225/226 - Pregnancy Prevention and Termination Flashcards Preview

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Flashcards in 225/226 - Pregnancy Prevention and Termination Deck (17)
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Do IUDs prevent ovulation?




What must be done before a surgical abortion is considered complete?

Check products of conception

Does not require pathology as long as the provider knows waht they are looking for - frond-like material


What kind of pain management is used during a surgical abortion?

Paracervical block w/lidocain


Usually do not need general anesthesia


Which method of emergency contraceptrion can be used within 72 hours (3 days) of exposure?

Which can be used wtihin 120 hours (5 days)?

  • 72h
    • High dose levonorgestrel (Plan B)
  • 120h
    • Anti-progestin: Ulipristal acetate
      • Requires prescripion
    • Copper IUD


Delays or alters ovulation, may impede tubal transport

Anti-progestin alters endometrial lining

NOT considered an abortion



What is the difference in MOA of a progestin-releasing IUD vs a copper IUD?

How does each IUD alter the menstrual cycle?

  • Progestin-releasing IUD
    • Local progestin -> endometrial atrophy; zygote cannot implant
    • Results in lighter periods, less cramping


  • Copper IUD
    • Endometrial inflammation -> prevents sperm from fertilizing
    • Results in heavier, more painful menstruation



Which drugs are used for medical abortion?

What are their MOAs?

Mifepristone followed by misoprostol


  • Mifepristone = anti-progesterone; terminates pregnancy
  • Misoprostol = prostaglandin analog; aids expulsion


Mifepristone given in clinic

Pt self-administeres misoprostol 24-48h later


How OCPs prevent pelvic inflammatory disease?

Chlamydia and gonorrhea can infect, but they cannot ascend due to thickened cervical mucous



How many visits does a medical abortion usually take?

Surgical abortion?

Medical = usually 2 visits, complete after 24h

Surgical = can be done in 1 visit, takes 5-10min


What is the most commonly performed gynecologic surgery performed in the USA?






Is a medical or surgical abortion more likely to result in bleeding and cramping after?




List the contraindications to medical abortion (7)

  • Ectopic pregnancy
  • IUD in place
  • Corticosteroid use (if long term)
  • Hemorrhagic disorders
  • Anticoagulant use (if concurrent)
  • Adrenal failure (chronic)
  • Allergy to mifepristone, misoprostol, or other prostaglandin



Which methods of contraception are safe for a woman with a hx of pulmonary embolism (after the acute phase)?

  • Copper IUD
  • Progestin-releasing IUD
  • Progestin only formulations
    • Oral, implants, injections

Anything with estrogen is contraindicated

Only copper IUD is safe during acute phase


What are the contraceptive effects of OCPs on each of the following:

  • Cervical mucus:
  • Endometrial lining:
  • Ovulation:

  • Cervical mucus:
    • Progestin thickens the mucus, thus preventing sperm migration
  • Endometrial lining:
    • Constant progestin -> atrophic endometirum; zygote cannot implant
    • Estrogen is not anti-contraceptive, but it prevents breakthrough bleeding
  • Ovulation:
    • Suppression by progestin (and a little bit by estrogen
    • Progestin decreases GnRH pulse frequency, which suppresses LH and LH surge
    • Estrogen suppresses FSH and contributes to LH surge inhibition



How does surgical abortion differ in the first vs. second trimester?

Abortion in the second trimester requires cervical preparation

Osmotic dilator and/or chemical ripening agents


In first trimester, dilate curvix, suction products of conception; do not need cervical preparation


What is the MOA of the progestin IUD?

Endometrial atrophy

Thickened cervical mucous prevents sperm migration


Does not prevent ovulation


What is the difference between progestin and progesterone?

Progestin = hormone used in birth control

Has gone through many "generations," but basically it has a longer half life than endogenous progesterone