Family Planning - Test 2

Question 1

What are the different forms of combined hormonal contraception?

Answer 1

Pills

Patch

Ring (vaginal) - NuvaRing

Question 2

What is the overall main mechanism of action of combined hormonal contraceptives?

Describe the specific mechanisms of contraception of progesterone.

Describe the specific mechanisms of contraception of estrogen.

Answer 2

Overall MOA: STOP OVULATION

Progestin inhibits the LH surge, thickens cervical mucus, and inhibits ciliary activity in oviducts

Estrogen inhibits FSH, and improves endometrial stability -> less bleeding

Question 3

What type of contraception would you recommend for a woman who has heavy bleeding and wants her contraception to help with that?

Answer 3

CHC (pills, patch, or ring) cuz the estrogen helps with bleeding

Question 4

Your patient wants to start a contraceptive but has factor V Leiden. What type of contraceptives should you avoid with this patient?

Answer 4

Avoid estrogen-containing contraceptives (combined)

Question 5

Your patient wants to start contraceptives but has a history of migraines w/ aura. What options should you discuss and what should you avoid?

Answer 5

Avoid estrogen-containing contraception.

Options are progestin-only: implant (Nexplanon/progestin etonogesterel), IUD (Levonorgesterel), injection (Depo Provera), pills (POPs)

Question 6

Your patient wants to get on contraception but doesn’t like the idea of delayed return to fertility. What should be avoided? What is a good option?

Answer 6

Depo Provera should be avoided

Progestin-only pills (POPs) offer immediate return to fertility

Question 7

Your patient wants to start contraceptives and is morbidly obese. What should be avoided and why?

Answer 7

Probably want to avoid estrogen-containing contraceptives due to risk of endometrial hyperplasia development.

Depo-Provera (progestin injection) has a side effect of weight gain, so not that either.

Question 8

Name four benefits that combined contraceptives offer over progestin-only methods.

Answer 8

1. Less bleeding
2. Less menstrual pain
3. Less acne
4. Increased bone density

Question 9

Rate the efficacy of the various types of CHCs.

Answer 9

Patch > Pill > Ring

Question 10

What is the MOA of a copper IUD?

Answer 10

Inhibits sperm motility and function; also increases inflammatory state in uterus to make it a hostile environment for sperm

Question 11

Do progestin-only contraceptives help with irregular bleeding?

Answer 11

Nope

Question 12

What method is the most effective long-acting reversible birth control?

Answer 12

Nexplanon/progestin ethonogesterel (arm implant)

Question 13

What is the main shitty thing about progestin-only pills?

Answer 13

They must be taken on a very regular basis (within 2 hours of the same time every day)

Question 14

What is the efficacy of Depo Provera? What are the main side effects?

Answer 14

Very efficacious (0.3% failure rate)

Side effects: weight gain and delayed return to fertility

Question 15

Name a benefit that Levonorgesterel IUD offers over the other progestin-only methods. Other than being a contraceptive, name two diseases that it is used to treat.

Answer 15

Less systemic progesterone

Treats endometrial hyperplasia and early stage endometrial cancer

Question 16

Name three methods of emergency contraception and rank them in order of efficacy.

Answer 16

Paragard copper IUD > Ulipristal EC (most effective pill) > Levonorgesterel-only EC

Question 17

Does emergency contraception terminate pregnancy, or prevent it?

Answer 17

Prevents it

Question 18

Describe the components of a pre-abortion work-up.

Answer 18

Counseling, informed consent

Pregnancy documentation, LMP history

PMH

PE

Blood work (Rh status, Hct)

Ultrasound to assess gestational age, look for abnormalities, multiparity, molar pregnancy

Question 19

What should a woman expect regarding symptoms and aftercare following an abortion?

Answer 19

Nausea should go away in 12-24 hours after abortion

Other symptoms might take a week to go away

Women can engage in normal activity as tolerated

Bleeding can be normal (common is spotting for next few days, followed by heavy bleeding and cramps and clots for few days, then back to spotting for a ~week)

If fever >38C happens or bleeding heavier than 1 maxi-pad/hour happens, call clinic

Follow-up in 2-4 weeks when pregnancy-related symptoms should be gone, cervix should be closed, uterus returned to non-pregnant size

Question 20

Should you give Rhogam to a Rh-D negative patient before a surgical abortion?

Answer 20

Fuck yeah

Question 21

Name four potential complications of surgical abortion.

Answer 21

Vasovagal reaction (most comon)

Post-abortal hematoma

Retained products can cause bleeding and cramping

Infection (rate is low)

Question 22

What is the treatment for post-abortal hematoma?

Answer 22

Re-aspiration of the uterus

Question 23

Describe the exact fucking protocol for a medical abortion with mifepristone + misoprostol. How far along in the pregnancy does this work until?

Answer 23

Works until 10 weeks gestational age.

200mg Mifepristone orally at the clinic

Then:

800mcg misoprostol vaginally anywhere from 24-96 hours later at home

OR

800mcg misoprostol bucally 48-72 hours later at home

OR

400mcg misoprostol sublingually 48 hours later at home

Question 24

What is the only medical treatment for ectopic pregnancy? Until how long into the pregnancy does this work?

Answer 24

Methotrexate, works until 50 days since LMP

Question 25

What is the management for an unsuccessful abortion?

Answer 25

Try it again with the drugs, or try a surgical abortion.

Question 26

An extremely fatal infection with __________ (name the bug) has happened a handful of times following abortion with mifepristone + misoprostol. What other related organism commonly (relatively) causes infection?

Answer 26

Clostridium sordelii is the fatal one

C. perfringens is more common (relatively)

Question 27

What is the MOA of ulipristal emergency contraception?

Answer 27

It is a progesterone antagonist