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Saude sexual e reprodutiva Flashcards

1
Q

Planeamento familiar

A
  • planning of when to have children and the use of birth control and other techniques to implement such plans

o Avaliação de eficácia
- Indice de Pearl- common measure used to summarize contraceptive effectiveness
. Number of pregnancies per 100 women a usar o metodo/years

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2
Q

Metodos mais eficazes

A
  • Implante é o melhor (uso perfeito e uso tipico)

- também bom o Depo provera, e DIU

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3
Q

Escolha do metodo

A
  • Age
  • Culture
  • Socio economic conditions
  • Objectives
  • Chronic diseases (alt hepatica nao deve fazer contraceção oral combinada)
  • Mechanism of action
  • Adverse events
  • Noncontraceptive benefits
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4
Q

Eligibilidade medica para utilizar metodo contracetivo

A
  • ACOG e WHO
  • Cat 1 : sem restrição
  • Cat2: beneficio > risco
  • cat 3: Risco > beneficio
  • Cat4: CI
  • Ex: LES com SAFF ->unico metodo cat 1 - DIU cobre, Contraceção oral combinada Cat 4
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5
Q

Class de metodos contracetivos

A 
- Não hormonais
o Fertily awareness methods 
. Calendar method
. Cervical mucus method (Billings)
. Basal body temperture (BBT)
. Symptothermal Method
. Fertility Monitoring Devices

o Withdrawal (coito interrompido)

o Barrier methods

o Lactational amenorrhea

o Intrauterine device

o Sterilisation (female/male)

- Hormonais
o Combined hormonal contraceptives  (estrogenio e progestativos)
. Oral
. Transdermal (Patch)
. Vaginal (ring)
. Injectable (não há em PT)

o Progestin-only contraceptives
. Oral
. Injectable (acetato de medroxiprogesterona)
. Subdermal (implante com etanogesterel)
. Levonorgestrel IUD (3 tipos com duração e quantidade de hormona diferente)

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6
Q

Metodo de calendario (Ogino e Knaus)

A
  • Evaluation six months (6 ciclos), ovulation occurs 14 days before next cycle
  • Periodo fertil:
    o First day = subtract 18 days from the shortest cycle experienced
    o Last day = subtract 11 from the longest cycle experienced
  • pressupost que a mulher so tem 1 ovulação por mês
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7
Q

Metodo do muco Billings

A
  • Evaluation of cervical mucus and
    sensations at vaginal introitus.
  • Periodo fertil: : Final day of stretchy,
    transparent mucus →3 days after
    cervical mucus is no longer detected
  • Após a menstruação o muco aumenta de volume e de filância, o 1- dia do periodo fertil inicia-se no 1º dia de muco filante e termina 3 dias após a filância máxima
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8
Q

Metodo de T basal

A 
- measured on waking and before
any activity
- Aum progesterone following ovulation →
 small increase in BBT (0,3 -0,8ºC), which remains until the beginning of next menstruation
- The couple avoids vaginal sex or uses
a barrier method from the first day of a
menstrual period until 3 days after the
woman's temperature has risen above
her regular temperature.
- T basal (oral, vaginal, rectal) 
the temperature rise identifies the end, rather than the onset of the fertile period
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9
Q

Metodo sintotermico

A
  • Observation of more than one indicator of fertility (BBT, cervical secretions, calendar)
  • More effective than using a single indicator
  • muito dificil de praticar
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10
Q

Amenorreia de lactação

A
  • Amamentação pos parto
    o Baby ≤ 6 months
    o Mother still amenorrhea
    o Practices exclusive breastfeeding on demand, day and night
    o Efficacy ≥ 98%- 6 meses
  • Hormonas na amamentação: chupar aum prolactina -> dim LH e beta-endorfina-> dim GnRH -> dim LH
  • Inibição da ovulação
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11
Q

Metodos de barreira

A 
- Mechanical
o Condom (male, female), diaphragm, capuz cervical
  • Spermicides: (nonoxinol-9)
    o Creams, foams, films, vaginal suppositories
  • Mixed
    o Contraceptive sponge
  • Advantages:
    o Accessibility, easy to use, male contraception, provide protection STIs
  • Disadvantages:
    o Irritability/allergy, interferes with sexual intercourse,
    effectiveness variable
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12
Q

Contracetivo hormonal combinado

A 
- Estrogen component: 
Ethinyl estradiol (EE), estradiol valerate, 17 ß estradiol (2 ultimos mais parecidos com o estrogenio nativo)
  • Progestin component:
    o Derived from testosterone
    Levonogestrel, gestodene, desogestrel, etonogestrel, norelgestromin,
    norgestimate,dienogeste

o Derived from progesterone
Cyproterone acetate, chlormadinone acetate, nomegestrol

o Derived from spironolactone
Drosperinone

  • VIA:oral, vaginal,transdermal, injectable
  • Formulações: 21, 24 ou 28 pills/monophasic (todas a mesma dose), biphasic (2 doses), triphasic
  • Def em estudos epidemiologicos:

o First generation oral contraceptives- ≥ 50 µg EtinilEstradiol

o Low dose oral contraceptives- ˂ 50 µg EE

o Second generation- 20,30, 35 µg EE + levonorgestrel, norgestrel, norgestimate (- risco trombose que 3 gen)

o Third generation- 15, 20,25,30 µg EE+ desogestrel/ gestodene

o Fourth generation- drosperinone/dienogest (bom para acne e hemorragias)/ normegestrol acetate (mais natural mas as mesma CI)

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13
Q

Mecanismo de ação de CHC

A
  • Estrogen:
    o Stability to the endometrium (menos spotting)
    o Inibition FSH (prevents the emergence of a dominant follicle)- Os estrogenios por inibicao da libertacao de fsh- inibem a emergencia do foliculo domimante
    o Aum intracellular progestational receptors
- Progestogen:
o Inibition LH  (inibition ovulation)
o Decidualized endometrium
o Thick cervical mucus
o Alteration of motility of fallopian tubes
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14
Q

CI Cat4 CHC

A
  • Venous/pulmonar thromboembolism
  • Ischemic heart disease, stroke
  • Known thrombogenic mutations
  • Age ≥35 years + smoking ≥15 cigarettes per day
  • Postpartum ˂ 21 days + other factors for VTE
  • Breastfeeding ≤ 6 weeks postpartum
  • Hypertension (systolic ≥160 mmHg or diastolic ≥100 mmHg)
  • Complicated valvular heart disease
  • Major surgery + prolonged immobilization
  • Multiple risk factors for arterial cardiovascular disease
  • Systemic lupus erythematosus (positive antiphospholipid antibodies)
  • Breast cancer
  • Cirrhosis, Hepatocellular adenoma or malignant hepatoma
    Migraine with aura
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15
Q

Beneficios não contraceção dos CHC

A 
- Menstrual cycle disorders
o Menorrhagia
o Dysmenorrhea
o PMS and premenstrual dysphoric disorder
o Prevention of menstrual migraine
  • Cancer risk reduction: endometrial, ovarian and colon cancer
  • Hyperandrogenism: acne,hirsutism
  • Others: pelvic inflamatory disease, fibrocystic breast disease, endometriosis, ectopic pregnancy, leiomyomas
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16
Q

CI Cat4 da contraceção so de progesterona

A
  • Doença mamária
17
Q

Mec ação de contraceção so de progesterona

A

-Oral, subdermico, injetaveis e DIU de Levanorgesterel

  • Reduction of sperm penetrability of cervical mucous
  • Alteration of endometrium and reducing likelihood of implantation
  • Supression of ovulation (menos DIU de levanorgesterel)
  • Desvantagens: : Irregular bleeding patterns, functional ovarian cysts, headaches, emotional lability, acne, breast pain, weight gain, changes in libido
18
Q

Interações farmacologicas

A
  • Drugs that increases liver microsomal enzyme (não se aplica aos injetaveis nem DIU)
    o Estroprogestatives, progestin-only pill, implant
  • Anticonvulsivants: (exception-gabapentin, levetiracetam, and tiagabine, sodium valproate)
  • Antibiotics: rifampim and rifabutin (TB)
  • Antiretrovirais: protease inhibitors (exception: Atazanavir, Amprenavir, Indinavir),
    ↑ toxicity of antiretrovirals
19
Q

DIU

A

tipos:
o Unmedicated IUDs (corpo estranho)
o Cooper IUDs (não e abortivo pois atua antes da implantação)
o Levonorgestrel (LNG)IUDs

MEC Ação:
o Cooper IUD: toxic to the sperm, oocytes and endometrium
o LNG IUD: thickens cervical mucus, supresses endometrial proliferation, supression ovulation (25%)

20
Q

CI DIU

A

o Pregnancy

o Uterine malformations

o Significantly distorted uterine anatomy (miomas pex principalmente submucosos)

o Pelvic inflamatory disease (current or in last 3 months)-> mas a taxa de provocar é baixa

o Unexplained vaginal bleeding

o Gestational trophoblastic disease

21
Q

EA e Complicações do DIU

A 
- EA:
o Pelvic pain
o Spotting
o Very heavy periods
o Vaginal discharge
o Acne, Hirsutism (LNG IUD)
o Weight gain (LNG IUD)
o Headache (LNG IUD)
o Ovarian cysts (LNG IUD)
- Complicações
o Expulsion
o Infection
o Uterine perfuration
o Pregnancy
  • Desvantagens:
    o Need professional trained for placement
    o Increased uterine bleeding (except with LNG IUD)
    o > risk inflamatory pelvic disease if STIs
22
Q

Esterilização

A
  • Metodos de oclusão tubarica

o Mini-laparotomy

o Laparoscopic (+ comum):
. Cut and closed (cortada e cozida)
. Sealed- electrocogulation
. Closed- clips, rings

o Hysteroscopic
Essure® (items de titanio que pode migrar), Adiana®

o Culdoscopy

  • HOMEM -> VASECTOMIA
  • Advantages:
o Highly  effective and cost-effective
o Outpatient procedure
o Local anesthesia
o Lower  rate of complications: 
o Infection, haematoma, bleeding, 
o Granuloma formation, epididymitis
  • Disadvantages:
o Surgical
o Not protect sexually transmitted diseases
o Not provides immediate sterilisation:
. 20 Ejaculations/12 weeks
o Require semen analyses
23
Q

Aconcelhamento preop esterilização

A
  • Permanent contraception
  • Long- Acting Reversible Contraceptives
  • Discuss advantages, disadvantages, anesthesia
  • Possibility of failure
  • Not protect sexually transmitted diseases
  • Informed consent process
    Age ≥ 25 years (Artg 10º, Law 3/84)
24
Q

Contraceção de emergência

A
  • Indicações:
    o Unprotected sexual intercourse
    o Violation
    o Incorrect use of contraceptives

Tipos e eficácia:

  • Método Yuzpe - 47-89% (Yuzpe- 200g de etinil-estradiol e 1mg de levonorgestrel (8 cp de miranova dose unica ou 4 de 12-12h))- eficácia depende da altura do ciclo
  • Levonogesterel - 59-94%- depende da altura do ciclo
  • Acetato de ulipristal - 98-99%
  • DIU cobre- 99%
25
Q

Tipos de contraceção de emergência

A

Emergency contraceptive pills:

o Combined estrogen/progestogen
(Yuzpe regimen)- YUZPE-30 µg etinilestradiol +150 µg levonogestrel,4cp de 12/12h, 1 dia

o Progestogen only
Single dose levonorgestrel (LNG),1,5 mg

o Selective progesterone receptor modulator
Single dose ulipristal acetate (UPA),30 mg

  • DIU cobre
  • MEC ação:
    o Levonorgestrel: inhibition ovulation, prevents follicular rupture or cause luteal dysfuntion

o UPA: delay or inhibition ovulation, if admistred immediately before ovulation.- ulipristal inibe a ovulação após o pico de LH (efeito no endometrio antiprogestagenico, inibi a implantação mesmo que tenha ocorrido a fertilização)

o Cu-IUD: toxic to ovum and sperm, inhibition fertilization

  • ESTES METODOS PODEM SER USADOS ATE 5 DIAS APOS FALHA- SE FOR MAIS DE 3 RECOMENDA-SE O MODELADORES DE RECETORES DE PROGESTERONA E DIU COBRE
  • CI: GRAVIDEZ
26
Q

DIU cobre

A
  • Should be fitted within the first 5 days (120 h) of unprotected sexual
    intercourse or within 5 days of the earliest expected date of ovulation
  • Toxic to ovum and sperm, inhibition fertilization
    Pre- and post- fertilisation effects
  • Failure rate < 1%
  • Long- Acting Reversible Contraceptive
  • CI: Cu-IUD for emergency contraception semelhante routine Cu-IUD insertion
  • Nulliparity, age, previous ectopic pregnancy,risk of STIs are not contraindications to use IUD

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