FAMILY PLANNING Flashcards
1
Q
Family Planning: Initial Evaluation
A
Medical history
Obstetric and GYN history
Physical exam
o Pap Smear
o Wet mount
o GC/chlamydia DNA probe test
2
Q
Family Planning: BC and Disease Prevention
A
o Gynecological history and physical exam essential
o Risk for STIs and history of BC methods
o Sexual dysfunction/concerns
o Health promotion
o Menstrual cycle information
o Medications used
o Previous Pap smears and resolutions
o Cigarette, alcohol, and drug use/abuse
o Condoms are the only method that prevents STIs
3
Q
Family Planning: Education
A
- Always need condoms to prevent STIs, no other form of contraceptive prevents
- Nothing is 100% effective, must be used appropriately to be effective
- Best forms are long term as most effective, less risk of user error
4
Q
Birth Control (BC) Education
A
- Option should be affordable, easy to use and obtain, 100% effective, safe, mutually accepted, and reversible
- Most popular forms of BC are OCs, the diaphragm, and condoms
- Depo-Provera and the copper IUD are also popular options
- Gynecological history and physical exam essential and should address
o Risk for STIs and history of BC methods
o Sexual dysfunction/concerns
o Health promotion
o Menstrual cycle information
o Medications used
o Previous Pap smears and resolutions
o Cigarette, alcohol, and drug use/abuse - Communication should be done in a nonjudgmental, supportive, accepting manner
- Areas of concern: poor body image, depression, poor nutrition, emotional/physical problems, myths, abuse from others, smoking, obesity, and family problems
5
Q
Physical exam (BC)
A
blood pressure, weight, height, LMP, breast cancer and BSE teaching, blood tests, a pelvic exam and pap smear.
Note: There is NO evidence to restrict BC prescription due to lack of pap smear
6
Q
BC: Methods of Contraception
A
- Chance
o Failure rate is 85% per year - Coitus Interruptus
o Withdrawal of penis before ejaculation
o Failure rate is 27%
o Not ideal, but better than no method – (failure rate similar to barrier methods)
o Advantages – no artificial barriers, chemicals, or devices - Fertility Awareness Method
o Periodic Abstinence (Natural Family Planning) – avoidance of intercourse during fertile periods
o Basal Body Temperature (BBT) and Cervical Mucus Changes – Basal body temp. and cervical mucus characteristics are recorded daily; unprotected intercourse is permitted only after signs of ovulation have subsided
o Failure rate is 25% during the first year
o Can be effective if couples are motivated, but usually requires education
7
Q
BC: Barrier Methods
A
- Male condom
o Should not be applied tightly
o Should extend one-half inch beyond tip of penis to collect ejaculate
o Use only with water-based lubricants as oil-based lubricants can break down condom
o Use new condom each time and BEFORE any sexual contact
o Adverse effects: irritation, allergic reaction, unfavorable oral sex, accidental splitting of condom
o Not best choice for under-25-group due to noncompliance and inconsistent use - Female condom
o Disposable and made of seamless polyurethane
o Fits loosely inside the vagina and covers perineum
o Difficult to handle
o Adverse effects: irritation and allergic reaction - Diaphragm
o Latex hemisphere with flexible rim that fits over the cervix
o Allows woman control, no systemic side effects
o A teaspoon of spermicide is placed in cup before insertion
o Insert against cervix before intercourse
o Insert up to 6 hours before and leave in 6-8 hours after intercourse
o Instructed to urinate before inserting to avoid UTIs
o Must be fitted for correct size
Requires refit if weight loss or gain of 10 lbs or after childbirth - Cervical cap
o Cup-shaped plastic or rubber device that fits snugly around cervix
o Can be used in women unable to use a diaphragm
o Only for women with normal Pap smears and repeat Pap smear done 3 months after initiation
o Adverse effects: allergic reaction, irritation, and displacement
8
Q
BC: Spermicidal Methods
A
- Vaginal contraceptive sponge
o One-size-fits-all disposable polyurethane sponge
o Treated with nonoxynol-9 (may increase the transmission of STIs including HIV)
o Adverse effects: irritation, displacement, toxic shock syndrome (TSS) - Foam, cream, film, jelly, and suppository
o Spermicide is nonoxynol-9 (may increase the transmission of STIs including HIV)
o Easy to use, readily available, relatively inexpensive
9
Q
BC: Spermicidal Methods Education
A
- Education
o Must be inserted correctly
o Must be inserted no more than one hour before intercourse; additional application is needed if one hour has passed since insertion
o One application is good for one act of intercourse only
o Must be left in place for 6 hours after
o Typical failure rates for spermicide use alone range between 20
10
Q
BC: Hormonal Methods
A
- Combination birth control pills – both estrogen and progesterone
- Progestin-only or minipills
- Depo Provera injections
- Newer methods – patch, ring, progestin IUD, nexplanon
- Do not protect from STIs or HIV
- .1 to 5% failure rate
11
Q
BC: Oral Contraceptives
A
- Action of Oral Contraceptive Pills
o Inhibits ovulation
o Thins endometrium
o Thickens cervical mucus
o Must take a pill at the same time each day - Estrogen/Progestin combination
o 28 pill pack
o Take 3 weeks of active pills, 1 week of sugar pills
o Many different forms
Ovcon, Ortho Tri-Cyclen and so on
o Relatively inexpensive, easy to obtain and not long term
o Can be stopped at any point
o Regular cycles, tend to be shorter and lighter
o Help with acne
12
Q
BC: Pregnancy, Postpartum, and OCs
A
- OCs should be started no earlier than 4 to 6 weeks after delivery in non-nursing women
- Estrogen decreases the amount and quality of breast milk
- Progestins promote breast milk production so progestin-only OCs should be used in women who are breastfeeding
13
Q
BC: Combination OCs (COCs)
A
- Most effective, reversible form of birth control
- Relatively inexpensive and least invasive
- Benefits
o Decreases menstrual flow (blood loss) and PMS symptoms
o Less risk of ectopic pregnancy and salpingitis
o Fewer ovarian cysts
o Reduction in dysmenorrhea
o Reduction in risk of ovarian and endometrial cancer
o Protection against PID
o Improvement in acne
o Good menstrual cycle control (28-365 regimens)
o Beneficial effect on bone mass
BC: OC Safe Use - Indicated for women with normal weight, nonsmokers, normal BP and cholesterol, no diabetes, no family history of heart disease
- Full history, gynecologic exam, Pap smear, lipid profile, and CBC lab tests done before an OC is prescribed to prevent adverse effects
14
Q
BC: OC Contraindications
A
Absolute Contraindications
Clotting disorder or family history of thrombophilia
Cardiovascular disease
Cerebrovascular disease
Cancer
Liver disease
Pregnancy
Undiagnosed vaginal bleeding
Relative Contraindications
* Smokers > 35 y/o
* HTN
* DM
* Migraines (especially if they begin or worsen while using OCPs)
* Lactation
* Obesity
* Age over 50
* Active gallbladder disease
* Sickle cell disease
* Hyperlipidemia
15
Q
BC: OC Adverse Effects
A
- Elevated thyroid and cortisol levels
- Altered lipid profile
- Estrogens decrease glucose tolerance
- Risk for thromboembolism (especially in smokers)
- Risk for hypertension, MI, cervical dysplasia and cancer with long-term use
- Migraines, depression, and fluid retention
- Decreased action if taking antibiotics or anticonvulsants
