Contraception / Preconceptional Counselling

Question 1

The risk of ectopic pregnancy with a ten-year probability following Tubal sterilisation

Answer 1

7.3 ectopic pregnancies per 1000 procedures.

Question 2

LNG-IUS (Mirena) contains

Answer 2

52 mg levonorgestrel

Question 3

If a pregnancy occurs and the IUD is not subsequently removed, the incidence of spontaneous abortion is approximately …. times greater than would occur in pregnancies without an intrauterine device.

Answer 3

If a pregnancy occurs and the IUD is not subsequently removed, the incidence of spontaneous abortion is approximately three times greater than would occur in pregnancies without an intrauterine device.

Question 4

Mechanisms of Action of IUD

Answer 4

induce a local inflammatory reaction of the endometrium, creating an environment that is hostile to sperm so that fertilization of the ovum does not occur. The primary effect of the progestin in the LNG-IUS is to thicken cervical mucus. This impedes sperm penetration and access to the upper genital track.

Question 5

If a pregnancy occurs and the IUD is not subsequently removed, the incidence of spontaneous abortion is approximately —- times greater than would occur in pregnancies without an intrauterine device. Once the IUD is removed, the complication rate becomes similar to that of a pregnancy without an IUD.

Answer 5

If a pregnancy occurs and the IUD is not subsequently removed, the incidence of spontaneous abortion is approximately three times greater than would occur in pregnancies without an intrauterine device. Once the IUD is removed, the complication rate becomes similar to that of a pregnancy without an IUD.

Question 6

Actinomyces organisms are often identified in routine cytology in women with IUDs in place.

Answer 6

If the woman is asymptomatic, she may be followed without therapy at usual intervals. The IUD should not be removed from an asymptomatic colonized woman. In the rare event that a significant pelvic infection is present, the woman should be treated with long-term antibiotics (usually penicillin) and the IUD removed.

Question 7

IUDs shouldn’t be inserted into women with any of the following six conditions:

Answer 7

(1) pregnancy or suspicion of pregnancy, (2) acute PID, (3) postpartum endometritis or infected abortion, (4) known or suspected uterine or cervical malignancy, (5) genital bleeding of unknown origin, and (6) a previously inserted IUD that has not been removed.

Question 8

Female sterilization 5-year cumulative failure probability of 13 per 1000 procedures, with failures sometimes occurring years after the sterilization procedure. Risk factors for failure included age and method of sterilization; the younger the woman, the higher the risk of failure.

Answer 8

Postpartum partial salpingectomy carried the lowest 10-year cumulative risk of failure (7.5 per 1000 procedures), and Hulka clips (which are no longer available) carried the highest risk (36.5 per 1000 procedures)

Question 9

Mechanism of Action of OCP

Answer 9

Changes in the cervical mucus (which prevent sperm transport into the uterus), the fallopian tube (which interfere with gamete transport), and the endometrium (which reduce the likelihood of implantation) represent secondary contraceptive effects of the progestin component. Contraceptive steroids prevent ovulation mainly by interfering with release of gonadotropin-releasing hormone (GnRH) from the hypothalamus.

Question 10

A woman’s baseline risk of venous thromboembolism (VTE) increases by …. times if she ingests estrogen-containing oral contraception.

Answer 10

A woman’s baseline risk of venous thromboembolism (VTE) increases by three times if she ingests estrogen-containing oral contraception.

Question 11

Endometrial cancer and OCP

Answer 11

Compared with nonusers, women who use OCs for at least 1 year have an age-adjusted relative risk of 0.5 for development of endometrial cancer between ages 40 and 55. This protective effect is related to duration of use, increasing from a 20% reduction in risk with 1 year of use to a 40% reduction with 2 years of use to about a 60% reduction with 4 years of use. This protective effect persists for at least 15years after stopping use of OCs.

Question 12

Ovarian Cancer and OCP

Answer 12

T he risk of ovarian cancer decreases by about 20% for every 5 years of use. For woman using OCs for 15 years or more, the risk is almost halved. One year of use may obtain a protective effect. OCs reduce the risk of the four main histologic types of epithelial ovarian cancer: serous, mucinous, endometrioid, and clear-cell, and the risk of both invasive ovarian cancers and tumors of low malignant potential (borderline tumors). The protective effect continues for at least 30 years after the use of OCs ends. OC use also reduces the risk of ovarian cancer in women with BRCA-1 and BRCA-2 mutations and in those with a family history of ovarian cancer to the same extent as in women without these risk factors.

Question 13

OCP and colorectal cancer

Answer 13

A meta-analysis of published studies of the relationship between OCs and colorectal cancer showed that OC ever-use was associated with a 15% to 20% reduction in the risk of colorectal cancer

Question 14

OCP absolute contraindications, including

Answer 14

history of vascular disease (thromboembolism, thrombophlebitis, atherosclerosis, and stroke) and systemic disease that may affect the vascular system (e.g., active lupus erythematosus with vascular involvement or diabetes with retinopathy or nephropathy). Cigarette smoking by OC users older than age 35 and uncontrolled hypertension are also contraindications. As breast or endometrial cancer may involve hormone-sensitive tumors, avoiding OC use is prudent. Other contraindications include undiagnosed uterine bleeding and elevated triglyceride levels. Pregnancy, Women with active liver disease should not take OCs. Women who have recovered from liver disease, such as viral hepatitis.

Question 15

NuvaRing (CONTRACEPTIVE VAGINAL RING) contains:

Answer 15

containing 2.7 mg of ethinyl estradiol and 11.7 mg of etonogestrel.
placed in the vagina for 21 days and then removed for up to 7 days to allow withdrawal bleeding.

Question 16

DIANE-35OCP contains

Answer 16

cyproterone acetate 2 mg (anti-androgen) and ethinylestradiol 35 microgram

Question 17

progestin EC is Plan B One Step (with generic forms Take Action, Next Choice One Dose, and My Way also available), contains

Answer 17

1.5-mg levonorgestrel single dose pill or two 0.75-mg pills given 12 hours apart, both to be given within 72 hours from the time of unprotected sex.

Question 18

LNG and breast cancer

Answer 18

Among women who used the levonorgestrel-releasing intrauterine device (LNG-IUD), the relative risk of breast cancer was 1.21 (95% CI, 1.11–1.33) compared with never-users of hormonal contraception, but the risk did not increase with duration of use.

Question 19

Ways of female sterilization

Answer 19

1) madlener (crushing the tubes only)< highest failure rate
2) kroener fimberiectomy has high failure rate
3) by laparoscopy : electrocautery (uni/bipolar FR: 4:1000), clip (hulka or filshie FR 1:1000), falope ring (Silastic Band)
4) Pomeroy

Question 20

tubal interruption itself lowers later ovarian cancer rates by – percent, and salpingectomy may offer a —to —percent reduction.

Answer 20

tubal interruption itself lowers later ovarian cancer rates by 30 percent, and salpingectomy may offer a 40-to 80-percent reduction.

Question 21

Essure Permanent Birth Control System by hysteroscopy

Answer 21

Chronic pelvic pain after hysteroscopic sterilization may develop in 2 to 6 percent of those with inserts (Chudnoff, 2015; Kamencic, 2016; Yunker, 2015). Pain may stem from tubal perforation, device migration, or the device itself (Adelman, 2011). Importantly, device removal is not curative in all symptomatic patients (Ciatk, 2017; MUISell, 2019).

Question 22

With regards to contraception failure, the pearl index refers to:

Answer 22

Number of pregnancies in 100 woman-year.

Question 23

The American Academy of Neurology recommends consideration of antiseizure medication discontinuation before pregnancy in suitable candidates (Jeha, 2005). These include women who satisfy the following criteria:

Answer 23

(1) have been seizure-free for 2 to 5 years,
(2) display a single seizure type,
(3) have a normal neurological examination and normal intelligence,
(4) show electroencephalogram results that have normalized with treatment.

Question 24

DM and OCP

Answer 24

The Centers for Disease Control and Prevention’s U.S. Medical Eligibility Criteria (USMEC) guidelines posit that concerns of increased complications warrant limiting the use of combined OCs to diabetic women who are otherwise healthy, younger than 35 years, of normal weight, and without any coexisting cardiovascular or microvascular conditions, including hypertension, retinopathy, or nephropathy. These limitations apply regardless of route of administration.

Question 25

Regardless of IUD type, the cumulative 3-year expulsion rate approximates … percent following nonpuerperal insertion (Madden, 2014; Simonatto, 2016).

Answer 25

Regardless of IUD type, the cumulative 3-year expulsion rate approximates 10 percent following nonpuerperal insertion (Madden, 2014; Simonatto, 2016).

Question 26

MR imaging at — or — Tesla with an IUD in place is safe

Answer 26

MR imaging at 1.5 or 3 Tesla with an IUD in place is safe

Question 27

Risk of perforation with IUD

Answer 27

Rates approximate 1 case per 1000 insertions, and risks include puerperal insertion and breastfeeding

Question 28

When progestin implant inserted and how many time takes for contraception effect to take place ?

Answer 28

etonogestrel implant is ideally inserted within 5 days of menses onset. With LNG-releasing implants, contraception is established within 24 hours if inserted within the first 7 days of the menstrual cycle. For transitioning methods, an implant is placed on the day of the first placebo COC pill; on the day that the next DMPA injection would be due; or within 24 hours of the last POP (Merck, 2019). In women certain that they are not pregnant, insertion at other times of the cycle is followed by an additional method that serves as a back-up method for 7 days.

Question 29

Progestin implant method insertion

Answer 29

the supine patient positions her nondominant arm against the bed so that the arm is abducted and the elbow is flexed. With a sterile pen, the insertion site is marked 8 to 10 cm proximal to the humerus’ medial condyle and 3 to 5 cm posterior to the groove between biceps and triceps muscles (Iwanaga, 2019). A second mark is placed 4 cm proximal to the first and serves as a guide for the insertion path along the arm’s long axis. The Nexplanon is inserted using sterile technique. The area is cleansed aseptically, and a 1-percent lidocaine anesthetic track is injected beneath the skin along the planned insertion path. The implant is then placed. After placement, both patient and provider should palpate and identify both ends of the 4-cm implant. To minimize bruising at the site, a pressure bandage is created around the arm and is removed the following day.

Question 30

Certain progestins within COC are also linked with greater VTE rates. such what ?

Answer 30

A slightly higher VTE risk with drospirenone-containing COCs

Question 31

DM and COCs use ?

Answer 31

For diabetic women, COCs may be used in nonsmokers with disease duration <20 years and without associated vascular disease, nephropathy, retinopathy, or neuropathy .

Question 32

Failure rate with perfect-use and typical use ?

Answer 32

COCs are a highly effective form of contraception but their effectiveness depends on being taken properly. The perfect-use failure rate is 0.3%, but the typical-use failure rate is approximately 7%.

Question 33

What is the approximate risk o the uterine perforation complication per intrauterine device insertion?

Answer 33

1 in 1000

Question 34

What is the spontaneous expulsion rate or the intra-
uterine device during the first year after placement?

Answer 34

5 percent

Question 35

Which one has the highest cumulative probability of failure in 5 years?
a. Bipolar sterilization
b. Unipolar sterilization
c. Band or clip placement
d. Puerperal sterilization

Answer 35

Bipolar sterilization