family planning

Question 1

define perfect use effectiveness and typical use effectiveness

Answer 1

perfect use effectiveness describes effectiveness while the contraceptive method was being used correctly. The termtypical use effectiveness describes effectiveness while the contraceptive method was being used incorrectly.

Question 2

2. Relate the unintended pregnancy rate with the choice to use contraception.

Answer 2

7% of women don’t use contraception. 49% of all pregnancies are unintended. 47% of all unintended pregnancies occur in women not using contraception,

Question 3

List the female barrier methods

Answer 3

female condom, diaphragm, cervical cap, sponge +/- spermicide

Question 4

requirements for sperm transport

Answer 4

cervical entry, thin cervical mucus and patent fallopian tube

Question 5

Methods for thickening cervical mucus and why this works as contraception

Answer 5

Thin cervical mucus is required for sperm transport. Progestin: pills, depot medroxyprogesterone acetate (depo-provera), implant, progestin IUD (mirena).

Question 6

List methods for female sterilization

Answer 6

ligate fallopian tube, occlusion of fallopian tube or complete removal (salpingectomy)

Question 7

The primary mechanism of action of hormonal contraceptives

Answer 7

suppress the secretion of gonadotropins (FSH and LH) through negative feedback inhibition. Inhibition of FSH prevents follicle development and inhibition of LH prevents the surge necessary for ovulation

Question 8

List the forms of contraception used to prevent ovulation

Answer 8

1. Progestin only: pills (micronor), medroxyprogesterone acetate (depot provera), progestin IUD (mirena). 2. estrogen and progestin: OCPs, transdermal patch, transvaginal ring

Question 9

describe natural family planning methods

Answer 9

1. billings ovulation method: recognize signs of feritlity. 2. symptothermal method: basal body temp rises after ovulation. Uses body temp, cervical mucus and calendar predictions. 3. LH predictor kits.

Question 10

Concerns with natural family planning methods

Answer 10

sperm can last 3-6 days, variable cycles

Question 11

Describe the temperature method

Answer 11

The woman is required to abstain from intercourse from the onset of the menses until the third consecutive day of elevated basal temperature

Question 12

Describe cervical mucus method of contraception

Answer 12

Once the first day that copious, slippery mucus is observed to be present, abstinence is required every day thereafter until 4 days after the last day when the characteristic mucus is present

Question 13

List methods for thinning endometrium and why this works as contraception

Answer 13

A thick endometrial lining is required for implantation. Progestin thins endometrium and estrogen stabilizes endometrium

Question 14

Pharmacological Effects of Progestins as Contraceptives

Answer 14

1. Inhibits ovulation by suppressing function of hypothalamic-pituitary-ovarian axis. 2. modifies mid cycle surges of LH and FSH. 3. diminishes ovarian hormone production. 4. reduces activity of cilia. 5. thins endometrium. 6. thickens cervical mucus to impede sperm transit

Question 15

Concerns with progestin only pill

Answer 15

Plasma levels drop by 24 hrs. Thickening of cervical mucus lasts 27 hours. Missed pill >3 hrs puts woman at risk. Only causes anovulation in about 50% of cycles

Question 16

Depoprovera length of efficacy

Answer 16

injection that is effective for 12 weeks.

Question 17

Implanon MOA

Answer 17

progestin only implant - inhibits ovulation, thickens cervical mucus, causes atrophy of endometrium AND decreases tubal motility. Can cause amenorrhea or unscheduled bleeding

Question 18

Levonorgestrel MOA and length of action

Answer 18

Lasts for 5 years. Has some ovulation inhibition, decreases tubal motility, atrophic endometrium, really thickens cervical mucus. Causes oligoamenorrhea and amenorrhea

Question 19

MOA of combined hormonal contraception

Answer 19

ie pill, patch, ring with both E and P. Inhibits ovulation (mainly progesterone), thickens mucus, decreased tubal motility

Question 20

Copper IUD mechanism of action and length of action

Answer 20

Spermicidal via release of copper ions. Copper acts as spermicide at cervix and causes inflammatory reaction in uterus. Causes increase in enzymes, prostaglandins, WBCs and copper ions that impair sperm function. Approved for 10 years but shown to be effective for 12.

Question 21

Contraceptive and noncontraceptive benefits of estrogen

Answer 21

Contraceptive: stabilizes uterine lining (less breakthrough bleeding), and less follicle development. Noncontraceptive: reduces SHBG (less acne, etc). Reduces ovarian cancer, endometrial, colon cancer risks

Question 22

Risks of estrogen

Answer 22

•Estrogen increases clotting factors II, VII, X, XII, factor VIII and fibrinogen. Shift towards thrombus formation and prevention of clot dissolution. Greater risk of venous and arterial clots (more venous).

Question 23

Who should avoid combined hormonal contraception

Answer 23

Smoker >35 years, CAD, risk of/ history of clots, uncontrolled HTN, diabetes with vascular changes, migraines with aura, liver/gallbladder dz, breast cancer, major surgery with prolonged immobilization

Question 24

MOA of emergency contraception and uses

Answer 24

Prevents pregnancy AFTER sex (not the abortion pill). High dose of hormones disrupts follicular development, blocks LH surge, inhibits ovulation, disrupts luteal phase

Question 25

List the emergency contraceptives

Answer 25

1. Yuzpe method: combined OCPs in high dose. 2. Plan B: high dose. 3. Copper IUD. 4. Ella: Ulipristal acetate (progesterone receptor modulator)

Question 26

spermicides MOA and use

Answer 26

Nonoxynol 9- Surfactant that immobilizes or kills sperm on contact by destroying the cell membrane. A sponge containing the surfactant is inserted into the vagina before intercourse

Question 27

spermicides risks

Answer 27

increased risk of vaginal erosions and HIV transmission

Question 28

describe use of a diaphragem

Answer 28

Must be left in place for at least 8 hours after last coital act and should be used with spermicide. Usually more comfortable for women who have had babies

Question 29

Risks of diaphragm use

Answer 29

increased risk of UTIs due to mechanical obstruction of urine outflow

Question 30

Describe use of cervical cap

Answer 30

silicone rubber fits over the cervix. Placed before intercourse and used with spermicide applied to cervical and vaginal surfaces. Fit nulliparous women better than parous

Question 31

Which condoms are best

Answer 31

latex condoms have less slippage/breakage and are better than polyurethane and animal tissue. Animal tissue condoms don’t prevent transmission of STDs

Question 32

describe periodic abstinence as contraception

Answer 32

conception can only occur if coitus takes place during the 5 days preceding ovulation or the day of ovulation. Thus, if couples would only avoid coitus on these 6 days each month, conception would not occur.

Question 33

complications of vasectomy

Answer 33

hematoma (in up to 5% of the subjects), sperm granulomas (inflammatory responses to sperm leakage), and spontaneous reanastomosis

Question 34

describe vasectomy

Answer 34

outpatient procedure- 20 mins. Cut vas deferens then seal the ends

Question 35

describe female sterilization

Answer 35

general anesthesia- The most common techniques used today include the Filshie clip and the Silastic band (Falope ring). Both techniques require the surgeon to completely visualize the entire tube. The tube is grasped with the clip applier in the mid-isthmic portion such that the free end of the clip extends beyond the tube into the mesosalpinx. The isolated tubal segment undergoes necrosis

Question 36

What is a microinsert

Answer 36

A device inserted in proximal oviduct to occlude the tubes