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OB/GYN > Contraception & sterilization > Flashcards

Contraception & sterilization Flashcards

1
Q

What % of women use contraception?

A

90

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2
Q

what % of pregnancies are unintended?

A

55

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3
Q 
theoretical & actual failure rates of:
calendar method
ovulation method
symptothermal method
postovulation method
A 
theoretical:
calendar = 9%
ovulation = 3%
symptothermal = 2%
postovulation = 1%

actual failure rate for all these is 25%

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4
Q

theoretical & actual failure rate of:
male condom
female condom

A

theoretical:
male condom = 2%
female condom = 5%

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5
Q

which form of contraception has the lowest theoretical failure rate? highest?

A 
lowest = monthly injection of combo ES and PG (Lunelle) close second = combo ES and PG pill, Mirena IUD, vasectomy
highest  = cervical cap w/spermicide in parous women; spermicide alone is pretty high too.
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6
Q

which form of contraception has lowest actual failure rate? highest?

A 
lowest = Mirena IUD
highest = cervical cap w/spermicide in parous women.  Spermicide alone is pretty high too.
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7
Q

what is fialure rate of coitus interruptus?

A

15-25%

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8
Q

what is lactational amenorrhea?

A

hypothalamic suppression of ovulation during nursing

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9
Q

what % of lactating women will become pregnant while nursing?

A

15-55%

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10
Q

how long should lactational amenorrhea be used as a method of contraception?

A

no longer than 6 mos, and only as long as the woman is experiencing amenorrhea. It only works when breastmilk is the only form of nutrition.

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11
Q

what are best ways to increase effectiveness of condom?

A

leave well at tip to collect ejaculate

use a spermicide-containing condom or use a spermicide along with it

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12
Q

SE’s of condom use?

A

hypersensitivity to latex, lubricant, or spermicide

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13
Q

advantages of condom use?

A

also protects against STD, esp HIV

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14
Q

what is a female condom?

A

polyurethane pouch that penis is inserted into. Two rings, one hangs outside vagina, other is at cervix.

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15
Q

which has higher failure rate, male or female condom?

A

female

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16
Q

how is a diaphragm used?

A

spermicidal jelly placed on rim. It is placed in vagina over cervix before intercourse. Remains in for 6-8h after.

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17
Q

SE’s of diaphragm

A

bladder irritation
UTIs
S. aureus colonization, => TSS
hypersensitivity

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18
Q

disadvantages of diaphragm use:

A

m/b fitted & prescribed by physician :. more expensive.

needs t/b replaced q2y or when pt loses 20% or more of bw, and after pg’y

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19
Q

diff b/w cervical cap and diaphragm

A

cap fits directly over cervix, held in place by suction. It m/also be prescribed by physician and used w/spermicide.

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20
Q

what is most common cause of failure of cervical cap?

A

dislodgement. Esp in parous women.

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21
Q

advantages of cervical cap?

A

inserted 6h prior to intercourse, left in 1-2d

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22
Q

disadvantages of cervical cap?

A

foul discharge dvps after day 1
m/b refitted after a pg’y or large wt change
difficult technique to place and remove it

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23
Q

what are the 2 most widely used spermicides?

how do they work?

A

nonoxynol-9
octoxynol-9
work by disrupting cell mems of spermatozoa + act as mech’l barrier to cervix

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24
Q

what forms can spermicides come in?

A

vaginal creams, gels, films, suppositories, foams, tablets

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25
Q

when do spermicides need to be placed?

A

30 mins before intercourse, s/b used w/other barrier methods

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26
Q

do spermicides protect against STDs?

A

debatable. Some say yes, some say they make you more susceptible. Condoms recommended whenever STD protection is desired.

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27
Q

what are the 2 IUDs available in U.S. now?

A

copper (ParaGuard)

levonorgestrel (Mirena)

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28
Q

what is the most widely used method of reversible contraception is the world?

A

the IUD

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29
Q

what are absolute CI’s for IUD placement?

A 
current pg'y
undx'd abnormal vaginal bleeding
suspected GYN malig
acute cervical, uterine, or salpingeal infection
hx of PID
copper allergy (Wilson's dis)
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30
Q

what are relative CI’s to IUD?

A

nulliparity or desire for future childbearing
prior ectopic pg’y
hx of STDs, esp in past 3 mos
multiple sexual partners
moderate or severe dysmenorrhea
uterine anomaly/fibroid distorting uterine cavity

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31
Q

how does IUD work?

A

elicits a sterile inflam response => sperm are engulfed by inflam cells.

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32
Q

what does the addition of copper do for an IUD? Levonorgestrel?

A

copper hampers sperm motility
Levonorgestrel is a form of PG. Thickens cervical mucus, atrophies endometrium, prevents implantation, reduces tubal motility.

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33
Q

what are rare but serious SE’s of IUDs?

A 
pain & bleeding
pg'y
expulsion
perforation
infection
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34
Q

IUD => increased risk of what?

A

insertion-related PID

SAB when becoming pg w/IUD in place

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35
Q

what to do if a pt becomes pg w/an IUD in place?

A

remove the IUD

36
Q

how long is IUD good for?

A

Paraguard approved for 10 years

Mirena approved for 5 years

37
Q

how soon after a SAB can a new IUD be inserted? How soon after an elective abortion? after delivery?

A

immediately after SAB or induced ab

1 week after delivery

38
Q

how do IUDs influence rate of ectopic pregnancies?

A

decrease the overall risk, but in those who do become pregnant w/an IUD in place, a higher % will be ectopic

39
Q

what % of women will experience amenorrhea with Mirena in place and for how long?

A

20% of women will be amenorrheic for 1 year. 60% will be amenorrheic for 5 years.

40
Q

IUDs are less well-tol’d by who?

A

nulliparous women

41
Q

IUDs are ideal for who?

A

monogamous multiparous woman for whom the pill is CI’d

42
Q

why is failure rate of IUD higher during 1st year?

A

b/c of unrecognized expulsion

43
Q

what is a monophasic OCP?

A

pill containing a fixed-dose of ES and progestin in each tablet.
Taken daily for first 21 days of a 28-d cycle. On last week, placebo or no pill is taken so that withdrawal bleeding occurs.

44
Q

what is Seasonale?

A

a monophasic pill taken for 84d straight. Only get 4 periods per year. Used for pts w/menstrual-related disorders to allow longer hrm’l suppression and fewer withdrawal bleeds.

45
Q

how do OCPs work?

A

provide - fdbk to ant pit => suppression of FSH and LH surge => no ovulation. Also thicken cervical mucus and decrease endometrial thickness.

46
Q

what is a multiphasic OCP?

A

vary the dose of ES and/or progestin

47
Q

what are common reasons for d/c’ing use of pill?

A

nausea, breakthrough bleeds, necessity of taking pill daily

48
Q

what are some meds that reduce the efficacy of OCPs?

A 
St. Johns wort
nevirapine
griseofulvin
rifampin
carbamazepine
phenytoin
barbiturates
49
Q

what are some meds whose efficacies are changed by OCPs?

A 
phenothiazides (chlorpromazine, anti-psych)
diazepam
theophylline (asthma)
methyldopa
hypoglycemics
chlordiazepoxide
TCAs
50
Q

OCPs w/ES in what dose have higher rates of MI, stroke, VTE, PE?

A

50 micrograms

51
Q

even at lower doses of ES, what kind of women are still at high risk of VTE dis?

A

women over age 35 who smoke

52
Q

what is the effect of OCP use on breast cancer risk?

A

unsure. It has been studied a lot, no conclusive findings.

53
Q

what are the complications ass’d w/OCP use?

A 
DVT
PE
CVA
MI
HTN
cholelithiasis
cholecystitis
benign liver adenomas (rare)
cervical cancer (rare)
retinal thrombosis (rare)
54
Q

absolute CI’s of OCP use?

A 
thromboembolism
PE
CAD
CVA
smoker over age 35
breast or endometrial ca.
unexplained vaginal bleeding
abnl liver fct
known or suspected pg'y
severe hypercholesterolemia or hyperTG
55
Q

relative CI’s of OCP use?

A 
uterine fibroids
lactation
DM
sickle cell dis or sickle C dis
hepatic dis
HTN
SLE
age 40+ and high risk for CVD
migraine HAs
seizure disorders
elective surgery
56
Q

what are the health benefits of OCPs

A 
decreased risk of ovarian ca
decreased risk of endometrial ca.
decreased risk of ectopic pg'y (b/c of decreased pg rates)
decreased PID rates
decreased benign breast dis
57
Q

how do transdermal contraceptives work? How are they used?

A

suppress ovulation just like OCPs.

Apply to skin for 3 weeks straight, take it off and leave it off for 1 week => withdrawal bleed.

58
Q

what is theoretical and actual failure rate of OCPs?

A

theoretical 0.1%

actual 3%

59
Q

how does the nuva ring work? How is it used?

A

same as OCPs, suppresses ovulation. Inserted in woman’s vagina, one size fits all. Kept in 3 weeks, removed during 4th week for withdrawal bleed. Keep it in for intercourse, or put it back within 3 hrs if its taken out.

60
Q

how do progesterone-only forms work?

A

thicken cervical mucus, thinning endometrial lining, suppress ovulation 50% of time.

61
Q

how are POP (PG-only pills) different from traditional pill?

A

only contain a small daily dose of progestin. Are taken every day of cycle, no hrm-free days.

62
Q

which is more effective, progestin-only or combo pills?

A

combo. POPs have a failure rate of 8%. Combo OCPs have a failure rate of 3%.

63
Q

who are POPs ideal for?

A

nursing mothers
women over age 35 who smoke
women w/HTN, CAD, CVD, SLE, migraines, hx of VTE dis.

64
Q

disadvantages of POPs?

A

irregular menses
irreg ov’y cycles
increased rates of ectopic pg’y
m/b taken at same time each day. Delay of +3h = “missed pill”

65
Q

what is Depo-Provera

A

injectable medroxy-progesterone acetate (DMPA). Injected q3mos

66
Q

SE’s of Depo-Provera

A 
irregular bleeding (70% experience this during 1st year)
depression
 wt gain
hair loss
breast tenderness
67
Q

Women using DMPA for 2+ years may experience what? What to do about it?

A

a reversible decrease in bone mineralization (similar to lactating moms.) Encourage Ca2+, vit D, exercise, smoking cessation.

68
Q

how long does it take for fertility to return after cessation of Depo-Provera?

A

6-18 mos (average is 10)

69
Q

how does emergency contraception used?

A

high-dose ES and PG, or progestins alone taken within 72h after intercourse to suppress ovulation, fertilization, or implantation

70
Q

what is Plan B?

A

Progestin-only ECP taken w/in 72h of unprotected sex

71
Q

what is 1st-line choice of ECP?

A

Plan B

72
Q

SE’s of ECP?

A 
nausea 
vomiting
(anti-emetic given)
HA
dizziness
breast tenderness
73
Q

what is the most effective form of ECP?

A

emergency IUD insertion

74
Q

emergency IUD insertion is not acceptable for who?

A

women w/multiple sexual partners

rape victims

75
Q

what are diff methods of tubal ligation? Which one is most effective?

A

occlusion w/Falope ring
clipping w/Hulka clips
ligation w/electrocaugery & sutures
Pomeroy method (usually immediately post-partum w/epidural still in place)

most effective = Falope ring

76
Q

what is Essure?

A

polyester fibers & a spring coil is inserted into uterus into tubes. Over 12 weeks, tissue grows inward => tissue barrier.
Need to use a back-up method for 3 mos. HSG is done 3 mos later to confirm complete occlusion.

77
Q

Essure is a good option for who?

A

obese women
women w/prior ab’l surgeries
those w/risk of anesthesia complications

78
Q

highest success rates for tubal ligation occur in who?

A

post-partum sterilization

79
Q

SE’s of tubal ligation?

A 
pain
menstrual disturbances (post-tubal ligation syndrome - but most cases are 2/2 d/c of hrm'l contraceptives)
80
Q

who tends to seek reversal of tubal ligation?

A

highest regret is women under age 30

1% of women seek reversal procedures

81
Q

how long of a period of back-up contraception is needed after vasectomy and why?

A

6-8 weeks, until azoospermia is confirmed by semen analysis

sperm can remain viable in proximal collecting tubules of testes

82
Q

what are antisperm antibodies?

A

antibodies that form against sperm, occurs in 50% of pts who have vasectomies

83
Q

SEs of vasectomy

A

rare
skin bleeding, infection
rxt to sutures or local anesthesia

84
Q

which is better, tubal ligation or vasectomy?

A

vasectomy. Its safer, less expensive, can be performed as an outpt.

85
Q

what is success rate of vasectomy reversal?

A

60-70%. Pregnancy rates are 18-60%

OB/GYN (29 decks)

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