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Bushra's Contraception > UKMEC 4 > Flashcards

UKMEC 4 Flashcards

1
Q

UKMEC 4, A condition which represents an unacceptable health risk if the method is used

CHC
Menarche to <40=1, ≥40=2

A

1 - Breastfeeding, 0 to <6 weeks postpartum

2 - Postpartum (in non-breastfeeding women), 0 to <3 weeks, With other risk factors for VTE

3 - Smoking: ≥15 cigarettes/day

4 - HTN:

a) Consistently elevated BP levels Systolic ≥160 mmHg or diastolic ≥100 mmHg 1 1 1 2 1 4
b) Vascular disease

5 - Current and history of ischaemic heart disease

6 - Stroke (history of cerebrovascular accident, including TIA)

7 - Venous thromboembolism (VTE)

a) History of VTE
b) Current VTE (on anticoagulants)

8 - Major surgery, With prolonged immobilisation

9 - Known thrombogenic mutations (e.g. factor V Leiden, prothrombin mutation, protein S, protein C and antithrombin deficiencies)

10 - Valvular and congenital heart disease, Complicated (e.g. pulmonary hypertension, history of subacute
bacterial endocarditis)

11 - Cardiomyopathy, Impaired cardiac function

12- Cardiac arrhythmias, Atrial fibrillation

13 - Migraine with aura, at any age

14 - Current breast cancer

15 - Cirrhosis, Severe (decompensated)

16 - Liver tumours

a) Benign Hepatocellular adenoma
b) Malignant (hepatocellular carcinoma)

17 - Systemic lupus erythematosus (SLE) with Positive antiphospholipid antibodies

18 - Positive antiphospholipid antibodies

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2
Q

UKMEC 4, A condition which represents an unacceptable health risk if the method is used

Cu-IUD
LNG-IUS

Menarche to <20=2, ≥20=1
Menarche to <20=2, ≥20=1

A

1 - Postpartum sepsis

2 - Post-abortion sepsis

3 - GTD: Persistently elevated hCG levels or malignant disease
___________________________________
INITIATION ONLY

1 - Unexplained vaginal bleeding (suspicious for serious condition) before evaluation, INITIATION

2 - Cervical cancer, Awaiting treatment, INITIATION

3 - Endometrial cancer, INITIATION

4 - Current PID, INITIATION

5 - Sexually transmitted infections (STIs),

a) Chlamydial infection (current) Symptomatic,
b) Purulent cervicitis or gonorrhoea (current)

6 - Pelvic Tuberculosis
_______________________________

LNG-IUS

Current breast cancer

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3
Q

Current breast cancer

A 
Cu-IUD only UKMEC 1
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
UKMEC 4
LNG-IUS 
IMP 
DMPA 
POP 
CHC
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4
Q

Past breast cancer

A 
Cu-IUD only UKMEC 1
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
UKMEC 3
LNG-IUS 
IMP 
DMPA 
POP 
CHC
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5
Q

Postpartum (in breastfeeding or nonbreastfeeding
women, including postcaesarean section)

Cu-IUD
LNG-IUS

A 
UKMEC 1
- 0 to <48 hours 
- ≥4 weeks 
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
UKMEC 3
- 48 hours to <4 weeks 
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
UKMEC 4
- Postpartum sepsis
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6
Q

Age and contraception

A

Cu-IUD
Menarche, to <20=2, ≥20=1

LNG-IUS
Menarche, to <20=2, ≥20=1

IMP
After menarche =1

POP
After menarche =1

DMPA
Menarche to <18=2, 18-45=1, >45=2

CHC
Menarche to <40=1, ≥40=2

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7
Q

High risk of HIV infection

A 
UKMEC 1
 IMP  POP CHC
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
UKMEC 2
- Cu-IUD 
- LNG-IUS
- DMPA
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8
Q

HIV infected

CD4 count ≥200 cells/mm3

A 
UKMEC 1
- IMP 
- DMPA 
- POP 
- CHC
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
UKMEC 2
- Cu-IUD 
- LNG-IUS

If CD4 count <200 cells/mm, INITIATION is UKMEC 3
_____________________________
c) Taking antiretroviral (ARV) drugs

  • Certain ARV drugs have the potential to affect the bioavailability of steroid hormones in hormonal contraception.
  • For up-to-date information on the potential drug interactions between hormonal contraception and ARV
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9
Q

Tuberculosis

a) Non-pelvic :
b) Pelvic

A 
UKMEC 1
a) Non-pelvic :All
b) Pelvic:
- IMP 
- DMPA 
- POP 
- CHC
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
UKMEC 4 : INITIATION      4 1 1 1 1 1 
Pelvic TB:
- Cu-IUD 
- LNG-IUS 
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
UKMEC 3 : Continuation     3 1 1 1 1 1

Pelvic TB:

  • Cu-IUD
  • LNG-IUS
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10
Q

Diabetes

b) Non-vascular disease
(i) Non-insulin dependent
(ii) Insulin dependent
c) Nephropathy/retinopathy/neuropathy
d) Other vascular disease

A

History of gestational disease : all 1 1 1 1 1 1
- UKMEC 1
_________________________________
b) Non-vascular disease 1 1 1 1 1 2
Non-insulin dependent or Insulin dependent

  • Cu-IUD UKMEC 1
  • All hormonal UKMEC 2,
    ____________________________________
    c) Nephropathy/retinopathy/neuropathy 1 2 2 2 2 3
    d) Other vascular disease 1 2 2 2 2 3
  • Cu-IUD UKMEC 1
  • All hormonal other than CHC, UKMEC 2,
  • CHC UKMEC 3
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11
Q

Thyroid disorders

a) Simple goitre
b) Hyperthyroid
c) Hypothyroid

A

UKMEC 1

1 1 1 1 1 1

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12
Q

Gallbladder disease

a) Symptomatic
(i) Treated by cholecystectomy
(ii) Medically treated
(iii) Current
b) Asymptomatic

A
  • Cu-IUD 1 1 1 1 1 1

UKMEC 1
__________________________________
a) Asymptomatic 1 1 1 1 1 2
b) Symptomatic: Treated by cholecystectomy 1 1 1 1 1 2

  • Cu-IUD UKMEC 1
  • All hormonal UKMEC 2,
    ____________________________________
    a) Symptomatic
    (i) Medically treated 1 2 2 2 2 3
    (ii) Current 1 2 2 2 2 3
  • Cu-IUD UKMEC 1
  • All hormonal other than CHC, UKMEC 2,
  • CHC UKMEC 3
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13
Q

History of cholestasis

a) Pregnancy related
b) Past COC related

A

a) Pregnancy related 1 1 1 1 1 2
All UKMEC 1 Except CHC UKMEC 2

__________________________
b) Past COC related 1 2 2 2 2 3

  • Cu-IUD UKMEC 1
  • All hormonal other than CHC, UKMEC 2,
  • CHC UKMEC 3
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14
Q

Viral hepatitis

A

b) Carrier 1 1 1 1 1 1
c) Chronic 1 1 1 1 1 1

UKMEC 1
_________________________________
a) Acute or flare 1 1 1 1 1

UKMEC 1 all other than CHC

  • CHC UKMEC 3: Initiation,
  • CHC UKMEC 2 : Continuation
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15
Q

Cirrhosis

A

a) Mild (compensated without complications) 1 1 1 1 1 1

UKMEC 1
_____________________________
b) Severe (decompensated) 1 3 3 3 3 4

  • Cu-IUD UKMEC 1
  • All hormonal other than CHC, UKMEC 3,
  • CHC UKMEC 4
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16
Q

Liver tumours

A

a) Benign
(i) Focal nodular hyperplasia 1 2 2 2 2 2

  • Cu-IUD UKMEC 1
  • All hormonal , UKMEC 2
    _________________________
    a) Benign: Hepatocellular adenoma 1 3 3 3 3 4
    b) Malignant (hepatocellular carcinoma) 1 3 3 3 3 4
  • Cu-IUD UKMEC 1
  • All hormonal other than CHC, UKMEC 3,
  • CHC UKMEC 4
17
Q

Inflammatory bowel disease (including Crohn’s disease and ulcerative colitis)

A

UKMEC 1

Cu-IUD 
LNG-IUS 
IMP 
DMPA 
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
UKMEC 2

POP
CHC

1 1 1 1 2 2

18
Q

ANAEMIAS

Thalassaemia
Sickle cell disease
Iron deficiency anaemia

A

UKMEC 1

All hormonal except in sickle cell disease, CHC
____________________________________
UKMEC 2

In all: Cu-IUD 
sickle cell disease, CHC
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Thalassaemia 2 1 1 1 1 1
Sickle cell disease 2 1 1 1 1 2
Iron deficiency anaemia 2 1 1 1 1 1
19
Q

Rheumatoid arthritis

A

UKMEC 1

Cu-IUD
_______________________
UKMEC 2

  • All hormonal
    ________________________
    1 2 2 2 2 2
20
Q

Systemic lupus erythematosus (SLE)

A

UKMEC 1

Cu-IUD
_______________________
UKMEC 2

  • All hormonal

_______________________
But if positive antiphospholipid antibodies with or without SLE then CHC UKMEC 4
_______________________________________
a) No antiphospholipid antibodies 1 2 2 2 2 2

b) Positive antiphospholipid antibodies 1 2 2 2 2 4

Positive antiphospholipid antibodies 1 2 2 2 2 4

21
Q

Sexually transmitted infections (STIs)
a) Chlamydial infection (current) I C I C
(i) Symptomatic 4 2 4 2 1 1 1 1
(ii) Asymptomatic 3 2 3 2 1 1 1 1
b) Purulent cervicitis or gonorrhoea (current) 4 2 4 2 1 1 1 1
c) Other current STIs (excluding HIV & hepatitis) 2 2 1 1 1 1
d) Vaginitis (including Trichomonas vaginalis
and bacterial vaginosis) (current) 2 2 1 1 1 1
e) Increased risk for STIs 2 2 1 1 1 1

A

UKMEC 1

Other than IUD & IUS all
________________
UKMEC 2

1) Other current STIs (excluding HIV & hepatitis)
2) Vaginitis (including Trichomonas vaginalis and bacterial vaginosis) (current)
3) Increased risk for STIs
______________________________
UKMEC 2, Continuation

1 - Chlamydial infection (current) 
 (i) Symptomatic 
 (ii) Asymptomatic 
b) Purulent cervicitis or gonorrhoea (current) 
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
UKMEC 3:  Initiation,

Chlamydial infection (current) Asymptomatic
______________________
UKMEC 4: Initiation,

a) Chlamydial infection (current) Symptomatic
b) Purulent cervicitis or gonorrhoea (current)
__________________________________________
a) Chlamydial infection (current) I C I C
(i) Symptomatic 4 2 4 2 1 1 1 1
(ii) Asymptomatic 3 2 3 2 1 1 1 1
b) Purulent cervicitis or gonorrhoea (current) 4 2 4 2 1 1 1 1
_____________________________________
c) Other current STIs (excluding HIV & hepatitis) 2 2 1 1 1 1
d) Vaginitis (including Trichomonas vaginalis
and bacterial vaginosis) (current) 2 2 1 1 1 1
e) Increased risk for STIs 2 2 1 1 1 1

Bushra's Contraception (21 decks)

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