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REPRODUCTION > Contraception and termination of pregnancy > Flashcards

Contraception and termination of pregnancy Flashcards

1
Q

For how long do ovum and sperm survive in the female genital tract?

A

Ovum survives for up to 24 hours

Sperm survives for up to 5 days

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2
Q

What factors are monitored for natural family planning?

A 
Basal body temperature 
Cervical mucous 
Cervical position 
Standard/ fertile days 
Breastfeeding
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3
Q

How can basal body temperature be used to monitor fertility?

A

Taken before rising in the morning

Increase of >0.2 sustained for at least 3 days after at least 6 days of lower temp indicates ovulation

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4
Q

Describe the position of the cervix when fertile vs when infertile

A

Cervix is high in the vagina, soft and open when fertile

Cervix is low in the vagina, firm and closed when less fertile

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5
Q

What days of the menstrual cycle are the most fertile?

A

8 to 18

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6
Q

What criteria must be met for breastfeeding to be considered an effective method of contraception?

A

Exclusively breast feeding

Less than 6 months post natal

Amenorrhoeic

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7
Q

What methods of contraception are combined hormonal methods and which contain progesterone only?

A

Combined:
COC, patches, vaginal ring

Progesterone only:
POP, implant, depo injection

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8
Q

What methods of emergency contraception may be available to patients?

A

Copper IUD

Oral medications: UPA or LNG

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9
Q

What is the most effective method of emergency contraception?

A

Copper IUD

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10
Q

When can a copper IUD be installed for emergency contraception and what is the reason for this?

A

5 days after UPSI or up to 5 days after the earliest expected date of ovulation

This is because pregnancy doesn’t implant within the first 5 days - so this is a safe time to insert

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11
Q

What are the differences between UPA and LNG, the two oral methods of emergency contraception?

A

UPA
Anti progestogen
Can work during the LH surge but not after the peak
Up to 5 days post UPSI

LNG
High dose progestogen
Works until just before the LH surge
Up to 3 days post UPSI

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12
Q

In which circumstances should UPA, an oral emergency contraceptive NOT be used?

A

If hormonal contraception has been used in the last 7 days

If the patient has severe asthma, uncontrolled on oral steroids

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13
Q

How do combined methods of contraception, such as the pill, patch or ring work?

A

Contain both oestrogen and progestogen which act by negative feedback on the pituitary gland to inhibit ovulation, make cervical mucus thick and sticky and make the endometrium thinner

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14
Q

At what body weight would the combined hormonal patch not be recommended?

A

> 90kg

This is because there is possible decreased efficacy

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15
Q

Which method of contraception has the lowest failure rates?

A

The contraceptive implant

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16
Q

Which methods of contraception are considered short-acting and which are considered long-acting?

A

SHORT ACTING
Combined hormonal contraception

LONG ACTING 
Contraceptive implant 
Depo injection 
IUS 
Cu IUD
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17
Q

What are some of the risks associated with methods of combined hormonal contraception?

A

Venous thrombosis

Arterial thrombosis

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18
Q

What is the treatment for acne and hirsutism which contains a high does of oestrogen and therefore also acts as a contraceptive?

A

Cyproterone acetate

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19
Q

How should a patient on CHC be reviewed?

A

Check BP at 3 months then either 6 monthly or annually

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20
Q

What is the cut off limit for BP for patients taking a combined hormonal method of contraception?

A

140/90

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21
Q

Migraine with aura is a contraindication for the use of which contraceptive?

A

Combined oral contraceptive pill

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22
Q

What are the risks and protective benefits for cancers associated with combined hormonal contraception?

A

Increased risk of breast cancer and cervical cancer

Protection against ovarian and endometrial cancers

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23
Q

The combined hormonal contraceptive is associated with being of benefit for which conditions?

A

Acne

PCOS

Premenstrual syndrome

Ovarian and endometrial cancers

24
Q

When can the CHC, POP, subdermal implant or DMPA all be started?

A

Within the first 5 days of regular menstruation or anytime in the cycle but should use condoms for the first 7 days

25
Q

When can IUS or Cu-IUD be started?

A

At anytime in the cycle if there has been no IPSI in the past 3 weeks or since the last period

26
Q

How often is the depo injection given?

A

Every 13 weeks

27
Q

What are some of the risks of the depo injection?

A

Increased risk of poor bone mineral density in people who already have bone problems

VTE

Interaction with liver enzyme inducers

28
Q

What may be some of the contraindications to the use of the depo injection?

A

Age <18 years or >45 years

BMI <20

Malabsorption

Hyperthyroidism

Amenorrhoea

29
Q

How does IUS work?

A

Effects implantation and mucus

30
Q

How does the Cu-IUD work?

A

Copper is toxic to the joining of egg and sperm

Inflammatory response in the endometrium

31
Q

Why are failure rates with the Cu-IUD slightly higher than with other methods of contraception?

A

Because it doesn’t contain any hormones and is dependent on its position in the uterus

32
Q

What are the risks associated with IUS and the Cu-IUD?

A

Infection

Perforation

Risks to pregnancy when in situ

Expulsion

33
Q

What is the major risk of clipping someone for female sterilisation?

A

If the patient is already pregnant it could cause an ectopic pregnancy

34
Q

What is meant by conscientious objection?

A

Doctors have the right to opt out of certain procedures because of personal beliefs and values

35
Q

The highest rates of termination of pregnancy are seen in which age group?

A

20-24

36
Q

What year was the abortion act?

A

1967

37
Q

What is the general law in Norther Ireland for when abortion can be performed?

A

Only if there is serious risk of harm to the mother

38
Q

What is the ‘Gillick competence’ used for?

A

To assess whether a young person can consent to TOP

39
Q

What are the general gestation limits for social termination of pregnancy?

A

23 weeks 6 days

40
Q

What are the gestation limits for termination of pregnancy for reasons of fetal anomaly?

A

Any gestation

41
Q

What are the NHS Tayside limits for surgical and medical termination of pregnancy?

A

Surgical termination up to 12 weeks

Medical termination up to 18 weeks and 6 days

42
Q

What weeks are considered early, late and mid trimester termination of pregnancy

A

Early is up to 9 weeks

Late 9-12 weeks

Mid trimester 12-24 weeks

43
Q

What is the 2 stage process for medical termination of pregnancy?

A

1) Oral mifepristone (anti-progesterone)

2) Vaginal or oral prostaglandin e.g misoprostol

44
Q

Medical termination of pregnancy is a 2 stage process, what can/ is done differently for early or late termination of pregnancy?

A

Early - option to complete the 2nd part at home

Late/ mid-trimester - repeated doses of prostaglandin (stage 2) given 3 hourly

45
Q

What method of surgical termination of pregnancy is used in Scotland?

A

Vacuum aspiration

46
Q

When can a vacuum aspiration for termination of pregnancy be performed?

A

6-12 weeks

47
Q

What are some of the possible complications of termination of pregnancy?

A

Pain

Haemorrhage

Infection

Uterine perforation and rupture

Cervical trauma

Anaesthetic complications

48
Q

What aftercare is offered to patients following termination of pregnancy?

A

Uterine pregnancy test at 2-3 weeks
(higher sensitivity than community tests as pregnancy hormones may still be elevated)

Anti D

Counselling

CONTRACEPTION

49
Q

A 35-year-old woman seeks contraception. She has heavy and painful periods. She smokes 10 cigarettes daily. Her BMI is 33 and BP 128/70. She is taking a drug for epilepsy that is a liver enzyme inducer.

What would be the best contraceptive for this woman?

A

intrauterine system (IUS)

50
Q

What is the single best method of contraception for a 46 year old with a BMI of 42. She is in a stable relationship. She smokes 20 cigarettes/day . She also has history of pelvic inflammation due to diverticular disease in the past. She also has multiple fibroid uterus including intramural and submucous fibroid.

A

Progesterone only pill

Given her previous history sterilisation will be risky. Difficult to fit Mirena and Hysteroscopic sterilisation with fibroid uterus.COCP Contraindicated in women age 40+ and with high BMI.

51
Q

A 40 year old woman seeks contraception. She smokes 30 cigarettes a day. Her BMI is 40 and she has heavy menstrual periods. She is sexually active. Her uterus is retroverted and normal size. What is the best contraceptive option?

A

Mirena IUS

52
Q

What factors may cause a woman to regret sterilisation procedures?

A

Performed at time of abortion

Young age (<30yrs)

Few or no children

Not in a relationship o a mutually faithful relationship

Coercian by a partner or medical personnel

53
Q

The efficacy of which methods of contraception is reduced by liver enzyme inducing drugs?

A

Combined oral contraceptive

Progesterone only pill

Subdermal implant

(not the IUS or IUD)

54
Q

What method of contraception is generally best for patients who are taking carbamazepine?

A

IUS or IUD

this is because it won’t be affected by enzyme induction

55
Q

What are the different time scales for when contraception becomes effective if it it not started on day 1 of the patients period?

A

Instant : IUD

2 Days : POP

7 Days : COC, Injections, Implant, IUS

REPRODUCTION (12 decks)

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