
less than 6/12 post natal
amenorrhoeic

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7
Q

UK MEC categories

A
  1. no restriction
  2. advantages outweigh risks
  3. risks generally outweigh advantages
  4. unacceptable risk
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8
Q

pear index is calculated how

A

number of accidental preg x 1200 / total number of months of exposure

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9
Q

list the types of LARC and the difference between the types

A

injectable contraceptive - depo, sayana

depo - IM
sayana - SC version

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10
Q

VLARC

A

IUD
IUS
Implant

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11
Q 
how does LARC work
how often is it given 
how long does it last
what are the other effects
what is the failure rate
A 
inhibits ovulation
every 13 weeks
lasts 14 weeks
makes mucous thick and sticky
makes endometrium thinner and less likely for implantation
0.2%
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12
Q

what examination is done before a LARC is given

A

BP and BMI recorded
smear test check
risk factors for osteoporosis

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13
Q

what is a person at risk of with injections and what other risks are there

A

osteo

underweight, anorexia, steroid use, FH, smoking, low trauma fracture, hypothyroid, coeliac, rheumatoid, IBD, chronic renal disease

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14
Q

when is depo started
how long does it take depo to start
when can depo be given if the first window is missed

A

up to and including day 5 without the need for additional contraception - before ovulation that month

7 days

after 5 days if certain not pregnant and needs to use condoms/abstain for the following 7 days

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15
Q

how can a person be reasonably certain that they are not pregnant

A

not had sex since their last periods
using reliable contraception
<7 days since last normal period
<4 weeks post partum and not breast feeding
breast feeding, amen and <6 months post partum
negative preg test and >3 weeks since UPSI

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16
Q

starting depo post partum
post TOP
if preg cannot be excluded

A

up to day 21 with immediate cover

up to day 5

do preg test in 3 weeks if neg then give depo

17
Q

side effects of depo

A

weight gain due to stimulation in appetite
delayed in returning fertility
irregular bleeding - commonest SE
osteo risk

18
Q

which is more cost effective LARC or VLARC

A

VLARC

19
Q 
IUD shape
hormonal?
contains what
gold standard
how does it work
A 
T shaped
non hormonal 
copper and plastic
380mm2 copper
copper is toxic to sperm and ovum joining
20
Q

IUD primary mode of action
other action
failure rate

A

prevention of fertilisation
inflam response in endometrium making it a toxic environment

0.6-0.8% (1/200)

21
Q

IUS what is it
types
what is the drawback for the second one

A

T shaped device with elastomere core (prog core)

52mg levonorgestrel
20 mcg daily released - decreases to 10 a day in year 5

13.5mg
14ug per day for first 24 days
decreases to 5ug per day at 5 years

not licensed for heavy periods and hormone replacement therapy

22
Q

IUS primary mode of action
other actions
failure rate

A

effect on implantation
can also stop ovulation (in some women)
endometrium made thinner, cervical mucous thicker

0.2% (1/500)

23
Q

what are some contra indications of IUD/IUS

A 
current pelvic infection
abnormal uterine anatomy 
wilsons disease
preg - esp if HCG are high
sensitivity to any of the constituents 
gestational trophoblastic disease where bHCG levels are abnormal/persistently raised
endometrial cancer
cervical cancer awaiting treatment
24
Q

what examination is done prior to insertion of IUS/IUD

A

PV to check uterine size/position

BP/pulse if condition indicates e.g. anxious, ht

25
Q

when can an IUD be fitted

A 
within the first 7 days of a period
any time - if not pregnant 
5 days after UPSI for EC
5 days after predicted ovulation
48 hours or >4 weeks post partum
immediately post TOP
26
Q

when can an IUS be fitted

what is it not used for

A

within the first 7 days of a period
any time if not preg

not used for EC - doesn’t work quick enough - takes 7 days to have an effect

if fitted outwith the 7/7 - use condoms

within 48 hours or >4 weeks post partum
immediately post op TOP up to day 7

27
Q

SE/problems with IUD

A

heavy prolonged menses
pain, infection, PIV - increased risk in first 20 days
perforation
expulsion
higher post 2nd trimester abortion, post natal
ectopic risk 9-50% if become pregnant

28
Q

SE of IUS

A 
lighter, less frequent bleeding, can be erratic
pain, infection PID in first 20 days
perforation
expulsion 
ectopic risk lower
29
Q

what is an implant
how long is it licensed for
what does it contain

A

single non biodegradable subnormal rod
3 years
68mg ENG - released 60/70ug in weeks 5-6 and 25-30 per day at the end of the 3rd year

30
Q

how does an implant work
other mechanisms
failure rate

A

inhibitor of ovulation
effects on endometrium and mucous
0-0.1%

31
Q

when can an implant be fitted

A

within first 5 days of cycle
up to day 5 post first/second trim abortion
on or before day 21 post partum

additional precautions first 7 days if she id not preg, quick start after EC, off license

32
Q

switching from another method to implant
when is immediately effective
when should she take extra precautions

A

immediate affective if fitted within 14 weeks of last active pill or depo
within 2-3 weeks of COC, patch, vaginal ring

additional precautions for 7 days if changing from POP or LNG-IUS
or switching from non hormonal method

33
Q

side effects of implant

A

irregular bleeding
weight gain
acne

nerve damage/vascular injury
deep insertion

Repro (56 decks)

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