OB Block 3 Flashcards

1
Q

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?

A

COCs

Pregnancy
Birth control is safer

Emergency, <5d after intercourse
Migraine w/ aura (no estrogens)

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2
Q

C-section delivery is a proxy for ?

What are the three leading causes of infant death?

A

Delivery mortality increase

Congenital malformations
LBW- 14% <500g survive infancy
SIDS

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3
Q

What country in the industrialized world has the highest rates of unintended pregnancy?

Why is this unique?

A

USA

Half use contraception
One third on OCPs

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4
Q

How much money is saved from teenage mother/pregnancy?

What are the three goals of preconception counseling?

A

$1445/mother/yr x 15yrs

Education
Preconceptional care
Reduced disparities/risks

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5
Q

When is preconception counseling conducted?

Future mothers w/ ? BMIs need counseling

A

Routine well visits
Neg preg tests
Planning future pregnancy
Prescribing birth control

> 30kg/m2
<18.5kg/m2

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6
Q

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?

A

40y/o at conception

SIDS Preterm IUGR LBW

Father present at birth

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7
Q

Highest form of BC in US?

What is the most effective?

Only contraceptive for PTs w/ breast cancer?

A

Combo pill

IUD/Implant

Copper IUD

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8
Q

What are the tiers of birth control

What is a commonality across the tiers??

A

1: Implant IUD Sterilization
2: Injection Pill Patch Ring
3: Barrier Behavior
4: Spermicide Sponge
No: Abortion Plan B

None have estrogen alone

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9
Q

What are the reasonably certain ways to determine female is not pregnancy

A

<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

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10
Q

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?

A

Copper

Cu IUD- Biman/cervical exam
LRIUD- Biman/cervical exam
CHC- BP measurement

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11
Q

What are the two times additional follow up is needed after birth control installation?

What BP measurements are concerning for PTs on birth control

A

IUD- exam for strings
CHC- BP after starting

> 160/>100= avoid COC/Depo

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12
Q

When are smokers and contraception used or avoided?

When are COCs and migraines used

What are the recommendations w/ DM

A

<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

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13
Q

How are PTs w/ RA managed w/ birth control

PTs w/ DVT/PE Hx can’t get ?

PTs w/ HIV can have ? methods?

A

SLE, no Abs- COCs ok
SLE, +Abs- avoid hormones
Caution w/ Depo, osteoporosis risk

No COCs

All ok
Spermicide inc transmissions

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14
Q

What methods can breast feeding moms use?

What are the indications a PT should use an IUD?

A

<1mon post partum- no COCs
Use progesterone

Stable, monogamous
Hormone avoidance, Cu
Nulliparous/adolescent
Levo IUD- dysfunctional bleeds

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15
Q

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

A

CA Antiphospholipid Abs Thromboembolic dz
10yrs

Progestin
M, K- 5yrs
L, S- 3yrs

Prevents fertilization and implantation via endometrium inflammation
No impact on ovulation

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16
Q

What adverse effect happens w/ Cu IUD

How long does it take for fertility to return after removal

A

Common in 1st 3mon:
Dysmenorrhea/heavier
Tx w/ NSAIDs

Immediately

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17
Q

How long does LNG IUD stay in and what is the MOA

What is a s/e

What is a benefit

A

5yrs w/ progestin release
Dec implantation/sperm motility
Inconsistent ovulation inhibition

Infection 1mon after placement
Irregular/spot bleed x6mon
Amenorrhea

Improves dysmenorrhea

18
Q

When are LVN IUDs placed

How long after placement do PTs need to f/u?

If lost/invisible what is the next step?

A

> 7 days after menses started, use back up x7 days

6wks

Exclude pregnancy
Cytologic brush to bring string into vagina
No string= US

19
Q

What is the increased risk if PT becomes pregnancy w/ IUD?

Nexplanon

MOA of Nexplanon

A

Ectopic pregnancy
2nd trimester miscarriage

Etonogestrel rod subdermal implant- 3yrs suppressed ovulation

Progestin inhibits LH release, implantation, sperm motility

20
Q

What is a benefit of Nexplanon?

Adverse effects

What are two absolute c/i for this method

A

Efficacy not affected by obesity

ALL progestin contraceptives- irregular/heavy bleeding

Current breast Ca
Pregnancy

21
Q

When is Nexplanon placed

What back up is needed

How long for fertility to return

A

W/in 5 day onset of menses

x7 days

6wks, up to 12mon

22
Q

Nexplanon is an option for ? PTs

Depo

MOA of Depo

A

Postpartum
Spot/Induced abortions

150mg IM q3mon delt/glut

Suppress LH
Inhibit sperm motility
Inhibits implantation

23
Q

What are non-contraceptive benefits of Depo?

What are C/is?

What is the absolute c/i?

A

Improves menorrhagia, dysmenorrhea and endometriosis pain
Dec endometrial hyperplasia Ca risk

Recent breast Ca
Progesterone pos Ca
Prior ectopic pregnancy
Pregnancy

Current breast Ca

24
Q

What needs to be added in diet for PTs on Depo

What is an adverse risk?

A

Vit D/Ca, Depo block endogenous estrogen secretion

Functional ovarian cyst

25
Q

POPs

What are the MOAs

What PTs is the primarily used in?

A

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

26
Q

What is PT misses time frame for POP

What are the absolute c/is to POPs

A

Back up x48hrs

Breast Ca
Pregnancy

27
Q

How many COC pill combos

How many patch forms

How many transvaginal ring forms

A

> 90

One

One

28
Q

What is the MOA of CHCs

A

Blocks LH, inhibit ovulation
Prog: suppresses ovulation, motility and implantation
Est: suppresses ovulation, stabilizes cycle control

29
Q

Most CHCs are less than ?mcg due to ?

3rd gen newer progestins

What are 4th generation progestins best for but w/ ? risk

A

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

30
Q

What is the most important effect of Tier 2 CHCs

The later the generation of progesterone= ?

CHCs have a hormone free interval lasting ? days

A

Suppression of GnRH to inhibit LH/FSH= inhibited ovulation

Less androgenic effects

4-7days for menstruation, if skipped= continuous

31
Q

What is the most popular reversible contraceptive in the US

What are the benefits

What are the risks?

A

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

32
Q

What are the non-contraceptive benefits of PO CHCs?

How long does it take for fertility to return?

A

Dec uterin bleeding, dysmenorrhea, acne and hirsutism
Improves PMDD Sxs d/t Drospirenone

1-2wks after stopping
Regular in 12mon

33
Q

Define PO CHC 1st Day Starts

Define “Sunday Starts”

Define “Quick Starts”

A

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

34
Q

Absolute c/is for use of CHCs

A

Slide 77, Deck 1

35
Q

What are potential complications from CHCs

A
HTN
Mood swings
Stoke
Thromboembolism
Inc cholelithiasis
Post pill amenorrhea
Benign hepatic tumors
36
Q

What are the continuous PO contraceptives

How are these different than other OCPs?

S/e risks are same as OCPs but inc of ?

A

EE + Levon
EE
Levon + EE

Other OCPs skip placebo week

Break through bleeding

37
Q

Transdermal CHCs use

What are the adverse facts of this form?

A

1 patch x 3wks
Patch free x 7d for menses

Inc risk of VTE
>90kg inc patch failure rate

38
Q

Backup requirements for transdermal CHCs

Detached patch procedures

A

Delayed during 1st wk- reapply and back up x 7days

82/83

39
Q

Why are CHC vaginal rings poor choices for deployments?

What are the back up reqs?

What steps are taken if this falls out?

A

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

40
Q

What are the shared advantages of NuvaRing and OrthoEvra?

Vid 1 1 18 00

A

Compliance, return of fertility

41
Q

Trends w/ contraception that are declining and increasing?

A
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