OBS + GYNAE Flashcards
Which form of contraception is effective immediately?
Copper IUD.
Which form of contraception is effective after 2 days?
POP.
Which forms of contraception are effective after 7 days?
COCP
Implant
Injection
IUS
Which types of contraception consist of combined hormones?
COCP
Which types of contraception contain only progesterone?
POP
Implant
Injection
IUS
Which types of contraception are non-hormonal?
Copper IUD
Mechanism of action of COCP?
Inhibits ovulation.
Mechanism of action of POP?
Thickens cervical mucous.
Mechanism of action of contraceptive implant?
Primary MoA = inhibits ovulation.
Secondary MoA = thickens cervical mucous
Mechanism of action of contraceptive injection?
Primary MoA = inhibits ovulation.
Secondary MoA = thickens cervical mucous
Mechanism of action of copper IUD?
Decreases sperm motility and survival due to toxic effects.
Mechanism of action of hormonal IUS?
Primary MoA = prevents endometrial proliferation.
Secondary MoA = thickens cervical mucous.
Most effective form of contraception?
Implant.
How long does the contraceptive implant last?
3 years.
How long does the Depo Provera last?
3 months.
How long does the copper IUD last?
5-10 years.
How long does the hormonal IUS last?
3-5 years.
When does the POP provide immediate contraceptive protection?
If commenced up to or on dat 5 of the cycle.
Instructions for missing 1 COCP at any time?
Take missed pill ASAP.
Take next pill at normal time, even if this means taking 2 pills in one day.
**No emergency contraception needed.
Instructions if more than 1 COCP is missed?
1) Take the last pill ASAP.
2) Take the next pill at normal time, even if this means taking 2 pills in one day.
3) Use barrier contraception until the pill has been taken for 7 days.
**Further steps depend on the time of cycle that the pills have been missed and if the patient has had UPSI.
Additional steps if 2 COCPs are missed and the patient has had UPSI in week 1 or the pill free interval?
Emergency contraception required.
Additional steps if 2 COCPs are missed and the patient has had UPSI in week 2 of cycle?
Use barrier contraception until pill taking has been re-established for 7 days.
Additional steps if 2 COCPs are missed and the patient has had UPSI in week 3 of cycle?
Omit the pill free interval.
When is the cerazette (desogestrel) POP considered as being taken late?
If taken >12 hours late (>36 hours after last one).
When are all POPs aside from desogestrel considered as being taken late?
If taken >3 hours late (>27 hours after last one).
What actions are required if a patient takes a POP late
1) Take missed pill ASAP and take next pill at normal time, even if this means taking 2 in one day.
2) Continue taking the rest of the pack.
3) Extra precautions (condoms) should be used until pill-taking has been re-established for 48 hours.
UKMEC 3 COCP contraindications.
>35 + smoking <15 a day. BMI >35 FHx thromboembolic ideas in primary relative <45 y/o. Controlled HTN Immobility (including wheelchair use) BRCA carrier Current gallbladder disease
UKMEC 4 COCP contraindications.
>35 + smoking >15 a day Migraine with aura PMHx thromboembolic disease or thrombogenic mutation PMHx of stroke or IHD Breastfeeding <6 weeks post party Uncontrolled HTN Current breast cancer Major surgery with prolonged immobilisation Positive antiphospholipid antibodies
When is contraception required from in the postpartum period?
From 21 days.
An inter-pregnancy interval of <12/12 is associated with which complications?
Increased risk preterm birth
Increased risk low birth weight
Small for gestational age baby
Which methods of contraception can be started any time postpartum regardless of breastfeeding?
POP
Injectable contraception
How quickly is POP effective if started on day 21 in the postpartum period?
Immediately
How quickly is injectable contraception effective if given on or before day 21 in the postpartum period?
Immediately
How quickly is POP effective is started after day 21 in the postpartum period?
After 2 days.
1) Which injectable contraception can be given immediately after birth?
2) Which injectable contraception causes heavy bleeding if given immediately post partum?
1) Norethisterone.
2) Medroxyprogesterone.
When can the IUD or IUS be inserted to provide effective contraception?
Within 48 hours of delivery or after 4 weeks of delivery.
What are the contraindications to IUD/IUS insertion directly after childbirth?
Intrapartum/ postpartum sepsis
Prolonged rupture of the membranes
Why can the COCP not be used for contraception in the first 21 days after childbirth?
Due to increased risk of VTE postpartum.
When can the COCP be used as contraception after childbirth?
On day 21 if not breastfeeding.
After 6 weeks if breastfeeding.
What are the conditions that need to be met to ensure that lactational amenorrhoea as a form of contraception is effective?
Full breastfeeding
Amenorrhoeic
<6/12 postpartum
When is contraception required for peri-menopausal women?
If <50, until they are amenorrhoeic for 2 years.
If >5/= 50, until they are amenorrhoieic for 1 year.
Which forms of contraception can be used up until the age of 50?
COCP
Depo Provera
Which forms of contraception can be continued in patients older than 50?
POP
Implant
IUS
Management of uncomplicated candidiasis?
1st = PV clotrimazole
2nd = PO fluconazole or itraconazole
Management of complicated candidiasis?
**DM/ immunocompromised/ pregnant.
PV clotrimazole/ miconazole for 7/7.