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Unintended Pregnancy Flashcards

1
Q

Who has highest rates of UPP

A
  • Teenagers
  • 20-24 yr olds
  • Poorest women w/o HS graduation
  • Black
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2
Q

Rates of teen pregnancy, birth, abortion

A
  • Historic lows

- Less sex, better contraception

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3
Q

UPP in US vs Wold

A

US has significantly higher rates of teen pregnancy and abortion

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4
Q

Barriers to preventing teen pregnancy

A
  • Myths about safety of HC, IUDs, implants
  • Difficult dispensing practices (Requiring pap, BhCG testing for HG/LARC, delayed initiation of LARC, age/parity restrictions for IUD)
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5
Q

Counseling strategies for early, middle, late teens

A
  • Early: Visual aids, here and now, parental involvement
  • Middle: Provider as friend. Avoid preaching, peer counseling, harm reduction
  • Late: Mentor, discuss, future goals
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6
Q

Federal programs to decrease health disparities

A
  • Title X - funds clinics providing family planning services in high needs communities
  • ACA - Extending BC coverage, requiring insurers to cover BC (religious exceptions for some companies)
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7
Q

Why do most UPP occur?

A
  • Non use or inconsistent use of BC

- Due to misconceptions: Magical thinking, thought partner sterile, didn’t follow directions

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8
Q

Risk Calculations

A
  • Absolute risk is risk in general population of an ADE (x/10,000)
  • Relative Risk compares risks of developing a disease in two groups (6/10,000 and 2/10,000 = 3x risk)
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9
Q

Which Risk Calculation is better

A

Absolute

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10
Q

Categories of Relative Risk

A

1 = It does not effect risk
RR >1 = increased risk
RR

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11
Q

Risk Level Descriptive terms

A

High =

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12
Q

Pregnancy Risk Comparisons

A

OC is 0.06 for non smoker
Pregnancy is 11.5
Deaths/100,000

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13
Q

Oral Contraceptive Risk value

A

1.5/100,000 non smoker
58.8/100,000 heavy smoker
IUD is 0.01
Abortion is 1.0

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14
Q

Urine Pregnancy Test

A

Positive if BhCG = 25ml

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15
Q

Assessment for UPP

A
  • UPT
  • EGA by LMP
  • Bimanual/TVUS
  • BhCG levels
  • Bleeding r/o ectopic
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16
Q

BhCG in prengnacy

A

Doubles in 72 hours, increases by 53% in 48 hours

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17
Q

Discriminatory Zone

A

BhCG - 1500-2000, gest sac visible on sono

  • If you cannot see the sac the pregnancy may be growing elsewhere
  • Above DZ TVUS guides management
  • Below DZ BhCG guides follow up
18
Q

Risks for ectopic pregnancy

A

Hx of ectopic, tubal surgery, IUD, DES exposure

19
Q

R/o tests for ectopic

A

Exam, sono, BhCG 48-72 hours apart

20
Q

Discriminatory signs - Cardiac

A

+ confirms live pregnancy

If Crown-Rump- Length >7mm and there is no cardiac activity then you probably have fetal death

21
Q

Discriminatory signs - Gestational Sac

A

-Double decidual/ring sign
-Eccentric implantation (off to the side)
-Elliptical
>25mm Mean Sac Diameter with no yolk sac or embryo you may have fetal demise

22
Q

BhCG levels

A

-Non pregnant

23
Q

Slower rate of BhCG increase

A

Ectopic, non-viable IUP, early pregnancy loss

24
Q

BhCG decrease

A

Early pregnancy loss

25
Threatened abortion
- Any bleeding early in pregnancy - Bleeding with closed cervix, no tissue - Viable cervical pregnancy is emergency transfer to ER
26
Inevitable abortion
-Bleeding, open cervix, tissue
27
Incomplete AB
-Bleeding, cramping, partal passage of tissue
28
Complete AB
-All tissue expelled
29
Missed AB
- Non viable pregnancy, not yet passed - Closed cervix - Sono shows no sac growth for 5-7d, Anembryonic pregnancy (Sac >16mm with no embryonic pole), embryonic pole >5mm w/o cardiac activity
30
Management for Early Pregnancy Loss
Exceptant management is ok for 4 weeks in all cases - Use uterotonics for incomplete and complete - Use abotificants for threatened or missed - Surgical aspiration for Threatened, Missed, Incomplete
31
CRLs on Sono
12 weeks - 5-6 cm 16 weeks - 11-12 24 weeks - 30cm
32
Medical vs Surgical Abortion timing
medical up to 9 weeks | Surgical up to 24 weeks
33
Vacuum Aspiration
- When - First trimester - 14 weeks - Cervical Dilation at 12 weeks w/ Miso - Vaccum x 1 - Sedation: local analgesia --> deep IV - Prophylactic Doxy 100-200 mg - Contraception immediate - 5d - 2 vists
34
Dilation and Evacuation
-When - >14 weeks -
35
Dilation and Evacuation
- When - 20-24 weeks - Cervical Dilation at 16 weeks w/osmotic dilator with Miso PRN - Amnionic infusion of digoxin, forceps, curette, vacuum x 2 - Sedation: Paracervical block + general anesthesia - Prophylactic Doxy 100-200 mg - Contraception immediate - 5d - 2 -3 visits
36
Medication abortion (FDA)
- What: Milfepristone 600 mg in office - When: up to 49 days after LMP - US at initial visit - Minimum vists 3 - Misoprostol 400 mcg in office 48 hours after Milfe - F/u 7-14 days + sono - Contraception day after miso or 7d after milfe - IUC after sono confirms complete
37
Medical Abortion (Empirical Evidence)
- What: Milfepristone 200 mg in office - When: up to 63 days after LMP - US at initial visit - Minimum vists 2 - Misoprostol 800 mcg at home 24-48 hours after Milfe - F/u 7-14 days + sono - Contraception day after miso or 7d after milfe - IUC after sono confirms complete
38
Medical Abortion vs Surgical Abortion
Surgical: 10-30 minute procedure, mild bleeding 1 week Painful induced miscarriage, analgesia needed Privacy, at home Same emotions Contraception immediately ``` Medical: Heavy bleeding 4-6 hours and several weeks Several pain management options Medical facility Same emotions Contraception immediately w/in a week ```
39
Contraindications Medical Abortion
- Allergy to meds - Cannot follow directions - Chronic renal insufficiency - Severe anemia 9wks EGA - Unable to follow up - Surgical contraindicated
40
Contraindicated Surgical Abortion
-Uncontrolled DM, HTN -Current respiratory compromise -Severe anemia 14 weeks if hx of C-Sec or myomectomy AND placenta previa/overlying scar (go to hospital) >24 weeks
41
Possible Complications
Abnl bleeding, Continuing pregnancy, incomplete, infection | -With surgical: uterine perforation, vaginal or cervical lacerations, rxn to anesthesia

GYN (7 decks)

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