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JL Reproduction and Sexual Health > Week 2 part 1 > Flashcards

Week 2 part 1 Flashcards

1
Q

What factors are involved in natural family planning?

A
  1. Basal body temperature
  2. Cervical mucous
  3. Cervical position
  4. Standard days
  5. Breast feeding
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2
Q

What is an increase in body temp greater than 0.2 degrees and sustained for at least 3 days?

A

Basal body temperatue

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3
Q

What is mucous like post ovulation?

A

Thick and sticky

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4
Q

When is the cervix high in vagina, soft and open?

A

When fertile

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5
Q

What is cervix like when less fertile?

A

Low in vagina, firm and closed

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6
Q

What days in a 28 days cycle (stsndard days) are most fertile?

A

8 to 18

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7
Q

What are the 3 criteria for effective contraception with breast feeding?

A
  1. Exclusively breast feeding
  2. Less than 6/12 post natal
  3. Amenorrhoeic
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8
Q

In contraception - what slows transport of ovary down tube?

A

Progesterone only

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9
Q

In contraception what method renders uterus unable to be viable for implant?

A

Hormonal methods

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10
Q

What is pearl index used for?

A

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

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11
Q

Name two long activing reversible contraception LARC

A
  1. Depo provera IM medroxyprogesterone acetate

2. Sayana press (SC version)

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12
Q

Name three very long acting reversible contraception VLARC

A
  1. IUD
  2. IUS
  3. Implant
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13
Q

What is the primary mode of action of depo provera/sayana press?

A

Inhibits ovulation

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14
Q

What do all progersterone methods of contraception have an effect on cervical mucous mby?

A

Making it thick and sticky so sperm cannot pass through. Also thins endometrium.

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15
Q

When is depo provera/sayana fiven?

A

Every 13 weeks

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16
Q

What examination is doen before prescribing depo provera. sayana?

A

Record BP and BMI
Check smear
Consider RF for osteoporosis

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17
Q

What are these risk factors for: underweight, anorexia, prolonged steroid use, XS alcohol intake, immoblity, FH, smoking and low trauma fracture?

A

Osteoporosis

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18
Q

What are these chronic conditions risk factors for: hypothyroidism, coeliac disease, RA, hyperparathyroidism, IBD, chronic renal disease?

A

Osteoporosis

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19
Q

When can depo be started?

A

Up to and including day 5 of cycle - without need for any additional contraception

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20
Q

When is conception most likely/

A

Having sex on day of ovulation

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21
Q

If a woman wants to start depo but is beyond day 5 of cycle - what can seh do?

A

Any other time considering she is reasonably cdetain not pregnant and needs to use condoms or abstain for 7 days

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22
Q

Using depo - how long does it take to inhibit ovulation?

A

7 days

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23
Q

Could you be pregnant if fully breast feeding, amenorrhoeic and less than 6 months post partum?

A

No

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24
Q

Name four side effects of depo?

A

Weight gain
Delay in return of fertility
Irregular bleeding
Osteoporosis risk

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25
Q

What is T shaped, non-hormonal, contains copper and plastic and is gold standard for contraception?

A

Intra uterine Device - LARC

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26
Q

What is primary mode of action for IUD?

A

Prevents fertilisation - inflammatory response in endometrium (toxic for fertilised egg)

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27
Q

What contraception is a plastic device with progesterone hormone on its core?

A

Intra uterine system (IUS)

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28
Q

What is the low dose 13.5mg LNG-IUS lisenced for?

A

Only contraception - small uterine cavity

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29
Q

What does IUS secrete?

A

Levonorgestrel

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30
Q

How does IUS work?

A

Effects on implantation

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31
Q

What does current pelvic infection, abnormal uterine cavity, pregnancy, GTD, endometrial ca and cervical ca contraindicate?

A

IUD and IUS

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32
Q

When can an IUD be fitted?

A

Within the first 7 days of period. aNYTIME if resonbly vertain not pregnant

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33
Q

If IUD used for EC when is it fitted?

A

Up to 5 days after unprotected sex. Or up to 5 days after predicted date of ovulation

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34
Q

If IUD fitted post partum when is it done?

A

Within 48 hours or greater than 4 weeks

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35
Q

When can IUS be fitted?

A

Within first 7 days of period. Anytime providing reasonably certain not pregnant

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36
Q

Can IUS be used for EC?

A

NO

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37
Q

Post partum fitting of IUS occurs when?

A

Either within 48 horus or greater than 4 weeks post partum

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38
Q

Give 3 side effects of IUD?

A
  1. Heavy prolonged menses
  2. Pain, PID increase risk
  3. Expulsion
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39
Q

Give three side effects of IUS?

A
  1. Lighter, less frequent bleeding
  2. Pain, PID increase risk in first 2- days
  3. Expulsion
40
Q

What is a single, non biodegradable subdermal rod/

A

Implant

41
Q

What does implant contain?

A

68mg ENG (etonogestrel)

42
Q

What does implant release in weeks 5-6?

A

60/70ug per day

43
Q

What does implant release per day end of year 3?

A

25-30ug

44
Q

How does implant work?

A

Inhibits ovulaiont

45
Q

When can implant be fitted?

A

Within first 5 days of cycle
up to day 5 post first/second trimester abortion
On or before day 21 post partum

46
Q

If switching from CHC pill or depo when is implant immediatly effective?

A

After last active pill in pack taken
Depo still within 14 weeks
If weeks 2-3 of COC, patch or Vaginal ring

47
Q

If switching from POP or LNG-IUS or nonhormonal method is implant immediately effective?

A

No need additional precautions for first 7 days

48
Q

Give three side effects of implant?

A
  1. Irregular bleeding
  2. Weight gain
  3. Acne
49
Q

Name the three short acting contraceptions?

A
  1. Combined hormonal contraception
  2. Progesterone only pill
  3. EHC
50
Q

Name some non-contraceptive benefits of CHC?

A
  1. Heavy menstrual bleeding
  2. Painful periods
  3. Acne
    .4 Irregular periods
  4. Premenstraul symtpoms
  5. Menstrual migraine
51
Q

Mode of action of CHC?

A

Inhibits ovulation via action on HPO axis to reduce LH and FSH. Also alters cervical mucous and thins endometrium

52
Q

Explain the standard regime of COC?

A

Take daily for 21 days then stop for 7 (for withdrawal bleeding). First 7 pills inhibit ovulation and remaining 14 maintain anovulation.

53
Q

When taking CHC when can follicular actyivity resume?

A

When 9 pills omitted from regime

54
Q

Explain standard regime for CTP

A

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.

55
Q

Explain standard regime for CVR

A

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

56
Q

What to do when missed one pill

A

If over 24 hours and less than 48: take missed pill asap then remaining pills at normal time. No EC required.

57
Q

What to do when miss two or more pills

A

Take most recent pill, remaining pills at right time and ABSTAIN from sex or condoms untol 7 pills taken consecutively

58
Q

When removing CTP how long before efficacy reduced?

A

48 hours

59
Q

When removing TVR how long before efficacy reduced?

A

Upt o48 horus

60
Q

Name three risks for CHC?

A

1/. Venous thrombosis

  1. Arterial thrombosis
  2. Adverse effects on some cancers
61
Q

What does EE from CHC do to clotting factor levels?

A

Reduce antithrombin III and protein S

62
Q

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?

A

VTE

63
Q

What does COC do to BP?

A

iNCREASE IT

64
Q

What does migraine with aura increase risk of?

A

ISCHAEMIC STROKE. Do not use CHC in individuals with migraine with aura.

65
Q

If a patient has personal history of breast cancer what contraception is contraindicated?

A

CHC

66
Q

Is thre increase of cervical cancer with CHC?

A

Yes if used for longer than five years

67
Q

What does CHC protect against?

A

Endometrium and ovarian cancers

Acne

68
Q

Name three side effects of CHC?

A
  1. Unscheduled bleeding
  2. Mood changes
  3. Weight gain
69
Q

Name two after emergency contraception?

A
  1. Levonelle 1500 (progesteron)

2. Ulipristal acetate (anti-progesterone)

70
Q

What are levonorgestrel, norethisterone?

A

Traditional POP

71
Q

What is etonorgestrel?

A

Longer actining newer POP

72
Q

wHAT DOES progesterone suppress?

A

FSH

73
Q

mODE OF action of etonorgestrel (new POP)?

A

Suppress ovulation

74
Q

What interactions does POP have?

A

Liver enzyme inducers (cytochrome P450) - instead use DMPA, IUS, copper IUD

75
Q

What do you do if missed one dose of POP and had unprotected sex?

A

EC and 2 days extra protection

76
Q

How many registered medical practioners are needed for abortion to take place?

A

Opinion of two

77
Q

Whi can terminate a pregnancy?

A

Only a registered medical practitioner

78
Q

Where can treatment for termination of pregnancy take place?

A

Only in NHS hospital or approved grounds

79
Q

How many doctors are required to sign the HSA1 certificate?

A

Two

80
Q

When can HSA2 certificate be completed?

A

By doctor within 24 hours of emergency abortion

81
Q

Who completes HSA4 form and who is it sent to?

A

Doctor and sent to CMO wirhin 7 days of aboriton

82
Q

Do doctors haev a right to opt out of certain procedures because of personal beliegs ?

A

Yes

83
Q

Can a doctor opt out of treatment in the case of an emergency?

A

NO

84
Q

What is the social legal limit for TOP?

A

23 weeks and 6 days

85
Q

What is the social legal limit for TOP for fetal anomaly?

A

Any gestation

86
Q

What is NHS tayside gestation termination limit?

A

18 weeks and 6 days

87
Q

What are the two stages for medical TOP

A
  1. Oral mefipristone 200mg

2. 24-48 hours later Vaginal prostaglandin (misoprostol)

88
Q

If aborting in late/mid-trimester - what repeated doses are given?

A

Of prostaglandin

89
Q

Give two surgical techniques for termination of pregnancy?

A
  1. Vacuum aspiration (6-12 weeks)

2. Dilatation and evacuation (13-24 weeks)

90
Q

What surgical TOP technique has a role in resource poor developing coun tries?

A

Manual vacuum aspiration

91
Q

In aftercare for TOP what patients are given anti D?

A

Rhesus positive

92
Q

Three EC methods

A

Levonelle - up to 72 hours
ellaOne - up to 120 hours
Copper IUD

93
Q

hOW DOES levonell work?

A

Inhibits ovulation

94
Q

How does ellaOne work?

A

Inhibits/delays ovulation

95
Q

Name a contraindication for ellaOne?

A

Breast feeding, antacids

96
Q

Name a contraindication for levonelle?

A

Enzyme inducers

JL Reproduction and Sexual Health (18 decks)

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