Lecture 10- Contraception Flashcards
Failure rate inherent in the method if the patient uses it correctly 100% of the time
method failure rate
Failure rate seen as the method is actually used by patients (this is more likely).
typical failure rate
What are the 2 types of IUDs?
Levonorgestrel-releasing IUD (2 types now)
Copper-containing IUD
Within how long must post-coital / emergency contraception be used?
72 hours
What do most OCP have for estrogen component?
Ethinyl estradiol
What is the pill that has progestin-only? What does it do?
“mini pill” it thickens cervical mucus, ovulation still occurs normally. Very time sensitive
Who should take the “mini pill”
Women who are lactating or women who have a contraindication to estrogen containing pill
What component of the pill provides the major contraceptional effect?
Progestational component by suppressing LH
What does estrogen in the pill do?
Suppresses the secretion of FSH to prevent follicle maturation
What are some side effects of the pill?
Breakthrough bleeding
bloating
weight gain
fatigue and headache
What are some contrainidcations of the pill?
VTE (venous thrombis embolism) CVA, AMI abnormal vaginal bleeding smoker >35 yo Liver disease breast CA
Can individual will gallbaldder disease have the pill?
Not the type that has estrogen in it
How long does the Nuvaring stay in for?
3 weeks, then take it out for a period then put one back in
What is an injectable hormonal contraception?
Depo-Provera
How often are Depo-Provera shots given?
q 3 months
What is Nexplanon?
Injected into the skin in sulcus of biceps muscle
Just progestrin
How long does nexplanon last?
3 years
How long does Ortho-Evra patch last?
Change every week then after 3 take it off for a period
Where is the IUD placed?
Goes in through cervical os and put it up into uterus and into fundus of the uterus
How does the IUD work?
Inhibits movement of sperm
Thin lining of uterus so embryo can’t implant
Thickening of cervical mucous (plug)
Which type of IUD release a small amount of copper and is a 10 year contraceptive?
Para gard
What is the 3 year contraceptive?
Skyla
What type of IUD releases small amount of levonogestrel into the uterus. Decreases menstrual blood loss and lasts up to 5 years?
Mirena
With which IUDs will you have heavier crampier periods first?
Paragard
What is the most common side effects of IUDS?
Spotting, heavier periods, uterine cramping
What is the slippage and breakage rate of male condom?
5-8%
What must a diaphragm be used with?
Spermacidal jelly or cream
How long must a diaphragm be left in after sex?
6-8 hours
What is a smaller version of the diaphragm applied directly to the cervix?
Cervical cap
Why don’t many people use the cervical cap?
TSS and high degree of displacement
When should spermacides be inserted?
10-30 minutes before each act of intercourse
What is the combined oral contraceptive regimen?
If you take 2 tablets w/in 72 hours after unprotected intercourse followed by 2 more tablets in 12 hours
What is the progestin-only regimen of postcoital contraception where 2 tablets of levonorgestrel are taken 12 hours apart.
Plan B
What does emergency contraception do?
Prevent ovulation and fertilization
Will not terminate an existing pregnancy
Why is vasectomy preferred over procedures done on women?
Generally more effective, safer, less expensive
What is the most common surgical approach for tubal ligation?
Minilaparotomy
Tube is grasped, ligated with suture to form loop then loop is excised (often do a time of C-section)
If an individual has a BTL and is then pregnancy what type pregnancy should you suspect?
Ectopic
What is where a titanium-dacron spring device is placed into the tubal ostia bilaterally?
Hysterscopic tubal occlusion
must have HSG 3 months after to confirm occlusion
What causes most UTIs?
bacteria ascending from the urethra.
What causes most first time infections of UTI?
E. Coli
Estrogen deficiency increases the risk of what?
UTI
What are some risk factors for UTI?
Hx of UTI frequent/recent sex diaphragm usage obesity, stones indwelling catheter postmenopausal status.
These are symptoms of what?Frequency, urgency, nocturia, dysuria. Some may report suprapubic tenderness. Fever is uncommon.
Lower UTI
These are symptoms of what; Frequency, urgency, dysuria with accompanied fever, chills, and flank pain.
Acute pyelonephritis
What lab evaluation should you do for a UTI?
Clean-catch midstream sample- UA
urine culture if no clinical improvement w/i 48 hours
What is therapy for UTI?
3-day therapy w/ Bactrim, Cipro, Levaquin in uncomplicated infection
If a person doesn’t improve with UTI treatment what can you do?
IM Rocephin or extend treatment for 5-7 days
If people are really ill with UTI what happens?
Go into hospital with IV antibiotic
What causes bladder pressure to exceed urethral pressure?
Detrusor muscle contracts and external urethral sphincter contracts
What are the three types of urinary incontinence?
Overflow
Stress
Urge
Name the type of incontinence: Uninhibited detrusor contractions. Ctx’s cause a rise in bladder pressure overriding urethral pressure leading to leakage. Patient feels extreme urgency and frequency, +/- nocturia.
Urge (detrusor overactivity)
Name the type of incontinence: Increased intra-abdominal pressure transmitted to the bladder, but not urethra, due to loss of integrity of the endopelvic fascia. The bladder neck descends, bladder pressure is elevated above intra-urethral pressure and leakage occurs. Patients reports involuntary loss of urine with activities (running, exercising, jumping) and cough, laugh, sneeze
Stress incontinence
Name the type of incontinence: Inability of the detrusor muscle to contract leading to lack of complete emptying. May be due to urethral obstruction or neurological deficit which impairs ability to perceive the need to void. Patient experiences continuous leakage of small amounts of urine.
Overflow incontinence
What is mixed incontinence?
Mixture of urge and stress incontinence
What is done to identify bladder lesions and foreign bodies?
Cystourethroscopy
How do you take a post-void residual volume?
Put a catheter in after after they have voided and see how much urine was left
What is simple urodynamic testing
Put saline in their bladder and see after how many mLs it starts to leak
WHat are some lifestyle treatments for urinary incontinence?
Weight loss, caffeine reduction, smoking cessation, treatment of constipation.
What are pelvic floor strengthening exercises?
Kegel exercises to strengthen pelvic floor and decrease urethral hypermobility
What drugs can be used in urge and sometimes stress incontinence?
Anti-cholinergics (Detrol, Ditropan, Oytrol, etc)
tri-cyclic antidepressants (impiramine)
What can you use in post-menopausal women for incontinence?
topical estrogen therapy
What are kegel exercises used for normally?
stress incontinence
What is a procedure where you Suspend and stabilize the anterior vaginal wall thereby stabilizing the bladder neck and proximal urethra in a retropubic position. Two or three non-absorbable sutures are placed on each side of the mid-urethra and bladder neck.
Retropubic colposuspension (Burch Procedure)
What is a procedure where you use Tension-free vaginal tape, mid-urethral sling to raise the bladder neck
Sling Procedures (TVT, TOT)
What can be injected transurethrally and periurethrally in the tissue around the bladder and urethra neck. This is second line therapy?
Collagen, carbon-coated beads, fat
What is one concern of progestin-only OCPs?
very time sensitive and ovulation continues normally in 40% of women
Who should not use the Ortho-Evra Patch?
women over 198 lbs (decrease efficacy)
How frequently is Depo-Provera given?
every 3 months
What form of birth control imparts a twofold risk of UTI?
diaphragm
What must be confirmed by semen analysis following vasectomy to ensure the procedure was effective?
azoospermia
What is the micturition reflex?
normal voiding reflex to urinate
