OBGYN Block 3 Flashcards
What is the MC form of contraception in the world?
What is the MC form used in the US?
IUD
PO CHCs
What two forms of contraception are not recommended for PTs w/ HTN?
What form is not recommended for PTs w/ migraine and aura?
Depo, CHC
CHCs
What are the 5 tiers of contraception?
What tier would PTs w/ HIV want to avoid?
1: implant, IUD, Sterilization
2: Ring Injection Pill Patch
3: Barrier Behavior
4: Spermicide Sponge Cream/Jelly/Foam
No: Plan-B Abortion
4: spermicide
What are the criteria for being reasonably certain PT is not pregnant?
<7d after start of normal menses
No intercourse since start of last normal menses
Correct/consistent contraception use
<7 days post-abortion
<4wks post-partum
Breastfeeding >85%, amenorrheic and <6mon post-partum
What form of contraception can HIV PTs use?
Breast feeding PTs should not be given COCs if they are post-partum for how long?
All forms, caution w/ spermicide
<1mon PP, no COCs
Use POPs
Tier 1 contraceptives are AKA ?
What are the indications for a PT to receive an IUD?
Long Acting Reversible Contraception (LARCs)
Hormone avoidance Adolescent Nulliparous Dysfunctional bleeds- Levon Stable relationship
What are the 4 brands w/ length of use?
What is their MOA?
? term encompasses the brand names?
Mirena- 5yrs
Liletta- 3yrs
Kyleena- 5yrs
Skyla- 3yrs
Prevention of fertilization
Levonorgestrel
Cu IUD
Endometrial inflammation
No impact on ovulation
Dec sperm/egg viability, motility
Anti-blastocyst action
Good for:
Breast Ca
Anti-phospholipid Ab syndrome
Thromboembolic dz
What are the s/e of Cu IUD?
How long does it take for fertility to return upon d/c of this form?
Menstrual changes- first 3mon
Possible dysmenorrhea or heavier cycles, Tx w/ NSAIDs
Immediately
Levonorgestrel IUDs are used for how long?
The long term progestin release of this form leads to what 3 results?
Used up to 5yrs
Dec sperm motility
Inconsistent ovulation inhibition
Endometrial atrophy prevents implantation
What are the s/e of using Levonorgestrel IUDs?
What is a benefit of using these?
Spot/irregular bleeds x 6mon
1mon post-insertion- device related infections
Improves dysmenorrhea
What do PTs have to do if Levonorgestrel device is placed >7d after menses started?
When do they need to f/u w/ PCM?
What is done if strings can’t be visualized?
Use back up x 7d
6wks
Verify non-pregnancy
Cytology brush to entangle strings and pull into vaginal vault
No strings= US
What are the S/Sxs of PT that has an IUD that has moved into lower uterine segment?
When are IUD expulsions more common?
Continued/new pelvic pain or cramps
First month
Placement <6wks post partum
<25y/o
If PT becomes pregnant w/ IUD in place, there is a higher change of ?
If PT has 2nd trimester miscarriage w/ IUD in place there is a higher likelihood for ?
Ectopic pregnancy
Infection
MOA of Etonogestrel rod implant
How long is this good for?
This form can’t be seen on ? imaging and is not affected by ? PT Hx
Inhibits LH, endometrial atrophy, thickens mucus=
Inhibits ovulation*, implantation and sperm motility
3yrs
Radiopaque
Obesity
What is the MC adverse effect of all progestin-only contraceptives?
What are the two absolute c/is for use?
Irregular/heavy uterine bleeds
Current breast Ca
Pregnancy
Nexplanons are placed w/in ? days of menses onset
What if this time limit is not met and device is still inserted?
5days
Back up x 7d
How long does it take for fertility to return after removal of Nexplanon?
When is Nexplanon use more preferred?
6wks, up to 1yr
Post-partum/abortion
Lactating
How often are Depo shots given?
What is the MOA
150mg q3mon IM- delt/glut
Same as progestin only:
Inhibits LH, endometrial atrophy, thickens mucus=
Inhibits ovulation, implantation and sperm motility
What is the non-contraceptive benefit of Depo?
What are the c/is?
What is the absolute c/i?
Improves dys/menorrhea, endometriosis pain
Dec risk hyperplasia/cancer
Inc risk functional cysts
Recent breast Ca
Progesterone + Ca
Prior ectopic pregnancy
Pregnant
Current breast Ca
What are the adverse effects of Depo use?
How does this effect post-partum status?
Bone loss, reversible (supp E secretion) Irregular bleeding Weight gain Amenorrhea Severe HTN Prolong anovulation/amenses after d/c
No impairment on milk production
What are POPs AKA and what is the only formula?
Norethindrone 0.35mg
Mini-pill
What is the MOA of POPs?
What is a non-contraceptive MOA?
Inhibits LH, endometrial atrophy, thickens mucus=
Inhibits ovulation, implantation and sperm motility
Unreliable ovulation inhibition
POPs are mostly used in ? PT population?
What PT education piece has to go with this Rx?
Breast feeding
Estrogen c/i PTs
Same 4hr window every day of use back up x 48hrs