Week 2 part 1 Flashcards
What factors are involved in natural family planning?
- Basal body temperature
- Cervical mucous
- Cervical position
- Standard days
- Breast feeding
What is an increase in body temp greater than 0.2 degrees and sustained for at least 3 days?
Basal body temperatue
What is mucous like post ovulation?
Thick and sticky
When is the cervix high in vagina, soft and open?
When fertile
What is cervix like when less fertile?
Low in vagina, firm and closed
What days in a 28 days cycle (stsndard days) are most fertile?
8 to 18
What are the 3 criteria for effective contraception with breast feeding?
- Exclusively breast feeding
- Less than 6/12 post natal
- Amenorrhoeic
In contraception - what slows transport of ovary down tube?
Progesterone only
In contraception what method renders uterus unable to be viable for implant?
Hormonal methods
What is pearl index used for?
To express failure rates - represents number of contraceptive failures per 100 women
Number of accidental pregnancies x 1200, divided by total number of months of exposure
Name two long activing reversible contraception LARC
- Depo provera IM medroxyprogesterone acetate
2. Sayana press (SC version)
Name three very long acting reversible contraception VLARC
- IUD
- IUS
- Implant
What is the primary mode of action of depo provera/sayana press?
Inhibits ovulation
What do all progersterone methods of contraception have an effect on cervical mucous mby?
Making it thick and sticky so sperm cannot pass through. Also thins endometrium.
When is depo provera/sayana fiven?
Every 13 weeks
What examination is doen before prescribing depo provera. sayana?
Record BP and BMI
Check smear
Consider RF for osteoporosis
What are these risk factors for: underweight, anorexia, prolonged steroid use, XS alcohol intake, immoblity, FH, smoking and low trauma fracture?
Osteoporosis
What are these chronic conditions risk factors for: hypothyroidism, coeliac disease, RA, hyperparathyroidism, IBD, chronic renal disease?
Osteoporosis
When can depo be started?
Up to and including day 5 of cycle - without need for any additional contraception
When is conception most likely/
Having sex on day of ovulation
If a woman wants to start depo but is beyond day 5 of cycle - what can seh do?
Any other time considering she is reasonably cdetain not pregnant and needs to use condoms or abstain for 7 days
Using depo - how long does it take to inhibit ovulation?
7 days
Could you be pregnant if fully breast feeding, amenorrhoeic and less than 6 months post partum?
No
Name four side effects of depo?
Weight gain
Delay in return of fertility
Irregular bleeding
Osteoporosis risk
What is T shaped, non-hormonal, contains copper and plastic and is gold standard for contraception?
Intra uterine Device - LARC
What is primary mode of action for IUD?
Prevents fertilisation - inflammatory response in endometrium (toxic for fertilised egg)
What contraception is a plastic device with progesterone hormone on its core?
Intra uterine system (IUS)
What is the low dose 13.5mg LNG-IUS lisenced for?
Only contraception - small uterine cavity
What does IUS secrete?
Levonorgestrel
How does IUS work?
Effects on implantation
What does current pelvic infection, abnormal uterine cavity, pregnancy, GTD, endometrial ca and cervical ca contraindicate?
IUD and IUS
When can an IUD be fitted?
Within the first 7 days of period. aNYTIME if resonbly vertain not pregnant
If IUD used for EC when is it fitted?
Up to 5 days after unprotected sex. Or up to 5 days after predicted date of ovulation
If IUD fitted post partum when is it done?
Within 48 hours or greater than 4 weeks
When can IUS be fitted?
Within first 7 days of period. Anytime providing reasonably certain not pregnant
Can IUS be used for EC?
NO
Post partum fitting of IUS occurs when?
Either within 48 horus or greater than 4 weeks post partum
Give 3 side effects of IUD?
- Heavy prolonged menses
- Pain, PID increase risk
- Expulsion
Give three side effects of IUS?
- Lighter, less frequent bleeding
- Pain, PID increase risk in first 2- days
- Expulsion
What is a single, non biodegradable subdermal rod/
Implant
What does implant contain?
68mg ENG (etonogestrel)
What does implant release in weeks 5-6?
60/70ug per day
What does implant release per day end of year 3?
25-30ug
How does implant work?
Inhibits ovulaiont
When can implant be fitted?
Within first 5 days of cycle
up to day 5 post first/second trimester abortion
On or before day 21 post partum
If switching from CHC pill or depo when is implant immediatly effective?
After last active pill in pack taken
Depo still within 14 weeks
If weeks 2-3 of COC, patch or Vaginal ring
If switching from POP or LNG-IUS or nonhormonal method is implant immediately effective?
No need additional precautions for first 7 days
Give three side effects of implant?
- Irregular bleeding
- Weight gain
- Acne
Name the three short acting contraceptions?
- Combined hormonal contraception
- Progesterone only pill
- EHC
Name some non-contraceptive benefits of CHC?
- Heavy menstrual bleeding
- Painful periods
- Acne
.4 Irregular periods - Premenstraul symtpoms
- Menstrual migraine
Mode of action of CHC?
Inhibits ovulation via action on HPO axis to reduce LH and FSH. Also alters cervical mucous and thins endometrium
Explain the standard regime of COC?
Take daily for 21 days then stop for 7 (for withdrawal bleeding). First 7 pills inhibit ovulation and remaining 14 maintain anovulation.
When taking CHC when can follicular actyivity resume?
When 9 pills omitted from regime
Explain standard regime for CTP
One patch is applied for 1 week to suppress ovulation. Thereafter the patch is reapplied weekly for a further 2 weeks. The fourth week is patch-free to allow a withdrawal bleed.
Explain standard regime for CVR
A ring is placed into the vagina and left continuously for 21 days. After a ring-free interval of 7 days to induce a withdrawal bleed, a new ring should be inserted
What to do when missed one pill
If over 24 hours and less than 48: take missed pill asap then remaining pills at normal time. No EC required.
What to do when miss two or more pills
Take most recent pill, remaining pills at right time and ABSTAIN from sex or condoms untol 7 pills taken consecutively
When removing CTP how long before efficacy reduced?
48 hours
When removing TVR how long before efficacy reduced?
Upt o48 horus
Name three risks for CHC?
1/. Venous thrombosis
- Arterial thrombosis
- Adverse effects on some cancers
What does EE from CHC do to clotting factor levels?
Reduce antithrombin III and protein S
What are obesity, smoking, age, thrombophilia, VTE, trekking over 4500m for 1 week, flights, reduced mobility, antiphospholipid syndrome and up to 6 weeks post natal risk factos for?
VTE
What does COC do to BP?
iNCREASE IT
What does migraine with aura increase risk of?
ISCHAEMIC STROKE. Do not use CHC in individuals with migraine with aura.
If a patient has personal history of breast cancer what contraception is contraindicated?
CHC
Is thre increase of cervical cancer with CHC?
Yes if used for longer than five years
What does CHC protect against?
Endometrium and ovarian cancers
Acne
Name three side effects of CHC?
- Unscheduled bleeding
- Mood changes
- Weight gain
Name two after emergency contraception?
- Levonelle 1500 (progesteron)
2. Ulipristal acetate (anti-progesterone)
What are levonorgestrel, norethisterone?
Traditional POP
What is etonorgestrel?
Longer actining newer POP
wHAT DOES progesterone suppress?
FSH
mODE OF action of etonorgestrel (new POP)?
Suppress ovulation
What interactions does POP have?
Liver enzyme inducers (cytochrome P450) - instead use DMPA, IUS, copper IUD
What do you do if missed one dose of POP and had unprotected sex?
EC and 2 days extra protection
How many registered medical practioners are needed for abortion to take place?
Opinion of two
Whi can terminate a pregnancy?
Only a registered medical practitioner
Where can treatment for termination of pregnancy take place?
Only in NHS hospital or approved grounds
How many doctors are required to sign the HSA1 certificate?
Two
When can HSA2 certificate be completed?
By doctor within 24 hours of emergency abortion
Who completes HSA4 form and who is it sent to?
Doctor and sent to CMO wirhin 7 days of aboriton
Do doctors haev a right to opt out of certain procedures because of personal beliegs ?
Yes
Can a doctor opt out of treatment in the case of an emergency?
NO
What is the social legal limit for TOP?
23 weeks and 6 days
What is the social legal limit for TOP for fetal anomaly?
Any gestation
What is NHS tayside gestation termination limit?
18 weeks and 6 days
What are the two stages for medical TOP
- Oral mefipristone 200mg
2. 24-48 hours later Vaginal prostaglandin (misoprostol)
If aborting in late/mid-trimester - what repeated doses are given?
Of prostaglandin
Give two surgical techniques for termination of pregnancy?
- Vacuum aspiration (6-12 weeks)
2. Dilatation and evacuation (13-24 weeks)
What surgical TOP technique has a role in resource poor developing coun tries?
Manual vacuum aspiration
In aftercare for TOP what patients are given anti D?
Rhesus positive
Three EC methods
Levonelle - up to 72 hours
ellaOne - up to 120 hours
Copper IUD
hOW DOES levonell work?
Inhibits ovulation
How does ellaOne work?
Inhibits/delays ovulation
Name a contraindication for ellaOne?
Breast feeding, antacids
Name a contraindication for levonelle?
Enzyme inducers
