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Obs & Gynae (Gynae) > Contraception & Termination of Pregnancy > Flashcards

Contraception & Termination of Pregnancy Flashcards

1
Q

Which is the only contraceptive to also offer protection from STIs?

A

Condoms

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2
Q

What is the Pearl index?

A

The number of unintended pregnancies per 100 women using a particular method of contraception per year

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3
Q

What are the three types of contraceptive which have the same failure rate for perfect use and typical use?

A

Contraceptive implant, IUD, IUS

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4
Q

What must always be assessed before prescribing any method of contraception?

A

Could the woman be pregnant

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5
Q

In post-menopausal women aged < 50 years, when can contraceptive use be stopped?

A

After two years of amenorrhoea

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6
Q

In post-menopausal women aged > 50 years, when can contraceptive use be stopped?

A

After one year of amenorrhoea

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7
Q

What guidelines should be followed when considering prescribing contraceptives to girls aged under 16 years?

A

Fraser guidelines

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8
Q

Under what age is it illegal to have sex, and clinicians must report if they are aware of?

A

13 years

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9
Q

Describe which women do not require contraceptives in the first 6 months post-partum?

A

Those who are exclusively breastfeeding and are amenorrhoeic

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10
Q

Which contraceptive method can be started at any time in the post-partum period?

A

Progesterone only pill

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11
Q

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?

A

If it is started after day 21 barrier contraceptives should be used for the next two days

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12
Q

If a woman is not breastfeeding, when can combined hormonal methods of contraception be given to women in the post-partum period?

A

At 3 weeks

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13
Q

If a woman is breastfeeding, it is not recommended to start combined hormonal methods of contraception until when?

A

6 months

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14
Q

Depot injections and implants can be started when in women who are breastfeeding?

A

6 weeks

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15
Q

When can Depot injections be started in post-partum women who are bottle feeding?

A

5 days

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16
Q

When can an implant be inserted in post-partum women who are bottle feeding?

A

21-28 days

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17
Q

When can intra-uterine contraceptives be inserted in post-partum women?

A

In the first 48 hours, or after 4 weeks

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18
Q

Emergency contraception is not required before what day post-partum?

A

21 days

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19
Q

Who is the calendar method of natural family planning not suitable for?

A

Women with irregular periods

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20
Q

What other type of contraception should always be used alongside diaphragms and caps?

A

Spermicide

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21
Q

How long must diaphragms and caps be left in for after sex?

A

6 hours

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22
Q

How long are spermicides effective for?

A

6-8 hours

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23
Q

Which hormones do combined oral contraceptives contain?

A

Oestrogen and progesterone

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24
Q

How do combined hormonal methods of contraception work?

A

Inhibiting ovulation

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25
Q

What are some options for combined hormonal methods of contraception?

A

Pills, patches and rings

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26
Q

What is the mechanism of action of Dianette (cyproterone acetate) and when should it be used?

A

Anti-androgen, used for women with acne and/or hirsutism

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27
Q

Why should Dianette not be used solely for contraceptive purposes?

A

It has a higher risk of VTE than other COCPs

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28
Q

After resolution of acne/hirsutism, how long should Dianette be continued for?

A

3-4 months

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29
Q

What effect do combined hormonal methods of contraception have on the menstrual cycle and periods?

A

Regular menstrual cycle, less pain, less heavy bleeding and less PMS

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30
Q

Combined hormonal methods of contraception reduce the risk of which malignancies?

A

Endometrial, ovarian and colorectal

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31
Q

Short-term side effects of combined hormonal methods of contraception usually resolve within what timeframe?

A

2-3 cycles

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32
Q

Describe the effect of combined hormonal methods of contraception on the risk of breast cancer?

A

Small increased risk, which becomes negligible 10 years after stopping the contraceptive

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33
Q

There are small increases in the risk of which malignancies with use of combined hormonal methods of contraception?

A

Cervical and breast

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34
Q

What is the absolute contraindication to the use of combined hormonal methods of contraception in smokers?

A

If aged > 35 and smoker of > 15 per day

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35
Q

A BMI greater than what is an absolute contraindication to use of combined hormonal methods of contraception?

A

39

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36
Q

What is an absolute contraindication to use of combined hormonal methods of contraception due to an increased risk of ischaemic stroke?

A

Migraine with aura

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37
Q

What are the absolute contraindications to use of combined hormonal methods of contraception regarding VTE risk?

A

Personal history of VTE or known thrombophilia

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38
Q

The presence of which malignancy is an absolute contraindication to the use of combined hormonal and progesterone-only methods of contraception?

A

Breast cancer

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39
Q

When should combined hormonal and progesterone-only contraceptives ideally be started?

A

In the first 5 days of regular menstruation

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40
Q

If a combined hormonal or progesterone-only contraceptive is started in the first 5 days of regular menstruation, is any additional contraceptive required?

A

No

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41
Q

If a combined hormonal contraceptive is started outwith the first 5 days of regular menstruation, what additional contraceptive cover is required?

A

Condoms for the next 7 days

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42
Q

What should be done if one combined oral contraceptive pill has been missed? Is any additional contraception required?

A

Take the missed pill as soon as possible, no additional contraception is required

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43
Q

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)

A

Take the last missed pill as soon as possible, use condoms for the next 7 days

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44
Q

How do progesterone-only methods of contraception work?

A

Inhibiting ovulation

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45
Q

Progesterone only methods of contraception can be used if a woman has been free of breast cancer for more than how long?

A

5 years

46
Q

If the progesterone only pill is started outwith the first 5 days of regular menstruation, what additional contraceptive cover is required?

A

Condoms for 2 days

47
Q

If the contraceptive implant or injection is started outwith the first 5 days of regular menstruation, what additional contraceptive cover is required?

A

Condoms for 7 days

48
Q

What effect does the progesterone only pill have on periods?

A

Irregular bleeding at first, then either regular or no periods

49
Q

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?

A

Take the missed pill as soon as possible and use condoms for the next 2 days

50
Q

What should be done if one progesterone pill is taken late, but still within 3 hours of the normal time?

A

Continue as normal

51
Q

How often is the contraceptive injection given?

A

Every 12 weeks

52
Q

What are some options for progesterone only methods of contraception?

A

Pills, implant, injections, IUS

53
Q

With which method of contraception is fertility slow to return after discontinuation (median time 10 months)?

A

Depot injections

54
Q

Long-term use of Depot injections for contraception is associated with what adverse effect?

A

Osteopenia

55
Q

Providing there are no other risk factors for osteoporosis, the contraceptive injection can be used up to what age?

A

50 years

56
Q

How long does the contraceptive implant last for?

A

3 years

57
Q

What hormone(s) is/are involved in the use of an intra-uterine system?

A

Progestogen only

58
Q

How does the levonorgestrel-releasing IUS work as a contraceptive?

A

It inhibits implantation

59
Q

How long can a levonorgestrel-releasing IUS be left in-situ for?

A

Up to 5 years

60
Q

When can an IUS or IUD be inserted in the menstrual cycle? Is any additional contraception required?

A

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

61
Q

What effect does the levonorgestrel releasing IUS have on periods?

A

Irregular bleeding/spotting for the first 6-9 months, reduced blood flow after this

62
Q

How does the copper-IUD work as a contraceptive?

A

Prevents fertilisation

63
Q

How long can a copper-IUD be left in-situ for?

A

5-10 years

64
Q

What must be done prior to insertion of a copper-IUD?

A

STI screen and prophylactic antibiotics for high risk individuals

65
Q

What antibiotic may be given before inserting a copper-IUD?

A

Azithromycin 1mg stat PO

66
Q

What may women experience after having a copper-IUD inserted?

A

Period-like cramps

67
Q

Why should IV atropine and resuscitation equipment be at hand when women are having a copper-IUD inserted?

A

Risk of cervical shock

68
Q

What is the rate of expulsion of a copper-IUD?

A

1 in 1000

69
Q

Copper-IUDs are associated with an increased risk of what up to 21 days following insertion?

A

PID

70
Q

What effect does the copper-IUD have on periods?

A

Causes worsened menorrhagia and dysmenorrhoea

71
Q

What is the biggest risk should a woman become pregnant with a copper-IUD inserted?

A

Ectopic pregnancy

72
Q

What investigation should always be done before female sterilisation?

A

Pregnancy test

73
Q

Which part of the Fallopian tubes are clipped during a female sterilisation procedure?

A

Isthmus

74
Q

What are the failure rates of male and female sterilisation?

A

1 in 200 for female, 1 in 2000 for male

75
Q

What is the biggest risk of male sterilisation?

A

Chronic testicular pain

76
Q

What must be done before having unprotected sex after a vasectomy?

A

Two negative semen samples and at least 24 ejaculations

77
Q

What is the most effective form of emergency contraception?

A

Copper-IUD

78
Q

When can the copper-IUD be inserted for emergency contraception?

A

Up to 120 hours after unprotected sex, or up to 5 days after likely ovulation

79
Q

What must be done before a copper-IUD inserted for emergency contraception can be continued long-term?

A

Pregnancy test 3-6 weeks later

80
Q

What is the mechanism of action of ulipristal acetate?

A

Anti-progestogen

81
Q

When can ulipristal acetate be used as emergency contraception?

A

Up to 120 hours after unprotected sex

82
Q

After taking either of the emergency contraceptive pills, a second pill should be taken if vomiting occurs within what timeframe?

A

3 hours

83
Q

What should be done regarding hormonal contraceptives after taking ulipristal acetate for emergency contraception?

A

Withhold for 5 days

84
Q

Caution should be exercised giving ulipristal acetate to women with which chronic condition?

A

Asthma

85
Q

When can levonorgestrel be given as emergency contraception?

A

Within 72 hours of unprotected sex

86
Q

When should the dose of levonorgestrel as an emergency contraceptive be doubled?

A

If the BMI is > 26 or weight is > 70kg

87
Q

What are the rules regarding two or more missed COCPs in the first week of the cycle?

A

Emergency contraception should be considered if the woman has had unprotected sex in the pill-free week or in week 1

88
Q

What are the rules regarding two or more missed COCPs in the second week of the cycle?

A

After seven consecutive days of taking the pill, there is no need for emergency contraception

89
Q

What are the rules regarding two or more missed COCPs in the third week of the cycle?

A

Finish the pills in the current pack, start a new pack the next day (omit the pill-free interval)

90
Q

What is an absolute contraindication to use of the copper IUD?

A

Pelvic inflammatory disease

91
Q

Which contraceptive has a proven association with weight gain?

A

Depot injections

92
Q

What are the rules regarding the COCP and undergoing surgery?

A

Stop 4 weeks before surgery, start 2 weeks after surgery

93
Q

Should a woman ever take more than two COCPs in one day?

A

No

94
Q

In a non-emergency situation, in order to go ahead, a termination of pregnancy must be authorised by how many doctors?

A

Two

95
Q

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?

A

One - within 24 hours

96
Q

What is the most common ground for abortion before 24 weeks gestation?

A

C- the pregnancy risks injury to the woman’s own mental or physical health

97
Q

Which women undergoing a termination of pregnancy require anti-D treatment?

A

All Rh negative women

98
Q

In the UK, medical terminations can be offered for pregnancies up to what gestation?

A

24 weeks

99
Q

What is the most common risk of a medical termination of pregnancy?

A

Failure

100
Q

How is a medical termination of pregnancy performed?

A

Oral mifepristone followed 48 hours later by oral or vaginal misoprostol

101
Q

In Scotland, the second part of a medical termination of pregnancy can be carried out at home if the gestation is less than what?

A

9 weeks

102
Q

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?

A

Every 3 hours- maximum 5 doses in 24 hours

103
Q

What procedure is indicated if medical termination of pregnancy is complicated by uncontrollable bleeding or if the procedure fails?

A

Surgical evacuation

104
Q

Surgical terminations are offered for pregnancies up to what gestation?

A

14 weeks

105
Q

What is given to prepare the cervix before a surgical termination of pregnancy?

A

Prostaglandins e.g. misoprostol

106
Q

What is the procedure of choice for surgical termination of pregnancy up to 12 weeks, and is the only surgical option offered in Scotland?

A

Vacuum aspiration

107
Q

What is the procedure of choice for surgical termination of pregnancy from 12-24 weeks?

A

Dilatation and evacuation

108
Q

What are the four main risks of surgical terminations of pregnancy?

A

Bleeding, infection, failure, uterine perforation

109
Q

What other procedure can be done at the same time as a surgical termination of pregnancy?

A

Insertion of long-acting reversible contraceptive

110
Q

The presence of a positive urinary pregnancy test how long after a termination of pregnancy is suggestive of incomplete abortion or a persistent trophoblast?

A

> 4 weeks

Obs & Gynae (Gynae) (5 decks)

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