Hinjke Flashcards
What is a tier 1 contraceptives?
Progestin implants and IUD
Implanon
Copper IUD
Mirena
What are tier 2 contraceptives?
DMPA, rings, patches, OCP
What is a tier 3?
Condoms, diaphragms, caps, shield, spermicides, withdrawal, fertility awareness, natural family planning
What is the mechanism of action of implanon?
Negative feedback on hypothalamus decreasing GnRH
Thickens cervical mucus
Thins endometrium
What is a contraindication to using implanon?
Breast cancer
What drugs may decrease the efficacy of implanon?
Phenobarbital
Dilantin
St. John’s Wort
What are the emergency contraceptions?
Combo OCPs with 100 mcg of ethinyl estradiol and .5 mcg levonorgestrel twice 12 hours apart
Copper IUD
Plan B
How does a copper IUD work?
Immobilizes and kills sperm
Prevents implantation if fertilization
How long does a copper IUD last?
10-20 years
What is a contraindication in copper IUD?
Wilson’s disease and PID
How is a copper IUD used for contraception?
Can use for up to 5 days after
What do you worry about when your perforate laterally?
Bleeding through uterine artery
If patient feels pain immediately afterward - think perforation
How does levonorgestrel work?
Thickens cervical mucous
Thins endometrium
Does NOT prevent ovulation
How long does levonorgestrel work?
5 years
What are the contraindications to levonorgestrel?
Breast cancer
PID
How do tier 2 contraceptives work?
Thicken cervical mucous
Preventing ovulation by suppressing LH surge
What is a contraindication to OCPs?
Aura or hx of migraines Hx of uncontrolled HTN Hx of TE, stroke, MI, breast cancer Advanced DM Unexplained dysfunctional uterine bleeding - could have cancer
If someone on OCPs comes in with RUQ pain, what should you be thinking?
Cholelithiasis or benign hepatic tumor
What is the downside to ortho evra patch?
Skin irritation
Must be under 198 pounds
Higher risk of DVT!
What do you give to milking mothers for contraception?
The progesterone only pill - micronor
How does progestin only work as a contraceptive?
Thickens cervical mucous
Inhibits ovulation
Who cannot use progestin only?
Women who have had breast cancer in the last 5 years
What do progesterone and estrogen do to triglycerides?
They make them go up so don’t use for someone with hyperlipidemia
What is DMPA?
An IM injection every 3 months
What is the biggest problem with the DMPA?
Weight gain
Return to fertility may be prolonged
What is a contraindication for using DMPA?
If the patient has asthma
What is the Yuzpe method?
Using OCPs for emergency contraception
What is plan B?
Progestin only
.75 mg of levonorgestrel
Can take up to 5 days after
89% effective
What female sterilization method is good for patients who aren’t good with anesthesia?
Hysteroscopic - can be done in office.
Put little stainless steel coils in the Fallopian tubes — inflammatory reaction causes closure of the tubes.
Do a hysterosalpingogram afterward to make sure the tubes closed
What is the Texas law in abortion?
Legal up to 20 weeks
After 16 - must happen in a hospital
Under 18 must have parental consent
Info on alternatives must be provided 24 hours before
Descriptions of US findings must be given
Must offer to view US
What can be used for abortions before 7 weeks?
Mifepristone - anti progesterone
Misopristol - prostaglandin that causes uterine contractions
What is placental abruption?
Premature separation of normally implanted placenta
What are the risk factors for placental abruption?
HTN, hx of abruption, trauma, short umbilical cord (less than 30 cm), tobacco use, PROM
What is a succenturiate placenta?
An accessory placenta
Associated with postpartum hemorrhage or infection
What is velamentous cord insertion?
Vessels only surrounded by fetal membranes, no Wharton’s jelly
What is vasa previa?
When vessels course over the cervical os.
Associated with perinatal mortality
What is a complication of velamentous cord insertion?
Fetal exsanguination
What is the Apt test?
When you are trying to figure out who is bleeding - mom or baby.
Take blood from vag, put in water and add KOH. RBCS will lyse. Mom’s Hb will be brown and baby’s will be red
What is the greatest risk factor for velamentous cord insertion?
Multiples
What is the management for velamentous cord insertion?
Immediat abdominal delivery
Woman comes in at 30 weeks with painless vaginal bleeding and no contractions. Her vital signs are stable and is afebrile. What is the dx?
Placenta previa
A girl comes in with light vaginal bleeding after intercourse. Everything else is good. Cervix is friable. What is the dx?
Ectropion of pregnancy
What is cervical ectropion?
When the endocervical columnar epithelium is exposed to the vaginal milieu by eversion.
Preggers Patient comes in with heavy bleeding, ab pain, firm uterus. What is the dx?
Placental abruption
What does a normal placenta look like?
Diameter = 22 cm
Thickness = 2-2.5 cm
Cord length = 55-60 cm
Gray wrinkled shiny and translucent
Pregger patient comes in with bright vag bleeding and no pain or contractions. How do you dx placenta previa?
Pelvic US
What is placenta accreta?
Deep attachment of the placenta through the endometrium and myometrium of the uterus due to defective desidual formation.
Lots of hemorrhage and often leads to a hysterectomy
Accreta - superior
Increta - invades partially into the myometrium
Percreta - extends to the serosa of uterus
What are the risk factors for placenta accreta?
Prior c-section!!!!!
Scar tissue - asherman’s
What is a good method for determining the cause of third semester bleeding?
Pelvic US
What is a low lying placenta?
When the placenta is with 2 cm of the cervical os