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GYN > Unintended Pregnancy > Flashcards

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
Q

Threatened abortion

A
  • Any bleeding early in pregnancy
  • Bleeding with closed cervix, no tissue
  • Viable cervical pregnancy is emergency transfer to ER
26
Q

Inevitable abortion

A

-Bleeding, open cervix, tissue

27
Q

Incomplete AB

A

-Bleeding, cramping, partal passage of tissue

28
Q

Complete AB

A

-All tissue expelled

29
Q

Missed AB

A
  • 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
Q

Management for Early Pregnancy Loss

A

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
Q

CRLs on Sono

A

12 weeks - 5-6 cm
16 weeks - 11-12
24 weeks - 30cm

32
Q

Medical vs Surgical Abortion timing

A

medical up to 9 weeks

Surgical up to 24 weeks

33
Q

Vacuum Aspiration

A
  • 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
Q

Dilation and Evacuation

A

-When - >14 weeks -

35
Q

Dilation and Evacuation

A
  • 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
Q

Medication abortion (FDA)

A
  • 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
Q

Medical Abortion (Empirical Evidence)

A
  • 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
Q

Medical Abortion vs Surgical Abortion

A

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
Q

Contraindications Medical Abortion

A
  • Allergy to meds
  • Cannot follow directions
  • Chronic renal insufficiency
  • Severe anemia 9wks EGA
  • Unable to follow up
  • Surgical contraindicated
40
Q

Contraindicated Surgical Abortion

A

-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
Q

Possible Complications

A

Abnl bleeding, Continuing pregnancy, incomplete, infection

-With surgical: uterine perforation, vaginal or cervical lacerations, rxn to anesthesia

GYN (7 decks)

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