OB Block 3 Flashcards
What is the MC form of contraception in US?
What has more detrimental impacts for morbidity and mortality, pregnancy or contraception?
When is the use of copper IUDs indicated and what PT population is this preferred?
COCs
Pregnancy
Birth control is safer
Emergency, <5d after intercourse
Migraine w/ aura (no estrogens)
C-section delivery is a proxy for ?
What are the three leading causes of infant death?
Delivery mortality increase
Congenital malformations
LBW- 14% <500g survive infancy
SIDS
What country in the industrialized world has the highest rates of unintended pregnancy?
Why is this unique?
USA
Half use contraception
One third on OCPs
How much money is saved from teenage mother/pregnancy?
What are the three goals of preconception counseling?
$1445/mother/yr x 15yrs
Education
Preconceptional care
Reduced disparities/risks
When is preconception counseling conducted?
Future mothers w/ ? BMIs need counseling
Routine well visits
Neg preg tests
Planning future pregnancy
Prescribing birth control
> 30kg/m2
<18.5kg/m2
Inc of autistic baby if father is above ? age
4 risks of second hand smoke exposure
What is one simple thing that can promote/increase baby/mother health and outcomes?
40y/o at conception
SIDS Preterm IUGR LBW
Father present at birth
Highest form of BC in US?
What is the most effective?
Only contraceptive for PTs w/ breast cancer?
Combo pill
IUD/Implant
Copper IUD
What are the tiers of birth control
What is a commonality across the tiers??
1: Implant IUD Sterilization
2: Injection Pill Patch Ring
3: Barrier Behavior
4: Spermicide Sponge
No: Abortion Plan B
None have estrogen alone
What are the reasonably certain ways to determine female is not pregnancy
<7d after menses start
No intercourse since start of last menses
Consistent contraception use
<7d post-abortion
<4wks postpartum
> 85% fully breastfeeding, amenorrhic, and <6mon postpartum
What is the only form of birth control that doesn’t require back up protection immediately after installation?
What three types need exams/tests prior to initiations?
Copper
Cu IUD- Biman/cervical exam
LRIUD- Biman/cervical exam
CHC- BP measurement
What are the two times additional follow up is needed after birth control installation?
What BP measurements are concerning for PTs on birth control
IUD- exam for strings
CHC- BP after starting
> 160/>100= avoid COC/Depo
When are smokers and contraception used or avoided?
When are COCs and migraines used
What are the recommendations w/ DM
<35, ok
+35, <15 smokes/day= caution
+35, +15 smokes/day, avoid
No aura, COC ok
Aura, any age- No COC, Depo ok
Controlled- all ok
End organ Dz/vascular/>20yrs w/ DM- no COC, caution w/ Depo
How are PTs w/ RA managed w/ birth control
PTs w/ DVT/PE Hx can’t get ?
PTs w/ HIV can have ? methods?
SLE, no Abs- COCs ok
SLE, +Abs- avoid hormones
Caution w/ Depo, osteoporosis risk
No COCs
All ok
Spermicide inc transmissions
What methods can breast feeding moms use?
What are the indications a PT should use an IUD?
<1mon post partum- no COCs
Use progesterone
Stable, monogamous
Hormone avoidance, Cu
Nulliparous/adolescent
Levo IUD- dysfunctional bleeds
Cu IUDs are particularly good for ? 3 PT populations and ow long does it stay in?
What do non-Cu IUDs contain and how long do they stain in?
What is it’s MOA
CA Antiphospholipid Abs Thromboembolic dz
10yrs
Progestin
M, K- 5yrs
L, S- 3yrs
Prevents fertilization and implantation via endometrium inflammation
No impact on ovulation
What adverse effect happens w/ Cu IUD
How long does it take for fertility to return after removal
Common in 1st 3mon:
Dysmenorrhea/heavier
Tx w/ NSAIDs
Immediately
How long does LNG IUD stay in and what is the MOA
What is a s/e
What is a benefit
5yrs w/ progestin release
Dec implantation/sperm motility
Inconsistent ovulation inhibition
Infection 1mon after placement
Irregular/spot bleed x6mon
Amenorrhea
Improves dysmenorrhea
When are LVN IUDs placed
How long after placement do PTs need to f/u?
If lost/invisible what is the next step?
> 7 days after menses started, use back up x7 days
6wks
Exclude pregnancy
Cytologic brush to bring string into vagina
No string= US
What is the increased risk if PT becomes pregnancy w/ IUD?
Nexplanon
MOA of Nexplanon
Ectopic pregnancy
2nd trimester miscarriage
Etonogestrel rod subdermal implant- 3yrs suppressed ovulation
Progestin inhibits LH release, implantation, sperm motility
What is a benefit of Nexplanon?
Adverse effects
What are two absolute c/i for this method
Efficacy not affected by obesity
ALL progestin contraceptives- irregular/heavy bleeding
Current breast Ca
Pregnancy
When is Nexplanon placed
What back up is needed
How long for fertility to return
W/in 5 day onset of menses
x7 days
6wks, up to 12mon
Nexplanon is an option for ? PTs
Depo
MOA of Depo
Postpartum
Spot/Induced abortions
150mg IM q3mon delt/glut
Suppress LH
Inhibit sperm motility
Inhibits implantation
What are non-contraceptive benefits of Depo?
What are C/is?
What is the absolute c/i?
Improves menorrhagia, dysmenorrhea and endometriosis pain
Dec endometrial hyperplasia Ca risk
Recent breast Ca
Progesterone pos Ca
Prior ectopic pregnancy
Pregnancy
Current breast Ca
What needs to be added in diet for PTs on Depo
What is an adverse risk?
Vit D/Ca, Depo block endogenous estrogen secretion
Functional ovarian cyst
POPs
What are the MOAs
What PTs is the primarily used in?
Norethindrone 0.35mg- only formula avail in US taken w/in 4hrs of each dose
Impairs sperm motility
Inhibits implant
Unreliable ovulation inhibition
Breast feeding PTs
Estrogen c/i PTs
What is PT misses time frame for POP
What are the absolute c/is to POPs
Back up x48hrs
Breast Ca
Pregnancy
How many COC pill combos
How many patch forms
How many transvaginal ring forms
> 90
One
One
What is the MOA of CHCs
Blocks LH, inhibit ovulation
Prog: suppresses ovulation, motility and implantation
Est: suppresses ovulation, stabilizes cycle control
Most CHCs are less than ?mcg due to ?
3rd gen newer progestins
What are 4th generation progestins best for but w/ ? risk
35mcg or less
Est: Less embolism risk
Prog: dec androgen affinity to dec acne/hirsutism/lipids
Dec androgen, neg lipid profil
PMS- breast tenderness/bloat
HyperK
What is the most important effect of Tier 2 CHCs
The later the generation of progesterone= ?
CHCs have a hormone free interval lasting ? days
Suppression of GnRH to inhibit LH/FSH= inhibited ovulation
Less androgenic effects
4-7days for menstruation, if skipped= continuous
What is the most popular reversible contraceptive in the US
What are the benefits
What are the risks?
PO CHCs
Dec ovarian colon and endometrial Ca risk w/ou inc breast Ca risk
Efficacy not changed by PTs weight
Inc arterial/venous clot
What are the non-contraceptive benefits of PO CHCs?
How long does it take for fertility to return?
Dec uterin bleeding, dysmenorrhea, acne and hirsutism
Improves PMDD Sxs d/t Drospirenone
1-2wks after stopping
Regular in 12mon
Define PO CHC 1st Day Starts
Define “Sunday Starts”
Define “Quick Starts”
Start on 1st day of menses, no back up needed
Arranged to avoid w/drawal bleeds on weekends
Start 1st sunday after menses starts, back up needed x 7days
1st pill taken when Rx filled, back up x 7days
Absolute c/is for use of CHCs
Slide 77, Deck 1
What are potential complications from CHCs
HTN Mood swings Stoke Thromboembolism Inc cholelithiasis Post pill amenorrhea Benign hepatic tumors
What are the continuous PO contraceptives
How are these different than other OCPs?
S/e risks are same as OCPs but inc of ?
EE + Levon
EE
Levon + EE
Other OCPs skip placebo week
Break through bleeding
Transdermal CHCs use
What are the adverse facts of this form?
1 patch x 3wks
Patch free x 7d for menses
Inc risk of VTE
>90kg inc patch failure rate
Backup requirements for transdermal CHCs
Detached patch procedures
Delayed during 1st wk- reapply and back up x 7days
82/83
Why are CHC vaginal rings poor choices for deployments?
What are the back up reqs?
What steps are taken if this falls out?
Reqs refrigeration
4mon shelf life, less if hot
Start day, none
Day 2-5 start- 7days
<3hrs: Replace w/in 3hrs
>3hrs: rinse, replace, back up x 7days
What are the shared advantages of NuvaRing and OrthoEvra?
Vid 1 1 18 00
Compliance, return of fertility
Trends w/ contraception that are declining and increasing?
Decline- Fertility Number of births per person Pregnant/Birth/Abortion rates Fetal/neonatal deaths
Increasing:
Age of first pregnancy
Low birth weights
Maternal/infant mortality
