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Isleans Mrcog Part 2 > Contraception > Flashcards

Contraception Flashcards

1
Q

Give advice:

On COCP 2 pills missed in week one day 1-7

A

Take last pill
EC needed
7day break as usual
Additional protection for 7 days

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2
Q

Give advice:

On COCP 2 pills missed in week two, day 8-14

A

Take last pill
EC not needed
7day break as usual
Additional protection for 7 days

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3
Q

Give advice:

On COCP 2 pills missed in week three, day 15-21

A

Take last pill
EC not needed
No 7 day break
Additional protection for 7 days

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4
Q

Give advice:

On COCP 2 pills missed in week four, day 22-28

A

Pull free week/placebo

EC if more than 7 days pill free plus EC

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5
Q

Give advice:

On Traditional POP missed pill by >3h

A

Take pill ASAP
EC needed
Additional protection for 2 days

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6
Q

Give advice:

On Desogestrel POP missed pill by >12h

A

Take pill ASAP
EC needed
Additional protection for 2 days

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7
Q

Give advice

14 weeks and 1 day since DMPA or 10+1 since NET-EN

UPSI within last 3 days

A

Give injection

Offer EC copper IUD or LNG

Additional protection for 7 days

UPT 21 days later

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8
Q

Give advice

14 weeks and 1 day since DMPA or 10+1 since NET-EN

UPSI within last 4-5 days

A

Give injection

Offer EC copper IUD

No additional protection if IUD

UPT 21 days later

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9
Q

Give advice

14 weeks and 1 day since DMPA or 10+1 since NET-EN

UPSI more than 5 days ago

A

Do not give injection

Do not give EC

Additional protection for at least 21 day

UPT 21 days later

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10
Q

How log should the copper IUD be used for if for EC only

A

Time next menstrual period

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11
Q

How effective is the copper IUD as an EC

A

99%

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12
Q

What is the mechanism of LNG EC

How effective is it

A

Inhibit ovulation by inhibiting LH surge

98%

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13
Q

What is the mechanism of UPA EC

How effective is it

A

Inhibition of ovulation, mechanism unknown

99%

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14
Q

What are the contraindications to the LNG EC

A

None

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15
Q

What are the contraindications to the UPA EC

A

Severe asthma
Taking enzyme inducers
Taking ant-acids

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16
Q

When using LNG EC for how long is additional contraception required

A

COCP 7 days
POP 2 days
Qlaira 9 days

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17
Q

When using UPA for how long is additional contraception required

A

COCP 14 days
POP 9 days
Qlaira 16 days

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18
Q

With UPA EC when should a repeat dose be considered

A

Vomiting within 3 hours

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19
Q

With LNG EC when should a repeat dose be considered

A

Vomiting within 2 hours

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20
Q

To what age can COCP be used till if no other contraindications

A

50yr

<30ug of ethynyloestradiol should be used

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21
Q

To what age can DMPA be used

A

50 yr

Re evaluate every 2 yr due to osteoporosis risk

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22
Q

To what age can POP be used till

A

Until menopause

If >50yr continue for 1yr amenorrhoea

If <50yr continue for 2yr amenorrhoea

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23
Q

How long can the Cu IUD be used for

A

5-10yr

If fitted >40yr it can be kept until menopause

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24
Q

When should the mirena be changed or removed

A

After 5 years

If fitted >45yr it can be kept for 7 years or until the menopause

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25
Q

How protective is breast feeding as a contraceptive

A

If exclusive the risk of pregnancy at 6 months is only 2%

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26
Q

When postpartum should contraception be started if pregnancy is not desired, at the latest

A

Day 21

27
Q

When can the COCP be started postpartum

A

On D21 of not breastfeeding

If more than 21 days, additional contraception for 7 days required

If breast feeding > 6months
Partial = UKMEC 3
Fully = UKMEC 4

28
Q

When can the POP be started postpartum

A

Any time

If > 21 days use additional contraception for 2 days

29
Q

When can the implant be started postpartum

A

Anytime

Will need 7 days additional contraception if after D21

30
Q

When can the Injection be started postpartum

A

If breast feeding >D21

If not breast feeding, anytime

Will need 7 days additional contraception if after D21

31
Q

Can EC be used postpartum

A

Not required within 21 days

If using UPA, don’t breastfeed for 36 hours

32
Q

How long after UPSI can the Cu IUD be used for EC

A

5 days or 5 days from ovulation if known

33
Q

Which EC should be offered 1st line

A

CU IUD due to its low failure rate

34
Q

How long after UPSI can the UPA be used for EC

A

120 hours

35
Q

How long after UPSI can the LNG be used for EC

A

72 hours is working licence, can consider up to 96 hours

36
Q

Regarding ongoing contraception following EC, what is not recommended until pregnancy excluded

A

Progestogen injectables

Can be used if other methods not appropriate or acceptable

37
Q

In women taking enzyme inducing drugs, what EC can be offered

A

Cu IUD

LNG 3mg

38
Q

For how long after taking enzyme inducers are EC effected

A

28 days

39
Q

What EC can be used more than once in a cycle

A

LNG

40
Q

What is the mechanism of each form of EC

A

CU IUD toxic to ovum and sperm

LNG inhibit ovulation

UPA inhibit ovulation

41
Q

With oral EC what is the rate of vomiting after treatment

A

1%

Nausea 20%

42
Q

Within what time period after LNG EC would UPSI not require further EC

A

12 hours

43
Q

Regarding IUD/IUS postpartum

What condition would result in a UKMEC 4 grading

A

Postpartum sepsis

44
Q

Regarding IUD/IUS postpartum

When would insertion be classified as UKMEC grade 1

A

<48 hours or > 4 weeks

> 48hr <4 weeks is considered UKMEC 3

45
Q

What contraceptions are UKMEC 1 immediately postpartum regardless of breastfeeding

A

Implant & POP

46
Q

Regarding IUD/IUS

At what age does insertion become UKMEC 2 and why

A

Under 20yrs due to the increased risk of expulsion

47
Q

What is the failure rate for vasectomy

A

1:2000

48
Q

What is the lifetime failure rate for filshie clips

A

1:200

2-3:1000 10yr failure rate

49
Q

What is the 5 year failure rate for hysteroscopic sterilisation

A

1:500

50
Q

How much copper is used in the most effective IUD

A

> 380mm2

51
Q

At what BMI is the failure rate of progesterone implants increased

A

> 40

52
Q

How effective is LNG EC at 72 hours after UPSI

A

85% effective

53
Q

How effective is UPA EC at 120 hours after UPSI

A

85% effective

54
Q

How effective is CuIUD EC at 120 hours after UPSI

A

99%

55
Q

When is a vasectomy considered a failure

A

If motile sperm are identified 7 months post procedure

56
Q

Regarding vasectomy

When can special clearance be given to cease additional contraception

A

When <100,000 non-motile sperm are observed in a fresh seamen sample post-vasectomy

57
Q

What progestogens have the lowest risk of VTE

A

First generation

Norethisterone
Levonorgestrel
Norgestimate

5-7:10,000

58
Q

What is the risk of VTE with

First generation progestogens

A

5-7 : 10,000

59
Q

What is the risk of VTE with Norethisterone

A

5-7:10,000

60
Q

Which generation progestogen is levonorgestrel

A

First generation

61
Q

Which generation of progestogens are the following

Desogestrel
Gestodene
Drospirenone

What is the risk of VTE

A

Third generation

3 Desperate Guests Drop None

Risk of VTE 9-12:10,000

62
Q

Which generation of progestogens are the following

Norethisterone
Levonorgestrel
Norgestimate

What is the risk of VTE

A

First generation

First Norene can’t Levitate Nor Gestimate

5-7:10,000

63
Q

What is the risk of VTE IN the general population

A

0.1-0.2:1000

64
Q

What is the risk of VTE IN the pregnant population

A

1-2:1000

Isleans Mrcog Part 2 (26 decks)

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