FSRH Contraception After Pregnancy

Question 1

What proportion of woman presented for delivery had conceived within a year of previous birth ?

Answer 1

1 in 13 which is just under 8%

Question 2

What pregnancy interval does the WHO recommend ?

Answer 2

24 months

Question 3

What form of contraception should not be offered at REM and why ?

Answer 3

CHC shouldn’t be offered until antiphospholipid diseased can be excluded

Question 4

Method unintended pregnancy rate, typical and perfect use : No Method

Answer 4

85%

Question 5

Method unintended pregnancy rate, typical and perfect use
Fertility awareness

Answer 5

24 %, 0.4-5%

Question 6

Method unintended pregnancy rate, typical and perfect use:
Female Diaphragm

Answer 6

12%, 6%

Question 7

Method unintended pregnancy rate, typical and perfect use:
Males condoms

Answer 7

18%, 2%

Question 8

Method unintended pregnancy rate, typical and perfect use:
CHC

Answer 8

9%, 0.3%

Question 9

Method unintended pregnancy rate, typical and perfect use:
POP

Answer 9

9%, 0.3%

Question 10

Method unintended pregnancy rate, typical and perfect use:
DPMA

Answer 10

6 %, 0.2%

Question 11

Method unintended pregnancy rate, typical and perfect use:
Cu-IUC

Answer 11

0.8%, 0.6%

Question 12

Method unintended pregnancy rate, typical and perfect use:
LNG-IUC

Answer 12

0.2%

Question 13

Method unintended pregnancy rate, typical and perfect use:
IMP

Answer 13

0.05%

Question 14

Method unintended pregnancy rate, typical and perfect use:
Female sterilisation

Answer 14

0.5%

Question 15

Method unintended pregnancy rate, typical and perfect use:
Vasectomy

Answer 15

0.15%, 0.1 %

Question 16

What risk are associated with an IPI of less than 12 months ?

Answer 16

increased risk of preterm birth, low birth weight and small for gestational age.

Question 17

Which women can use CHC after 21 days and which ones need ti wait 6 weeks ?

Answer 17

No VTE risk and not breastfeeding, CHC from day 21

VTE risk of breastfeeding then have to weight until after 6 weeks at which point it is UKMEC 2

Question 18

UKMEC for CHC under 3 weeks postpartum

Answer 18

3

Question 19

What UKMEC is the DEPO in the immediate postpartum period (less than 6 weeks)

Answer 19

2 due to theoretical increased VTE

Question 20

In which conditions developed during pregnancy does the UKMEC for CHC become a 2 ?

Answer 20

Hypertension
Cholestasis

Question 21

What are the 6 additional VTE risks the prohibit CHC before 6 weeks in none breastfeeding woman ?

Answer 21

immobility
transfusion at delivery
body mass index (BMI) ≥30 postpartum haemorrhage, post-caesarean delivery
pre-eclampsia or smoking

Question 22

What are the LAMs criteria and what’s it its unintended pregnancy rate

Answer 22

-Fully or nearly fully breastfeeding day and night (no other liquids given or only water, juice or vitamins given infrequently in addition to breastfeeds). No long intervals between feeds day or night (e.g. more than 4 hours during day and more than 6 hours at night)

-Amenorrhoeic

-Less than 6 months postpartum

2% failure rate if used perfected

study reported 5.2% failure rate in working mums that were expressing - was a bit of a shit study tho

Question 23

When can an IUC be fit post delivery

Answer 23

either 10 minutes after delivery of the placenta within the first 48 hours or 28 days after delivery

Question 24

How soon after childbirth in a none breastfeeding woman can they use FAM ?

Answer 24

4 weeks, when breast feeding need to wait 6 months

Question 25

After EMAH how soon have ovulation been reported to occur ?

Answer 25

8 days

Question 26

What is the pregnancy rate following copper coil EC ?

Answer 26

1 in 1000, 0.1%

Question 27

If a woman is treated with methotrexate for an ectopic, for how long should she be on contraception after this ?

Answer 27

at least 3 months according to RCOG and 6 months by SPC

Question 28

Explain the teratogenic nature of methotrexate ?

Answer 28

It is a folate antagonist that impairs DNA synthesis

Question 29

is conception within 3 month of methotrexate a definite infection for abortion ?

Answer 29

No but there would need to be targeted assessment for fetal malformations

Question 30

What consists a partial molar pregnancy ?

Answer 30

This can happens when two sperm fertilise one egg, resulting in a triploid karyotype.

Question 31

What is the typical ultrasound appearance of a partial mole

Answer 31

fetal pole, along side, snowstorm/ Swiss cheese appearance

Question 32

For how long should pregnancy be avoided after a partial mole

Answer 32

for two consecutive months with a normal HCG

Question 33

For how long after GTN treated with chemotherapy should a woman avoid pregnancy ?

Answer 33

1 year

Question 34

UKMEC in GTD with decreased HCG for coils ?

Answer 34

3

Question 35

How long post treatment for GTD should you wait before having a diaphragm fitted ?

Answer 35

6 weeks

Question 36

What are the risk and epidemiology of molar pregnancies ?

Answer 36

The chances of a molar pregnancy are about 0.1 - 0.2 % and are more common in those under 18 and those over 45 years of age, once you have had one, your subsequent risk is increased to 1-2%