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MB3 Obstetrics and Gynaecology > Contraception/abortion > Flashcards

Contraception/abortion Flashcards

(87 cards)

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1
Q

what percentage of pregnancies are unplanned?

A

30-50%

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2
Q

what poor outcomes may result from continuation of an unplanned pregnancy

A 
later and less frequent antenatal care
increased preterm birth and low birth weight 
increased postpartum depression 
reduced breastfeeding 
decreased bonding 
increased rates of neglect and abuse 
poorer long term developmental outcomes
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3
Q

how many unplanned pregnancies end in abortion

A

30-40%

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4
Q

what law allows for pregnancy termination in the UK

A

Abortion act 1967

recently NI extension to 11+6 wks and beyond 12wks in specific circumstances

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5
Q

what legal document is required for abortion and who needs to sign it

A

HSA1 - green form

2 doctors

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6
Q

what does clause C of the HSA1 allow

A

abortion allowed up to 23+6 weeks

continuance of pregnancy leads to greater risk than if it was terminated

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7
Q

what does clause E of the HSA 1 allow

A

abortion up to full term justified if there is risk the child born with a mental or physical abnormality leading to severe disability

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8
Q

true/false - in an emergency one doctor can sign a HSA1 form

A

true

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9
Q

healthcare professionals can refuse to participate in abortion care with select exceptions. what are these?

A

doesnt apply if emergency/life threatening
should not delay or prevent patient access to care
should not affect indirect tasks associated with abortion

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10
Q

what is the time aim from referral to initial termination consultation

A

5 days

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11
Q

what time aim is given between referral for termination and procedure

A

2 wks

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12
Q

methods of abortion?

A

medical

surgical

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13
Q

clinical assessment of gestation?

A

palpable uterus in >12wks

LMP and date of +ve UPT

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14
Q

USS assessment of gestation?

A

abdominal USS or transvaginal if <6wks

only given really for risk ie symptoms or risk of ectopic, uncertain dates or STOP

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15
Q

how may a MTOP be given <12 weeks

A

at home

mifepristone followed by misoprostol 24-48 hours later

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16
Q

in a patient who had MTOP <12 weeks with no bleed what do you do

A

<10wks - further dose of misoprostol if not bleeding within 4 hours
>10 wks to 11+6 - 3 further doses misoprostol

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17
Q

how long are MTOP available for

A

in scotland up to 19+6 before needing travel to england
theoretically in clause E to full term
to clause C - 23+6

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18
Q

what is an EMAH and what is contained in an EMAH pack

A 
early medical abortion at home 
mifepristone 
misoprostol 
antiemitic 
analgesia 
Abx 
6/12 POP 
patient info and contact info sheet 
LSUPT
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19
Q

how may MTOP be performed >12wks

A

inpatient procedure

dose mifepristone and repeated doses of PV misoprostol

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20
Q

how may STOP be performed <14 wks

A

electric vacuum aspiration under general anaesthetic

manual vacuum anaesthetic by local anaesthetic but only up to 10wks

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21
Q

how may STOP be performed >14 wks

A

dilatation of cervix and evacuation

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22
Q

complications of medical abortion

A

haemorrhage
failed/incomplete termination
infection

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23
Q

complications of STOP

A 
haemorrhage 
failed/incomplete 
infection 
uterine perforation 
cervical trauma
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24
Q

in who is Abx prophylaxis given for termination and what is given

A

medical abortion at high STI risk
all those undergoing STOP
doxy 7 days

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25
in who is rhesus iso-immunisation given and why
women at risk who are Rh-ve anti-D Ig abortion can be sensitising to lead to development of anti-D Ab can cross placenta in future pregnancies and leaf to destruction of Rh+ve foetal cells
26
what is given as VTE prophylaxis and for how long
risk assess if high risk then LMWH 1 week post abortion if very high risk then LMWH before abortion and considered up to 6 weeks after
27
can contraception be started right after abortion?
yes
28
is contraception fully effective after abortion
yes, if started within 5 days, if not then will take 2 days for POP or 7 for CHC, DMPA, SDI, LNG-IUS
29
when would you avoid use of an intrauterine method of contraception following termination
post abortion sepsis
30
when can barrier methods be used following termination
any time avoid FAM until regular periods sterilise consider after time as there is risk of regret or failure diaphragm cannot be used after 2nd trimester TOP
31
follow up following EMAH?
low sensitivity UPT at least 2 weeks after
32
most effective emergency contraceptive? terms of use
copper IUD | fit within 5 days of early possible day ovulation or 5 days after single episode of sex
33
true/false - oral methods of contraception are not affected by liver induding drugs
false- they are affected by them
34
mechanism of action of levonorgestrel, terms of use
large dose progestogen to inhibit ovulation need double dose if >70kg best if in 24hrs but up to 72 good for needing quickstart contraceptive
35
mechanism of action of ulipristal acetate, terms of use and caveat of use for POP
progesterone receptor modulator to block progesterone receptor 5 days post unprotected sex prevents LH surge licensed for 5 days POP cannot be used 5 days before or after
36
what forms of contraception prevent ovulation
most hormone methods except hormone coil suppress FSH/LH emergency to delay
37
what forms of contraception prevent fertilisation
condom, diaphragm, spermicide, sterilisation, IUS/IUD
38
what forms of contraception prevent implantation
hormonal IUD as a secondary copper coil as emergency
39
risk of pregnancy in withdrawal method in 1y
20%
40
factors to consider in contraception use
``` experience age child protection consent frequency/sex relationship status pregnancy risk and STI future plans lifestyle and compliance weight blood pressure PMHx breastfeeding SHx side effects procedure non hormonal effect?? migraine ```
41
what child protection concerns may arise with contraceptive advice
sex <13 age gap >2yrs in <18 power imbalance drug/alcohol use or grooming
42
non-contraceptive benefits of hormonal contraception
``` period pain heavy bleed irregular bleed ovulation pain PMS cyclical breast tenderness cysts endometriosis ovarian cancer acne/hirsutism ```
43
reasons for condom failure
``` too late wrong lube wrong technique wrong size inconsistent use wrong storage damage on opening expired ```
44
reasons for diaphragm failure
``` too late removed early wrong technique inconsistent no damage check ```
45
reasons for CHC, POP, DMPA failure
``` inconsistent use late injection wrong storage late replacement drug interaction ```
46
reasons for iatrogenic contraception failure
``` poor counselling no extra precaution recommended drug interaction malposition or expulsion incorrect insertion ```
47
how long does IUD/IUS last
3-10 years
48
complications of IUD/IUS insertion
perforation, PID, expulsion | invasive and pain
49
how long can copper coil be used
up to 10yrs | if inserted >40 then can be kept up to menopause
50
what is the only method of contraceptive that mahy be reliable post breast cancer
copper IUD
51
side effects of copper IUD
can make periods longer, heavier and more painful esp in first 3m
52
true/false - hormonal IUS is more effective than copper coil
true
53
side effects of IUS
irreg spotting, bleeding in first few months then side effects low
54
alternative indication for mirena coil
heavy periods, HRT, hyperplasia or endometriosis
55
what is the most effective contraceptive
SCI
56
how long does SCI last
3yrs
57
how long does SCI take to work
7 days
58
what side effect can happen with SCI
prolonged bleeding
59
what score category can be used for contraceptive eligbility
UKMEC
60
how does CHC act, what are the failure rates
prevent ovulation | 0.3% perfect use, user failure 8%
61
how to take CHC
start if first 5 days period or any time when not pregnant and use condoms for 7 days take 21 days with 7 day break can tricycle with 7 days off after or take continuously until bleed, come off 4 days and start
62
factors affecting effectiveness of CHC
impaired absorption in GI conditions increased metabolism, liver enzyme induction, drug interaction compliance
63
risks associated with CHC
``` venous or arterial thrombosis adverse effect cancers systemic HTN migraine with aura age >35 breast and cervical cancer ```
64
benefits associated with CHC
``` reduced ovarian and endometrial cancer benefit on acne reduced PCOS lesser PMS lesser intense bleeding ```
65
side effects of CHC
``` breakthrough bleed breast tenderness worsening acne nausea all major risks ```
66
risks of cervical cancer with CHC
increased after 5 years reduced after 10yrs condom use and HPV vaccination cervical screens
67
risks of breast cancer with CHC
increased but reduces 10 years off
68
risk of age >35 with CHC
UKMEC 2 risk but benefit outweighs consider other risks as they can be contraindication
69
risk of systolic HTN and management with CHC
small increase check 3m needs to be <140/90
70
risk of arterial thrombosis with CHC
increased risk MI or stroke | particularly in smoking or HTN
71
risk of venous thrombosis with CHC
depends on dosage prescribe with lowest risk involved discuss signs and symptoms
72
risks of migraine with aura and CHC
ABSOLUTE CONTRAINDICATION UKMEC 4 increases stroke risk need to establish true aura - change 5-20 mins before headache scotoma, altered sensation, taste, smell or hemiparesis
73
types of POP and mechanism
desogestrel, non-desogestrel | desogestrel acts to inhibit ovulation and all others thicken cervical mucus
74
how to take POP
taken day 1-5 period or any time if not pregnant and use condoms 7 days
75
absolute contraindication for POP
breast cancer
76
side effects POP
headache bleeding nausea acne
77
missed POP?
take at same time if late only matters if >12hrs if >12hrs then wont work for 2 days
78
how does depot provera or sayana press work
lowers oestradiol and suppresses FSH | isnt affected by enzyme affecting drugs so good for epilepsy
79
side effect sayana press/ DMPA
``` weight gain nausea acne headache bleeding ```
80
discuss bone health and depot
can cause issues with peak bone age if given in teens can be given if absolutely necessary but avoid cannot be used in poor Ca absorption or strong FHx try to avoid in menopause
81
how to use diaphragm/cap
use spermicide | put in before sex and take out after 6 hours
82
uses of diaphragm/cap
not wanting UID family spacing not good for absolute avoidance 71-88% effective
83
true/false - female sterilisation works better than male sterilisation
false
84
how effective is natural family planning
76% | only really if wanting something natural
85
counselling for vasectomy
weight up risk and benefit regret? consider other options
86
effectiveness of male sterilisation?
very low failure, very effective and can be hard to reverse
87
complications of vasectomy
``` pain anaesthetic infection bleeding haematoma failure - semen analysis needed ```

MB3 Obstetrics and Gynaecology (12 decks)

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