Contraception & Termination of Pregnancy Flashcards
Which is the only contraceptive to also offer protection from STIs?
Condoms
What is the Pearl index?
The number of unintended pregnancies per 100 women using a particular method of contraception per year
What are the three types of contraceptive which have the same failure rate for perfect use and typical use?
Contraceptive implant, IUD, IUS
What must always be assessed before prescribing any method of contraception?
Could the woman be pregnant
In post-menopausal women aged < 50 years, when can contraceptive use be stopped?
After two years of amenorrhoea
In post-menopausal women aged > 50 years, when can contraceptive use be stopped?
After one year of amenorrhoea
What guidelines should be followed when considering prescribing contraceptives to girls aged under 16 years?
Fraser guidelines
Under what age is it illegal to have sex, and clinicians must report if they are aware of?
13 years
Describe which women do not require contraceptives in the first 6 months post-partum?
Those who are exclusively breastfeeding and are amenorrhoeic
Which contraceptive method can be started at any time in the post-partum period?
Progesterone only pill
When is an additional barrier contraceptive required when giving the progesterone only pill to post-partum women? How long is an additional barrier contraceptive required for?
If it is started after day 21 barrier contraceptives should be used for the next two days
If a woman is not breastfeeding, when can combined hormonal methods of contraception be given to women in the post-partum period?
At 3 weeks
If a woman is breastfeeding, it is not recommended to start combined hormonal methods of contraception until when?
6 months
Depot injections and implants can be started when in women who are breastfeeding?
6 weeks
When can Depot injections be started in post-partum women who are bottle feeding?
5 days
When can an implant be inserted in post-partum women who are bottle feeding?
21-28 days
When can intra-uterine contraceptives be inserted in post-partum women?
In the first 48 hours, or after 4 weeks
Emergency contraception is not required before what day post-partum?
21 days
Who is the calendar method of natural family planning not suitable for?
Women with irregular periods
What other type of contraception should always be used alongside diaphragms and caps?
Spermicide
How long must diaphragms and caps be left in for after sex?
6 hours
How long are spermicides effective for?
6-8 hours
Which hormones do combined oral contraceptives contain?
Oestrogen and progesterone
How do combined hormonal methods of contraception work?
Inhibiting ovulation
What are some options for combined hormonal methods of contraception?
Pills, patches and rings
What is the mechanism of action of Dianette (cyproterone acetate) and when should it be used?
Anti-androgen, used for women with acne and/or hirsutism
Why should Dianette not be used solely for contraceptive purposes?
It has a higher risk of VTE than other COCPs
After resolution of acne/hirsutism, how long should Dianette be continued for?
3-4 months
What effect do combined hormonal methods of contraception have on the menstrual cycle and periods?
Regular menstrual cycle, less pain, less heavy bleeding and less PMS
Combined hormonal methods of contraception reduce the risk of which malignancies?
Endometrial, ovarian and colorectal
Short-term side effects of combined hormonal methods of contraception usually resolve within what timeframe?
2-3 cycles
Describe the effect of combined hormonal methods of contraception on the risk of breast cancer?
Small increased risk, which becomes negligible 10 years after stopping the contraceptive
There are small increases in the risk of which malignancies with use of combined hormonal methods of contraception?
Cervical and breast
What is the absolute contraindication to the use of combined hormonal methods of contraception in smokers?
If aged > 35 and smoker of > 15 per day
A BMI greater than what is an absolute contraindication to use of combined hormonal methods of contraception?
39
What is an absolute contraindication to use of combined hormonal methods of contraception due to an increased risk of ischaemic stroke?
Migraine with aura
What are the absolute contraindications to use of combined hormonal methods of contraception regarding VTE risk?
Personal history of VTE or known thrombophilia
The presence of which malignancy is an absolute contraindication to the use of combined hormonal and progesterone-only methods of contraception?
Breast cancer
When should combined hormonal and progesterone-only contraceptives ideally be started?
In the first 5 days of regular menstruation
If a combined hormonal or progesterone-only contraceptive is started in the first 5 days of regular menstruation, is any additional contraceptive required?
No
If a combined hormonal contraceptive is started outwith the first 5 days of regular menstruation, what additional contraceptive cover is required?
Condoms for the next 7 days
What should be done if one combined oral contraceptive pill has been missed? Is any additional contraception required?
Take the missed pill as soon as possible, no additional contraception is required
What should be done if two or more combined oral contraceptive pills have been missed? Is any additional contraception required? (regardless of where in the cycle the woman is)
Take the last missed pill as soon as possible, use condoms for the next 7 days
How do progesterone-only methods of contraception work?
Inhibiting ovulation
Progesterone only methods of contraception can be used if a woman has been free of breast cancer for more than how long?
5 years
If the progesterone only pill is started outwith the first 5 days of regular menstruation, what additional contraceptive cover is required?
Condoms for 2 days
If the contraceptive implant or injection is started outwith the first 5 days of regular menstruation, what additional contraceptive cover is required?
Condoms for 7 days
What effect does the progesterone only pill have on periods?
Irregular bleeding at first, then either regular or no periods
What should be done if one progesterone only pill is missed (i.e. more than 3 hours later than normal)? Is any additional contraceptive cover required?
Take the missed pill as soon as possible and use condoms for the next 2 days
What should be done if one progesterone pill is taken late, but still within 3 hours of the normal time?
Continue as normal
How often is the contraceptive injection given?
Every 12 weeks
What are some options for progesterone only methods of contraception?
Pills, implant, injections, IUS
With which method of contraception is fertility slow to return after discontinuation (median time 10 months)?
Depot injections
Long-term use of Depot injections for contraception is associated with what adverse effect?
Osteopenia
Providing there are no other risk factors for osteoporosis, the contraceptive injection can be used up to what age?
50 years
How long does the contraceptive implant last for?
3 years
What hormone(s) is/are involved in the use of an intra-uterine system?
Progestogen only
How does the levonorgestrel-releasing IUS work as a contraceptive?
It inhibits implantation
How long can a levonorgestrel-releasing IUS be left in-situ for?
Up to 5 years
When can an IUS or IUD be inserted in the menstrual cycle? Is any additional contraception required?
Any time, provided there is no current risk of pregnancy, condoms are required for an additional 7 days for IUS; no additional contraception is required for IUD
What effect does the levonorgestrel releasing IUS have on periods?
Irregular bleeding/spotting for the first 6-9 months, reduced blood flow after this
How does the copper-IUD work as a contraceptive?
Prevents fertilisation
How long can a copper-IUD be left in-situ for?
5-10 years
What must be done prior to insertion of a copper-IUD?
STI screen and prophylactic antibiotics for high risk individuals
What antibiotic may be given before inserting a copper-IUD?
Azithromycin 1mg stat PO
What may women experience after having a copper-IUD inserted?
Period-like cramps
Why should IV atropine and resuscitation equipment be at hand when women are having a copper-IUD inserted?
Risk of cervical shock
What is the rate of expulsion of a copper-IUD?
1 in 1000
Copper-IUDs are associated with an increased risk of what up to 21 days following insertion?
PID
What effect does the copper-IUD have on periods?
Causes worsened menorrhagia and dysmenorrhoea
What is the biggest risk should a woman become pregnant with a copper-IUD inserted?
Ectopic pregnancy
What investigation should always be done before female sterilisation?
Pregnancy test
Which part of the Fallopian tubes are clipped during a female sterilisation procedure?
Isthmus
What are the failure rates of male and female sterilisation?
1 in 200 for female, 1 in 2000 for male
What is the biggest risk of male sterilisation?
Chronic testicular pain
What must be done before having unprotected sex after a vasectomy?
Two negative semen samples and at least 24 ejaculations
What is the most effective form of emergency contraception?
Copper-IUD
When can the copper-IUD be inserted for emergency contraception?
Up to 120 hours after unprotected sex, or up to 5 days after likely ovulation
What must be done before a copper-IUD inserted for emergency contraception can be continued long-term?
Pregnancy test 3-6 weeks later
What is the mechanism of action of ulipristal acetate?
Anti-progestogen
When can ulipristal acetate be used as emergency contraception?
Up to 120 hours after unprotected sex
After taking either of the emergency contraceptive pills, a second pill should be taken if vomiting occurs within what timeframe?
3 hours
What should be done regarding hormonal contraceptives after taking ulipristal acetate for emergency contraception?
Withhold for 5 days
Caution should be exercised giving ulipristal acetate to women with which chronic condition?
Asthma
When can levonorgestrel be given as emergency contraception?
Within 72 hours of unprotected sex
When should the dose of levonorgestrel as an emergency contraceptive be doubled?
If the BMI is > 26 or weight is > 70kg
What are the rules regarding two or more missed COCPs in the first week of the cycle?
Emergency contraception should be considered if the woman has had unprotected sex in the pill-free week or in week 1
What are the rules regarding two or more missed COCPs in the second week of the cycle?
After seven consecutive days of taking the pill, there is no need for emergency contraception
What are the rules regarding two or more missed COCPs in the third week of the cycle?
Finish the pills in the current pack, start a new pack the next day (omit the pill-free interval)
What is an absolute contraindication to use of the copper IUD?
Pelvic inflammatory disease
Which contraceptive has a proven association with weight gain?
Depot injections
What are the rules regarding the COCP and undergoing surgery?
Stop 4 weeks before surgery, start 2 weeks after surgery
Should a woman ever take more than two COCPs in one day?
No
In a non-emergency situation, in order to go ahead, a termination of pregnancy must be authorised by how many doctors?
Two
In an emergency situation, in order to go ahead, a termination of pregnancy must be authorised by how many doctors? How soon must the certification of an emergency termination of pregnancy be completed?
One - within 24 hours
What is the most common ground for abortion before 24 weeks gestation?
C- the pregnancy risks injury to the woman’s own mental or physical health
Which women undergoing a termination of pregnancy require anti-D treatment?
All Rh negative women
In the UK, medical terminations can be offered for pregnancies up to what gestation?
24 weeks
What is the most common risk of a medical termination of pregnancy?
Failure
How is a medical termination of pregnancy performed?
Oral mifepristone followed 48 hours later by oral or vaginal misoprostol
In Scotland, the second part of a medical termination of pregnancy can be carried out at home if the gestation is less than what?
9 weeks
In a medical termination of pregnancy, how often are doses of misoprostol given? What is the maximum number of doses that can be given in a 24 hour period?
Every 3 hours- maximum 5 doses in 24 hours
What procedure is indicated if medical termination of pregnancy is complicated by uncontrollable bleeding or if the procedure fails?
Surgical evacuation
Surgical terminations are offered for pregnancies up to what gestation?
14 weeks
What is given to prepare the cervix before a surgical termination of pregnancy?
Prostaglandins e.g. misoprostol
What is the procedure of choice for surgical termination of pregnancy up to 12 weeks, and is the only surgical option offered in Scotland?
Vacuum aspiration
What is the procedure of choice for surgical termination of pregnancy from 12-24 weeks?
Dilatation and evacuation
What are the four main risks of surgical terminations of pregnancy?
Bleeding, infection, failure, uterine perforation
What other procedure can be done at the same time as a surgical termination of pregnancy?
Insertion of long-acting reversible contraceptive
The presence of a positive urinary pregnancy test how long after a termination of pregnancy is suggestive of incomplete abortion or a persistent trophoblast?
> 4 weeks
