SRH and early pregnancy Flashcards
failure of IUCD - how many women become pregnant within first year?
6/1000 perfect use 8/1000 typical use
failure of IUCD - how many women become pregnant within 5 years?
1-2/100
risk of IUCD expulsion
1/20
risk of uterine perforation with IUCD
up to 0.2%
risk of ectopic pregnancy with IUCD
1/20
desogestrel: missed pill
taken up to 12h later, ie within 12h of time pill was taken on preceding day (36h total)
norethisterone: missed pill
taken within 3h of time pill was taken on preceding day (27h total)
levonorgestrel: missed pill
taken within 3h of time pill was taken on preceding day (27h total)
POP: failure rate with perfect use
3/1000
Implant: failure rate
0.05% with typical use
implant: how many will have amenorrhea
1/5 (20%)
implant: how many will discontinue due to heavy or irregular bleeding
1/5 (20%)
TOA: poor prognostic factors associated with lack of response to medical treatment
size of abscess >5cm Age >40 Higher initial white cell count Smoking
female condoms: effective % with correct use vs typical use
95% correct use vs 79% Typical use (failure 21% )
male condoms: effective % with correct use vs typical use
98% correct use vs 82% typical use
diaphragm/cap: effective % with correct use
92-96% Should not be used during menstruation Spermicide reapplied if in situ >3h Do not remove until 6h from last intercourse
incidence of ectopic pregnancy
11/1000
maternal mortality rate for ectopic pregnancy
2/1000
complete molar pregnancy
abnormal diploid (androgenic: empty ovum + haploid sperm, XX) absence of fetal parts snowstorm appearance
partial molar pregnancy
3/1000 abnormal triploid (ovum + 2 sperm) fetal tissue present focal villous hydros and cystic spaces, increased AP diameter
risk of molar recurrence after x1
1/80
risk of molar recurrence after x2
20%
incidence of GTD
1/714 pregnancies
incidence of GTN
1/50 000 pregnancies
choriocarcinoma present in ___% of molar pregnancy
3% (1/40)
hyperemesis definition
1) protracted N/V 2) weight loss >5% 3) dehydration 4) electrolyte imbalance
hyperemesis incidence
0.2-3.6% (vs. NVP up to 80%)
progestogens associated with LOWEST risk of VTE (5-7/10 000)
norethisterone Norgestimate LNG
progestogens associated with INTERMEDIATE risk of VTE (6-12/10 000)
etonogestrel norelgestromin
progestogens associated with HIGH risk of VTE (9-12/10 000)
drosperinon desogestrel gestodene
cervical cap use
insert just before intercourse remove after 6
incidence of ectopic pregnancy
11/1000
USS features suggestive of ectopic
free peritoneal fluid complex of homogenous adnexal mass adnexal gestation sac with or without fetal pole/FHB tubal ring sign
uSS TV threshold
hCG 1000
FN rate of laparoscopy for ectopic diagnosis
3-4.5%
definition of ectopic according to NICE
adnexal mass moving separate to ovary with gestational sac +/- yolk sac +/- fetal pole
definition of probable ectopic according to NICE
adnexal mass moving separate to ovary with an EMPTY gestational sac (bagel sign, tubal sign) or complex inhomogenous mass
definition of possible ectopic according to NCIE
empty uterus or pseudosac
criteria for conservative management of tubal ectopic
1) clinically stable, pain free 2) <35mm (NICE) 3) bHCG <1000 (NICE) 4) no visible FH
when to repeat hCG if conservative management of tubal ectopic
D2, 4 and 7 needs to drop by at least 15%
criteria for medical management of tubal ectopic
1) hCG 1500-5000 2) no visible FH 3) no IUP 4) <35mm
when to repeat hCG if medical management of tubal ectopic
days 4 and 7
medical or conservative tubal ectopic management, hCG monitoring
if decreasing by >15%, repeat weekly until negative. if increasing or <15%, needs USS +/- repeat dose
MTX for tubal ectopic - how long to wait before next conception attempt
3/12
hCG monitoring for salpingotomy
day 7 then weekly
risk of persistent trophoblast with salpingotomy
7% (vs 1%)
risk of repeat ectopic after salpingotomy
8% (vs 5%)
risk of requiring further treatment after salpingotomy
1/5
what percentage of medical management ectopic will need second dose of MTX
3-27%
incidence of cervical ectopic
<1%
cervical ectopic USS features
empty uterine cavity, barrel shaped cx, gestational sac below internal os, absence of sliding sign, blood flow around sac
incidence of c-scar ectopic
1/2000 (13% misdiagnosed as IUP or cervical)
c-scar ectopic USS features
empty uterine cavity, GS or trophoblast anteriorly at level of internal os, embedded at site of previous scar, thin or absent layer of myometrium, doppler +, empty endocervical canal
incidence of interstital ectopic pregnancy
1-6%
interstitial pregnancy USS features
empty uterine cavity, POC or GS laterally in interstitial part of tube, <5mm myometrium, interstitial line sign
surgical options of interstitial pregnancy
electrocauterization, wedge resection or salpingotomy, hysteroscopic resection UAE + MTX
incidence of cornual pregnancy
1/7600 (rarest)
abx prophylaxis prior to STOP
200mg doxycycline PO stat
medical abortion dose <10/40
interval treatment mife/miso 24-48h (200mg mife + 800mcg miso)
medical abortion dose 10-24/40
200mg mife, + 800mcg miso PV, then 400mcg q3h
medical abortion dose 24-25/40
200mg mife, + 400mcg miso q3h
medical abortion dose 25-28/40
200mg mife, + 200mg miso q4h
medical abortion dose >38/40
200mg mife, + 100mcg miso q6h
incidence of N/V in pregnancy
up to 80%
incidence of HG
0.3-3.6%
TFT abnormal in ___% of HG
66% (check for TSH receptor antibodies)
what % of women will need time off work due to N/V in pregnancy
30%
when does HG usually resolve by
90% resolve by 20 weeks
common electrolyte abnormality in HG
hypokalemia, hyponatremia, decreased urea, increased creatinine
LFT abnormal in ___% of HG cases
40%
acid-base disturbance in HG
metabolic hypochloremic alkalosis
first line fluid replacement for HG
NaCL/KCl
first line antiemetics for HG
cyclizine, prochlorperazine, promethazine, chlorpromazine
second line antiemetics for HG
metaclopramide, domperidone, ondansetron
third line antiemetics for HG
corticosteroids (hydrocortisone 100mg IV BD, taper done to prednisolone 40-50mg PO)
PUQE score mild
<6
PUQE score moderate
7-12
PUQE score severe
13-15
incidence of complete molar
1/1000
most common karyotype complete molar
46XX (90%)
most common karyotype partial molar
69XXY (70%) triple X next most common
% of partial molar that is tetraploid or mosaic
10%
incidence of partial mole
3/1000
tumour marker expressed in partial mole
p57
follow-up for complete molar pregnancy
if hCG reverts back to normal within 56 days of pregnancy, then 6 months from date of evac; otherwise 6 months from normalization
follow-up for partial molar pregnancy
concluded once hCG has returned to normal on two samples, at least 4 weeks apart
how long to wait prior to conception after chemo for GTN
1 year after completion of treatment
% of women with GTN who achieve pregnancy
80%
incidence of choriocarcinoma after molar pregnancy
1/40 (3%)
when is emergency contraception required
from D21 postpartum, from D5 post TOP/SMM, if regular contraception compromised
EC for failed hormonal contraception: patch or ring
UPSI in week 1 or >58h HFI
EC: >9 completed days since last active pill was taken
consider EC if UPSI has taken place during or after HFI; take the most recent missed pill as soon as possible; condoms should be used or sex avoided until pill taken for 7 consecutive days; consider f/u pregnancy test
EC: 1 pill missed in week 1 after HFI
EC not required. take missed pill ASAP and continue remaining pills at usual time. No additional contraception required if correct use in week 1 and prior to HFI.
EC: 1 pill missed in week 2 or 3
EC not required. take missed pill ASAP and continue remaining pills at usual time. No additional contraception required if correct use in previous 7 days.
EC: 2-7 missed pills in week 1 after HFI
consider EC if UPSI during HFI or week1. Take most recent missed pill ASAP and continue remaining pills at usual time. Use condoms or sex avoided until pills have been taken for 7 consecutive days. Consider f/u pregnancy test.
EC: 2-7 missed pills in week 2 or 3 after HFI
EC not required if consistent correct use in previous 7 days. If >2 pills missed in 7 days prior to HFI, omit HFI. Condoms should be used or sex avoided until pills have been taken for 7 consecutive days.
EC: >7 consecutive pills missed in any week of pill taking
Consider EC. Manage as new start contraception. consider immediate pregnancy test. use condoms for 7 days.
EC: late or missed POP
(>27h traditional, >36h DSG) if UPSI or barrier failure before efficacy has been re-established (ie 48h after restarting). Missed pill should be taken ASAP (only 1 missed pill if more than 1 missed). Next pill should be taken at usual time. Additional contraception for 2 days.
EC: DMPA
late injection >14 weeks after last or within 7 days after late injection.
background VTE risk
2/10 000
pregnancy VTE risk
1-2/1000
levonorgestrel, norgestimate, morethisterone VTE risk
5-7/10 000
gestogene, desogestrol, drospirinone VTE risk
9-12/10 000
most common bacterial STI
chlamydia also most common cause of preventable infertility
EC-IUD, abx choice if risk of chlamydia
doxycyline 100mg BD x 7/7 if wishes to avoid risk of teratogenicity, azithromycin 1g stat + 500mg daily for 2 days.
EC IUD, abx risk of gonorrhea infection
ceftriaxone 1g IM stat
