Ob Unit 6

Question 0

HORMONAL METHODS OF CONTRACEPTIVES

Answer 0

HORMONAL METHODS

• Inhibit ovulation
• Cause endometrial changes that inhibit implantation
• Cause cervical mucus changes that are hostile to sperm
• Birth control pills/ ring/ patch, implanon, Depo-Provera
• Effectiveness can be decreased with certain medications
• *******Antibiotics, antiretrovirals, anticonvulsants, sedatives, antifungals, & antituberculosis drugs
• Failure due to omission of a pill, failure to replace contraceptive patch/ring, failure to get injectable dose at 3 month intervals
• Potential contraindications for use:
• *******Thromboembolic disease (DVT, PE), cerebrovascular disease, coronary artery disease, hypertension, hx of breast cancer, gallbladder disease, liver disease, estrogen-dependent tumors, smoking over the age of 35, diabetes for more than 20 years, less than 1 month postpartum
• ****Dependent on the amount of estrogen & progesterone in each “type”
• NO protection against HIV or other STIs

Question 1

ISSUES TO CONSIDER WITH CONTRACEPTIVE OPTIONS

Answer 1

• Comfort with their body
• Desire to keep contraception independent of intercourse
• Degree of cooperation they can expect from their partner
• Protection against STIs

Question 2

The hormonal method oral contraceptives (the pill)

Answer 2

• Must remember to take every day
• Combination pill with estrogen and progesterone most common
• Suppress action of hypothalamus & anterior pituitary leading to low levels of FSH & LH

Question 3

EMERGENCY CONTRACEPTION

Answer 3

• May be used after consensual unprotected intercourse as well as after sexual assault
• *******Methods include:
• *******Combined oral contraceptives (COCs)
• *******Progestin only pills (POPs)
• *******Copper IUDs
• *******Mifepristone – RU 486 (not used in US)
• *******Ella – prescription only – effective within 120 hours of unprotected sex

Question 4

PELVIC INFAMMATORY DISEASE

Answer 4

• Ascending infection of pelvic organs (uterus, tubes,ovaries, & supporting structures
• ****Can extend to cause pelvic peritonitis
• ****Gonorrhea/chlamydia infections most frequent cause
• ****High incidence with IUD users (increased risk up to 3 wks after insertion)
• ****Most apt to occur at end of menstrual period
• ****Major concern for FERTILITY later on

Question 5

HERPES GENITALIS

Answer 5

• Causative agent: herpes simplex virus- both Type I (cold sores) & Type 2 (traditional genital infections). Both may occur as vaginal infections b/c of oral-genital contact
• Signs & Symptoms: Same for both types!
• **Primary episode- blister like vesicles that appear a few days to 20 days after exposure. Rupture spontaneously to form extremely painful, open, ulcerated lesion, dysuria, flu-like symptoms, genital puritis or tingling.
• **Also may have inguinal lymph node enlargement.
• **Symptoms last 2-3 weeks.
• **After lesion heals, virus dormant residing in nerve ganglia of affected area.
• **Male may have lesions, greenish-yellow discharge, dysuria, urinary frequency

Question 6

Herpes Genitalis

Answer 6

• Diagnosis: pap smear, colposcopy, or HPV DNA test
• Treatment: NO CURE!!
• **Treated with acyclovir (zovirax), valacycovir (valtrex), or famciclovir (famver) to shorten shedding time
• **OR given at 36 weeks gestation to prevent active lesions.
• **May cleanse or douche with betadine solution or Burrow’s solution to prevent secondary infection.
• **Vit. C or lysine frequently suggested to prevent recurrence

Question 7

Herpes Genitalis

Answer 7

• Maternal Implications: Presence of an active lesion at time of delivery will require a C/section delivery.
• **Virus can transfer into amniotic fluid after ROM. 20-50% rate of spontaneous AB or stillbirth if infection occurs in 1st trimester.
• **Increased risk of cervical cancer questionable
• Fetal/Neonatal Implications: Ascending virus after ROM or direct contact with virus as baby passes thru birth canal almost always transmit infection to baby.
• **May be asymptomatic for 2-12 days, then develop fever, jaundice and seizures.
• **50% of babies who survive, suffer severe permanent brain damage.

Question 8

Herpes Genitalis

Answer 8

• Other Significant Information: Primary episode usually the worst. * Recurrence triggered by emotional stress, menses, ovulation, pregnancy, vigorous intercourse, poor health, tight clothing, overheating.
• Recurrence usually less painful.
• Teach patient to keep genital area clean & dry, wear cotton undies.