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Obs and Gynae Flashcards

1
Q

what causes stress incontinence?

A

weakened urethral sphincter muscles mean that the detrusor pressure > urethral closing pressure which causes leakage when coughing and exervising

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2
Q

RF for stress incontinence

A

menopause, vaginal births, congenital weakness, pelvic surgery

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3
Q

How do you investigate urinary incontinence?

A 
Urine stix - exclude UTI
freq/vol chart - functional capacity of the bladder
urodynamics
QoL questionaire
vaginal exam
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4
Q

how do you manage stress incontinence?

A
  1. Conservative - 3 months of pelvic floor exercises, lose weight, stop smoking, treat a cough and constipation
  2. peri-urethral bulking agents

Medication: Duloxetine

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5
Q

what causes overactive bladder?

A

overactive detrusor muscle

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6
Q

what are the RF for an overactive bladder?

A

MS/neurological/incontinence surgery/increasing age

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7
Q

what provokes symptoms of an overactive bladder?

A

provoked by cold weather, opening the front door, coughing and sneezing

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8
Q

how do you manage an overactive bladder? what are the side effects of the first line medical treatment

A
  1. Lifestyle - avoid excess fluids, caffeine, carbonated drinks, alcohol

1st line = oxybutynin (anti muscarinic) - relaxes the detrusor by blocking the parasym - SE = dry mouth/constipation/nausea
2nd line = mirabegron (B3 agonist)
3rd line = botox injection

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9
Q

what is a prolapse?

A

protrusion of organs into the vagina due to weaened pelvic floor

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10
Q

Features of a prolapse (retrocele/cystocele)?

A

dragging sensation
Cystocele - urinary frequency/urgency/incomplete emptying
Retrocele - constipation/difficulty defacating

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11
Q

what are the RF for a vaginal prolapse?

A

prolonged labour, trauma and surgery to the pelvic floor, forcep delivery, chronic cough, obesity, high BMI

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12
Q

How do you investigate a prolapse?

A

clench test

bimanual examination

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13
Q

How do you manage a prolapse?

A
  1. pelvic floor exercises, lose weight, treat cough, stop smoking
  2. pessary (SE - discharge)
  3. surgical repair
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14
Q

what does LH do?

A

binds to theca cells which stimulates production of androgens
induces ovulation

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15
Q

what does FSH do?

A

binds to granulosa cells and converts androgens to oestrogen, and stimulates the production of inhibin

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16
Q

what are primary and secondary amenorrhea?

A

primary - no period by the age of 16

secondary - periods stop for >6 months in women with a previous regular cycle

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17
Q

Name some causes for primary amenorrhea?

A

congenital malformation of organs
Turner’s syndrome
familial
androgen insensitivity

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18
Q

what is Turner’s syndrome? what are the signs?

A 
45X
Coarction of aorta
spade shaped chest - wide nipples and neck
horseshoe kidney
primary amenorrhea
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19
Q

what is androgen insensitivity syndrome?

A

peripheral insensitivity to testosterone despite having genotype 46XY - female phenotype but genetically male

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20
Q

name some causes of secondary ameonrrhea?

A 
thyrotoxicosis
PCOS
Asherman's syndrome
Sheeshan's syndrome
prolactinoma
hypothalamic
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21
Q

what is asherman’s syndrome?

A

scarred uterus from D&C - blood can’t leave uterus due to the scarring

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22
Q

what is sheeshan’s syndrome?

A

ischaemic damage to AP (panhypopituitarism)

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23
Q

name some causes of raised prolactin? what are the signs?

A

prolactinoma, antipsychotics (2nd generation)

galactorrhea, reduced libido, amenorrhea

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24
Q

how do you investigate amenorrhea?

A

bHCG, oestrogen, progesterone
FSH and LH levels
testosterone

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25
Q

what is menarche? when do you investigate?

A

first period - need to investigate if not started by 16. also investigate if no other sex characteristics by the age of 14.

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26
Q

what is the normal order of sexual development in a female?

A
  1. breast buds
  2. pubic hair
  3. axillary hair
  4. menses
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27
Q

what is the role of oestrogen?

A

prepares endometrium for implantation. Keeps the cervical mucus thin which is good for the sperm

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28
Q

what is the role of progesterone?

A

maintains the endometrium and creates a hostile environment to prevent more sperm entering the uterus.

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29
Q

what is dysmenorrhea?

A

painful periods with/without N&V.

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30
Q

how can you manage dysmenorrhea?

A 
Mefenamic acid (NSAID)
Tranexamic acid (if heavy bleeding)
COCP - suppresses ovulation
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31
Q

name some causes of dysmenorrhea?

A

endometriosis, adenomyosis, fibroids, polyp

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32
Q

what is endometriosis?

A

endometrial tissue is present outside of the uterus. Disease driven by oestrogen.
RETROGRADE MENSTRUATION THEORY

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33
Q

what is the presentation of endometriosis?

A 
cyclical pain with menstrual cycle
severe dysmenorrhea
adhesions
deep dyspareunia
dysuria, dyschezia
reduced fertility
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34
Q

what do you find on examination of an endometriosis patient?

A

fixed and retroverted uterus
uterosacral masses on ligament
cervical excitation

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35
Q

Ix for endometriosis?

A

TVUS/MRI
CA125
gold standard = laparoscopy

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36
Q

how can you manage a patient with endometriosis who wants to get pregnant?

A

Mefenamic acid, tranexamic acid

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37
Q

Name some treatments for endometriosis?

A
  1. COCP + paracetamol
  2. Mirena IUS
  3. GnRH analogue (Goserelin)
  4. surgical ablation of endometriosis lesions
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38
Q

name some complications of endometriosis?

A

subfertility, adhesions, chocolate cysts

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39
Q

what is a fibroid?

A

benign tissue of smooth muscle of the myometrium (oestrogen dependant)

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40
Q

how do fibroids present?

A

menorrhagia
subfertility (submucosal)
pain
mass effect on bladder/bowel

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41
Q

How do you investigate fibroids?

A

TVUS

histeroscopy + biopsy

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42
Q

how do you manage fibroids?

A

<3cm - Mirena coil

other: GnRH analogue, myomectomy, uterine artery embolisation

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43
Q

name complications of fibroids?

A

subfertility

red degeneration

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44
Q

what is FGM?

A

any cutting/removal to external female genitalia - ILLEGAL IN THE UK

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45
Q

Acute and chronic effects of FGM?

A

ACUTE - blood loss, death, sepsis, pain, urinary retention

CHRONIC - dyspareunia, apareunia, UTIs, urinary retention

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46
Q

name some physiological ovarian cysts?

A

follicular corpus luteal

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47
Q

name some pathological ovarian cysts?

A

dermatoid (mature teratoma)
mucinous
chocolate cysts

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48
Q

how do ovarian cysts present?

A 
asymptomatic
chronic pain/dull ache/cyclical pain
ACUTE - torsion
irregular bleeding
mass/ascites
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49
Q

IX for a ovarian cyst?

A

FBC, CA125, hCG, CEA
TVUS
MRI

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50
Q

what are the features of lichen sclerosis?

A

hourglass distribution of pearly white areas on the labia minora and the clitoris + regression of this tissue
ITCHY!

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51
Q

What is the definition of menopause?

A

<50 years - no periods for 24 months

>50 years - no period for 12 months

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52
Q

what are the features of the menopause?

A

menstrual irregularity
vasomotor - night sweats, hot flushes, palpatations
atrophy of genitalia and breasts
osteoporosis

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53
Q

How do you manage the menopause?

A 
diet and exercise
oestrogen cream for atrophic vaginitis
SSRI for hot flushes
HRT
bisphosphonates for osteoporosis
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54
Q

what do you use for HRT if the woman has a uterus?

A

opposed oestrogen

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55
Q

name some contradictions of HRT?

A

oestrogen dependant cancer, undiagnosed PV bleed, previous PE

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56
Q

name some side effects of HRT?

A

fluid retention, bloating, acne, tender breasts

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57
Q

what annual checks do you do on a patient

A

BP, weight, breasts, PV bleeding

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58
Q

Risks of HRT?

A

increased risk of Breast cancer, VTE, stroke, MI

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59
Q

what is PID? name some causes

A

upper genital tract infection

chlamydia, gonorrhea, uterine instrumentation, IUCD

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60
Q

how does PID present?

A

abdo pain, dyspareunia, vaginal discharge

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61
Q

how do you investigate PID?

A

STI triple swab check

FBC/CRP/blood cultures

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62
Q

name some complications of PID?

A

Fitz hugh curtis syndrome
recurrent/chronic PID
abscess
subfertility and ectopic pregnancies

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63
Q

how do you treat PID?

A

ceftriaxone, azithromycin, doxycycline

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64
Q

what is PCOS criteria? what does it include?

A

ROTTERDAM CRITERIA
hyperandrogenism
oligomenorrhea
PCO > 12 on US

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65
Q

signs of PCOS?

A

subfertility, oligomenorrhea, hirtuism, acne, obesity, hyperinsulinaemia, acanthosis nigricans

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66
Q

how do you Ix PCOS?

A 
TVUS 
LH and FSH - high LH:FSH ratio
testosterone raised
prolactin
CA125
TFT
glucose tolerance test
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67
Q

how do you manage PCOS?

A

GENERAL - weight loss, stop smoking, dietary advice
metformin - for increased insulin sensitvity
clomifene - induces ovulation
COCP - regulates cycle
cyroproterone - cream for hirsutism

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68
Q

what does PCOS increase the risk of?

A

endometrial cancer, T2DM, gestational diabetes

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69
Q

main feature of endometrial cancer?

A

POST MENOPAUSAL BLEEDING!

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70
Q

RF for endometrial cancer?

A

high BMI, post menopausal, HTN, PCOS, nullparity, late menopause, oestrogen only HRT, HNPCC

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71
Q

how do you investigate endometrial cancer?

A

TVUS - endometrial thickness >4?

hysteroscopy and biopsy –> FIGO staging

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72
Q

what is the commonest type of ovarian cancer?

A

serous cell

73
Q

what is cervical screening looking for?

A

CIN (levels of dykaryosis)

74
Q

what happens with the results of cervical screening?

A

BORDERLINE/MOD –> Test for HPV –> +ve –> colposcopy

MOD –> colposcopy

75
Q

who do we screen for cervical cancer?

A

25-50 screen 3 yearly

50-70 screen 5 yearly

76
Q

how do you manage CIN?

A

loop diathermy

77
Q

symptoms of cervical cancer?

A

post-coital and intermenstrual bleeding, discharge, pain, ureteric and bowel disruption

78
Q

what would you find on examination of a patient with cervical cancer?

A

irregular cervix surface, increased acetic acid uptake, rough and hard cervix, abnormal vessels

79
Q

what causes thrush? symptoms? Ix? management?

A

cause: candida albicans
signs: cottage white cheese discharge, fissures, pain and itch
Ix: MC&S, micella and spores
Mx: topical clotrimazole or oral fluconazole

80
Q

what causes trinchomonas? symptoms? Ix? management?

A

trinchomonas vaginalis
signs: strawberry cervix, thin fishy discharge
wet film: motile flagellates
Mx: metronidazole and contact trace

81
Q

what causes BV? symptoms? Ix? management?

A

gardenerella vaginalis
signs: fishy discharge, large vol, pH>4.5, positive whiff test (add KOH and there is an ammonia smell)
clue cells on microscopy
Mx: metronidazole

82
Q

what causes gonorrhea? symptoms? Ix? management?

A

neisseria gonorrhea
pres: abdo pain, discharge, post-coital bleeding
Ix: swab –> NAAT –> sensitivities
Mx = Ceftriaxone + azithromycin

83
Q

what causes chlamydia? symptoms? Ix? management?

A

symptoms: dysuria, discharge, post coital bleeding
Ix: swab –> NAAT
Mx: azithromycin + contact trace

84
Q

name some complications of chlamydia?

A

PID, fitz hugh curtis syndrome, Reiters

85
Q

what strains of HPV cause genital warts?

86
Q

who do we screen for breast cancer?

A

women aged 50-70 every 3 years with the mammogram

87
Q

commonest type of breast cancer?

A

invasive ductal carcinoma

88
Q

what are the RF for breast cancer?

A

BRCA 1/2, 1st degree

89
Q

who do you refer to a breast specialist?

A

> 30 - woman with lump/pain

>50 - nipple dischrge/retraction/abnormal changes

90
Q

how do we medically treat breast cancer? different age groups and their actions

A

pre-menopause - Tamoxifen (selective oestrogen receptor modulator)
post menopausal - aromatase inhibitor (anastrazole)
HER2 +ve - Herceptin

91
Q

Surgeries used for breast cancer?

A

mastectomy, wide local excision, radiotherapy, chemo, immune checkpoint inhibitors

92
Q

SE of tamoxifen?

A

increasd risk of VTE/EC/hot flushes/PV bleeding/amenorrhea

93
Q

name some benign breast lesions

A

fibroadenoma

cysts

94
Q

Discuss the development of the placenta?

A

develops from trophoblastic cells which invade spiral arteries and form sinuses. Villi form at 6 weeks and forms the functional placenta units –>placenta continues to grow until 16 weeks

95
Q

what are the functions of the placenta?

A

gas exchange, produces hCG/GF/oestrogen/progesterone, barrier to infection/drugs, nutrient transfer.

96
Q

what physiological changes are there during pregnancy?

A

HAEM - increased blood volume - produces physiological anaemia
CVS - increases in CO/SV, reduced peripheral resistance, varicose veins
VENTILATION - increases by 40%
reduced gut motility due to progesterone - constipation/GORD

97
Q

what are the role of progesterone and oestrogen during pregnancy?

A

PROGESTERONE - produced by placenta after day 35. Reduces the smooth muscle excitability (uterus/gut/ureters) and increases the body temperature

OESTROGEN - increases breast and nipple growth, water retention

98
Q

how many days into a pregnancy will the pregnancy test test positive?

A

9 days post conception

99
Q

what is the definition of infertility?

A

inability to conceive pregnancy after 2 years of trying with regular intercourse

100
Q

cause of infertility?

A

male causes
unexplained
ovulation failure
tubal damage (chlamydia/PID)

101
Q

Ix for infertility? what would you be looking at?

A

semen sample

21 day progesterone (low progesterone –> refer to specialist, if it is high this means that ovulation is occuring.)

102
Q

how do you score post-natal depression?

A

Edinburgh post-natal depression scale

103
Q

Features of a multiple pregnancy?

A 
uterus large for date
hyperremesis gravidarum
polyhydramnios
2 fetal heart beats
multiplicity of fetal parts
104
Q

what increases the risk of a multiple pregnancy?

A 
family history
previous twins
IVF
increasing maternal age
clomifene
105
Q

name some complications of a twin pregnancy?

A

polyhydramnios
pre-eclampsia
increased risk of APH
operatie delivery

106
Q

what is an ectopic pregnancy?

A

implantation of a fertilised ovum outside of the uterus (commonly within the fallopian tube)

107
Q

where is the most common site of ectopic pregnancy associated with rupture?

108
Q

what increases the risk of an ectopic pregnancy?

A

IUCD, PID, endometriosis, previous fallopian tube surgery

109
Q

what is the presentation of an ectopic pregnancy?

A 
6-8 weeks amenorrhea
unilateral pain (radiating to the shoulder)
PV bleeding
N&V
signs of shock
110
Q

what do you find on examination of a patient having an ectopic pregnancy?

what Ix would you do?

A

cervical excitation
tender abdomen
adnexal mass

bHCG - >1500
US uterus - empty

111
Q

How do you manage an ectopic pregnancy?

A

EXPECTANT - unruptured, no fetal HB, falling hCG - monitor hCG for 48 hours
MEDICAL - methotrexate
SURGICAL - if ruptured, pain, fetal HB, bHCG>1500 - Salpingectomy

112
Q

what is a miscarriage?

A

expulsion of conception products <24 weeks

113
Q

name some causes of recurrent miscarriages?

A

antiphospholipid syndrome
increasing maternal age
bicornuate uterus
fibroids

114
Q

what are the features of the 4 types of miscarriage (inevitable, incomplete, missed, threatened)

A

INEVITABLE - clots, pain, blood, os open
INCOMPLETE - blood, clots, pain, parts of foetus expelled
MISSED - foetus dead, no expulsion yet
THREATENED - painless PV bleed

115
Q

How can you manage a missed miscarriage?

A
  1. Expectant - wait for the foetus to be expelled spontaneously
  2. MISOPROSTOL (prostaglandin - causes contractions)
  3. surgical vacuum asipration
116
Q

how do you manage an abortion?

A

<9 weeks - Mifepristone (anti-progesterone) + prostaglandins for contractions
>9 weeks - surgical dilation and suction

117
Q

what is the definition of labour?

A

regular painful contractions, effacement of cervix, rupture of membranes and release of cervical plug

118
Q

what do you monitor during labour?

A

fetal - heart rate (CTG)
contractions
maternal - HR/BP/urine/temp

119
Q

what problems arise during stage 1 of labour - how do you manage this

A

inefficient contractions - syntocinin

cephalopelvic disproportion - C section

120
Q

what are the indications for an operative vaginal delivery?

A 
prolonged 2nd stage of labour
maternal exhaustion
fetal distress
under GP
assisted delivery of preterm
breech vaginal delivery
cord prolapse
121
Q

what is cord prolapse?

A

umbilical cord descends below the presenting part of the foetus. Causes cord compression and vasospasm resulting in foetal hypoxia

122
Q

what are the RF for cord prolapse?

A

premature, polyhydramnios, multiple pregnancy, long cord

123
Q

How do you manage a cord prolapse

A

emergency alarms
try and push the cord as far inwards as [possible
deliver fetus ASAP - C section or instrumental
get the patient on all fours

124
Q

complications of the PROMS?

A

maternal - chorioamnionitis, oligohydramnios

fetal - premature, pulm hypoplasia, infection

125
Q

causes of PROM?

A

BV, gonorrhea chlamydia

126
Q

how do you manage PROMs?

A

monitor temp - ensure no infection

10 days erythromycin

127
Q

how do you manage pre-term labour?

A

give corticosteroids - fetal lungs
GBS - give benzylpenicillin
Give an anti-oxytocin - Atosiban

128
Q

how do you manage breech position?

A

at 36-37 weeks undergo extracephalic version

129
Q

C/I to extracephalic version?

A

twins, placental praevia, uterine scars

130
Q

how do you manage shoulder dystocia?

A
  1. call for help
  2. episiotomy
  3. McRoberts manouvre
131
Q

what is a hydaditiform mole?

A

proliferating chorionic villi resulting in raised bhCG and increased symptoms of pregnancy

132
Q

presentation of hydatiform mole?

A 
early miscarriage
HG
uterus large for gestational age
strongly positive pregnancy tests
US - snowstorm effect
133
Q

what is hyperremesis gravidarum?

A

persistant vomiting, weight loss, ketosis

134
Q

features of hyperremesis gravidarum?

A

can’t keep food or drink down, lost weight, dehydration, malloryweiss tear, inability to swallow saliva

135
Q

Ix for hyperremesis gravidarum?

A

urine - UTI/ketosis
FBC - raised haematocrit
US - exclude mole
UEs - low K and Na

136
Q

Mx of hyperremesis gravidarum?

A

admit - correct UE disturbances and correct hydration status
Daily UEs
anti-emetic - promethazine

137
Q

RF for uterine rupture

A

pain during labour
usually occurs on LSCS scars - previous C section
obstructed labour, breech extraction

138
Q

how to manage a uterine rupture?

A

category 1 CS
give O2
cross match blood
post op Abx

139
Q

most common cause of puerperal infection? how do you treat this?

A

Endometritis

Gentamycin + clindamycin

140
Q

what is an APH?

A

genital tract bleeding occuring after 24 weeks

141
Q

name some causes of APH?

A

placental abruption, placenta praevia,vasa praevia

142
Q

how do you manage a APH?

A
  1. Admit - US - where is the placenta?

2. IVI - fluids, O2, raise legs

143
Q

what is abruption? Features of placenta abruption? what is it associated with?

A

placental detaches from uterus
pain, hard uterus, PV bleed, shock out of keeping with visible losses, fetal HR distressed
ASS: pre-eclampsia, smoking, cocaine, abdo trauma

144
Q

what is placenta praevia? RF and features?

A

placenta lying 2.5cm from the internal OS
RF - multiparity, previous C section, uterine surgery
FEATURES - shock proportional to visible losses, no pain, uterus not tender, FHR normal

145
Q

what is vasa praevia?

A

fetal placental vessels lie beneath the presenting parth

Rupture - painless PV bleeding, fetal distress, no pain

146
Q

what does GBS risk to the foetus?

A

meningitis, pneumonia, septicaemia

147
Q

when do you give benzylpenicillin in labour? (GBS)

A

preterm (<37 weeks)
urine sample +ve for GBS
temperature intrapartum
previous child affected by GBS

148
Q

what is pre-eclampsia?

A

HTN, proteinuria and oedema - occur after 20 weeks gestation due to failed trophoblastic invasion of the spiral arteries - raised BP

149
Q

what increased your risk of pre-eclampsia?

A

previous pre-eclampsia, chronic HTN, SLE, anti-phospholipid, CKD

150
Q

complications of pre-eclampsia?

A

HELLP, eclampsia, oedema, ARDS, placental abruption

151
Q

what are the symptoms of pre-eclampsia/eclampsia?

A

asymptomatic, headache, RUQ pain, N&V, oedema, flashing lights, hyperreflexia, tonic-clonic seizure

152
Q

how do you manage pre-eclampsia?

A

MONITOR: BP, URINE, UE/LFT/FBC, strict fluid balance, steroids for fetal lungs

  1. Labetalol
  2. Nifedipine
  3. Prophylactic MgSO4
153
Q

how do you manage eclampsia?

A

MEDICAL EMERGENCY - CALL FOR HELP
- O2/IVI/monitor sats
MgSO4 for seizure (need calcium gluconate to hand)
Monitor FHR

154
Q

what is HELLP syndrome?

A

haemolysis, elevated liver enzymes, low platelets

155
Q

what is the definition of SGA?

A

birthweight < 2.5kg

1 reading < 10th centile/static growth

156
Q

how do you manage a foetus which is SGA?

A
  1. refer for foetal US -e measure size

2. umbilical artery doppler (26-28 weeks)

157
Q

what are the RF for SGA?

A 
maternal age > 40
smoking
cocaine
pre-eclampsia
trisomies
congenital infections
158
Q

RF for gestational DM?

A

BMI>30, previous macrosomic baby, previous gestational DM, 1st degree relative with diabetes

159
Q

what is the diagnostic criteria for DM?

A

fasting glucose > 5.6

2hr glucose > 7.8

160
Q

when do you test for gestational DM?

A

previous gestational DM - OGTT at booking and at 24& 28 weeks
any RF for gestational DM - OGTT at 24 and 28 weeks

161
Q

how do you manage gestational diabetes?

A
  1. Diet and exercise
  2. Metformin
  3. Insulin
162
Q

what effect does gestational diabetes have on the foetus?

A 
Shoulder dystocia
macrosomia
polyhydramnios
stillborn
hypoglycaemia
163
Q

how do you manage chronic HTN in pregnancy?

A

switch the medication to labetalol

164
Q

what is pregnancy induced HTN?

A

HTN > 20 weeks of pregnancy (no proteinuria or features of pre-eclampsia._)

165
Q

when do you screen for anaemia during pregnancy?

A

at booking and 28 weeks

166
Q

how do you manage a MSU +ve sample (asymptomatic bacteruria) in a pregnant woman?

A

Cefalexin 500mg TDS

167
Q

what raises the risk of VTE in pregnancy?

A

Hx of VTE, family history, thrombophilia, SLE, sickle cell, age >35, obesity, parity >3, varicose veins, pre-eclampsia, immobility, dehydration

168
Q

how do you manage a VTE in pregnancy?

A

antenatal LMWH - continue until 6 weeks postpartum

169
Q

what are primary and secondary PPH?

A

primary - loss of >500mL blood in first 24hours after delivery of the baby
secondary - loss of >500mL >24hours after delivery

170
Q

name the causes of a primary PPH?

A

tone
trauma
thrombin
tissue

171
Q

name the causes of a secondary PPH?

A

usually due to retained placental tissue

172
Q

How do you manage a PPH?

A 
CALL FOR HELP
High flow O2, assess airway
2 large bore cannulas
cross match blood
IV hartmaans
  • deliver placenta, empty the uterus of clots
  • syntometrine (contracts the uterus)
  • repair any vaginal tears
  • rusch balloon/compression suture/uterine artery ligation
173
Q

when do you give anti-D immunoglobunlin?

A 
medical terminations
spontaneous miscarriage
evacuation of a mole
ECV
amnioscentesis
174
Q

what are the contraindications for the COCP?

A

BMI>30, breast feeding, HTN, VTE history, migraines with aura, breast cancer

175
Q

how does the COCP work?

A

inhibits ovulation due to negative feedback, inhibits proliferation of endometrium and thickened cervical mucus

176
Q

how does the POP work?

A

thickens mucus in the cervixand to a degree inhibits ovulation, thins the endometrium

177
Q

how long after unprotected sex can you take levongesterel? how does it work?

A

use within 72 hours

delays ovulation

178
Q

how long after unprotected sex can you take ullipristal acetate? how does it work?

A

120 hours after unprotected sex

progesterone receptor modulator

179
Q

how long after unprotected sex can you have the IUD fitted?

Finals (21 decks)

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