FAMILY PLANNING 1.2 (CompreGyne) Flashcards
What contraceptive methods are classified as Tier 3 (least effective, ≥18 pregnancies per 100 women per year)?
Barrier methods, lactational amenorrhea, periodic abstinence, coitus-related methods.
What is the diaphragm and how does it work?
A thin, dome-shaped latex or silicone membrane with a flexible rim that creates a barrier between the vagina and cervix.
What is the cervical cap and how does it work?
A cup-shaped silicone or rubber device that fits around the cervix, creating a barrier to sperm.
What should be used with the diaphragm and cervical cap for optimal effectiveness?
Spermicide.
How long should the diaphragm or cervical cap be left in place after intercourse?
At least 8 hours after the last coital act.
What is the failure rate of the diaphragm with typical use?
13-17% in the first year, but as low as 4-8% with perfect use.
What additional benefit might the diaphragm and cervical cap provide?
Possible reduction in risk of cervical dysplasia and cancer.
What is the only contraceptive method with FDA-approved labeling for pregnancy and STI prevention?
Male condom (latex and polyurethane).
What are key steps in proper male condom use?
Apply to erect penis before any contact, leave half an inch at the tip, withdraw while erect, grasp base to prevent spillage.
What is the typical-use failure rate of male condoms?
Around 15%.
What is the female condom and how does it work?
A soft, loose-fitting polyurethane sheath with two flexible rings, inserted into the vagina before intercourse.
What is the typical-use failure rate of female condoms?
0.21
What are the key criteria for effective use of lactational amenorrhea method (LAM)?
Continuous amenorrhea, exclusive breastfeeding (no supplements), up to 6 months postpartum, frequent night nursing.
What is the failure rate of LAM when used correctly?
Less than 2% in the first 6 months postpartum.
What are the three key assumptions of the calendar rhythm method?
Ovum is fertilizable for ~24 hours, sperm can fertilize for 3-5 days, ovulation occurs 12-16 days before menses.
What is the symptothermal method of periodic abstinence?
A combination of temperature, cervical mucus, and other physiologic signs to track ovulation.
What is the typical failure rate of periodic abstinence methods?
Around 24%.
What is the active ingredient in spermicides and how does it work?
Nonoxynol-9, a surfactant that immobilizes or kills sperm by destroying the sperm cell membrane.
What is the contraceptive sponge and how long is it effective?
A polyurethane sponge with spermicide, effective for 24 hours.
What is the failure rate of spermicides and the contraceptive sponge?
15-25%.
What is coitus interruptus and what is its major drawback?
Withdrawal before ejaculation; it does not protect against STIs.
What is the failure rate of coitus interruptus?
4% with perfect use, 22% with typical use.
What is emergency contraception (EC) and when can it be used?
Prevents pregnancy after unprotected intercourse; can be used up to 120 hours after sex.
What is the Yuzpe method of emergency contraception?
A high-dose combined oral contraceptive method taken in two doses 12 hours apart.
How effective is the Yuzpe method in preventing pregnancy?
Reduces risk by about 75%.
What is the most common form of emergency contraception today?
Levonorgestrel (Plan B One-Step and generics).
How does levonorgestrel emergency contraception work?
Delays or inhibits ovulation.
What is ulipristal acetate (Ella) and how does it compare to levonorgestrel?
A selective progesterone receptor modulator that delays ovulation for 5 days; 42% more effective than levonorgestrel.
What is the most effective form of emergency contraception?
Copper IUD, with 99% effectiveness if inserted within 5 days.
What is a key benefit of the copper IUD beyond emergency contraception?
It provides long-term contraception.
What are two major concerns regarding emergency contraception effectiveness?
May be less effective in heavier women and when used with long-term hormonal contraception.
What percentage of unintended pregnancies end in elective abortion?
About 40%.
What percentage of abortions occur in the first 12 weeks of pregnancy?
0.9
What is the most common method of abortion before 9 weeks’ gestation?
Medication abortion with mifepristone.
What is the predominant method of performing abortion in the first trimester?
Curettage by vacuum aspiration.
What is the manual technique for early pregnancy aspiration called?
Manual vacuum aspiration (MVA).
Up to what gestational age can MVA be performed?
Up to 10 weeks and sometimes later.
What type of vacuum aspiration is used after 10 weeks of gestation?
Electric vacuum aspiration (EVA).
What is required before performing vacuum aspiration?
Dilation of the cervix and anesthesia (local or IV sedation).
What should be done after vacuum aspiration to ensure complete evacuation?
Examine the tissue for the gestational sac, placenta, and fetal parts.
What can be used to confirm complete abortion if products of conception are not visualized?
Sonogram, serial hCG evaluation, or repeat ultrasound in 1 week.
What is the surgical technique used for abortion beyond the first trimester?
Dilation and evacuation (D&E).
What percentage of mid-trimester abortions in the U.S. are performed via D&E?
More than 90%.
Why is cervical preparation often needed before D&E?
To reduce the risk of uterine trauma, such as perforation and cervical injury.
What is the most commonly used cervical dilator for D&E?
Laminaria japonica (sterilized seaweed).
What drug can be used with laminaria to reduce the number of dilators needed?
Mifepristone.
What prostaglandin is used for cervical preparation before vacuum aspiration or D&E?
Misoprostol.
What is the mechanism of action of mifepristone?
It is a competitive inhibitor of the progesterone receptor, preventing progesterone from binding.
When combined with a prostaglandin, how effective is mifepristone for abortion?
More than 95% of early pregnancies terminate.
What is the FDA-approved regimen for first-trimester medication abortion?
600 mg mifepristone followed by 400 μg oral misoprostol 48 hours later.
What is the evidence-based regimen recommended by the Society of Family Planning?
200 mg mifepristone orally, followed by 800 μg misoprostol intravaginally or buccally 24-72 hours later.
Up to what gestational age is the evidence-based medical abortion regimen effective?
Up to 63 days gestational age.
What is the typical duration of bleeding after medication abortion?
7 to 14 days.
What is the most common method for second-trimester medical abortion?
Induction of uterine contractions with prostaglandins.
What is the dosage of prostaglandins used for second-trimester abortion?
400 mg intravaginally every 6 hours.
What is a key advantage of medical induction over D&E?
Avoidance of surgery and the opportunity to view or hold the fetus.
What is a disadvantage of medical induction compared to D&E?
Longer hospitalization and higher risk of retained products requiring further intervention.
What role does ultrasound play in abortion procedures?
It verifies gestational age and confirms intrauterine pregnancy.
What is the most common complication of surgical abortion?
Infection (~1% of cases).
What reduces the risk of infection in surgical abortion?
Perioperative antibiotic prophylaxis.
What is the overall mortality rate of elective abortion in the U.S.?
Less than 1 per 100,000 procedures.
What two factors are the most important determinants of abortion complications?
Gestational age and method of abortion chosen.
Why is early abortion safer than later procedures?
Complication rates increase progressively with gestational age.
What is the safest surgical method of abortion?
Suction curettage.
What is the most effective method of emergency contraception?
Copper IUD.
What is the second most effective method of emergency contraception?
Oral ulipristal acetate (Ella).
What is the failure rate of coitus-related contraceptive methods in the first year?
Highest among all methods.
What are the most effective reversible contraceptive methods?
IUDs, implants, and sterilization (failure rate <1%).
What is the primary mechanism of action of the LNG-IUS?
Thickening of cervical mucus.
How does the contraceptive implant prevent pregnancy?
It inhibits ovulation and may cause irregular bleeding.
What is a common side effect of the DMPA injection?
Amenorrhea and potential weight gain.
What is a major risk of combined hormonal contraceptives?
Increased risk of venous thromboembolism (VTE).
What group of women should avoid estrogen-containing contraceptives?
Women with multiple risk factors for VTE or cardiovascular disease.
How does delaying abortion access affect maternal safety?
Increases the risk of complications by pushing abortion to later gestational ages.
