Contraception & Unintended Pregnancy Flashcards
(87 cards)
1
Q
fertilization occurs in ___________ junction
A
ampullar isthmic
2
Q
fertilized egg is surrounded by:
A
zona pellucida
3
Q
Egg is capable of fertilization for ___-____ hours
A
12-24
4
Q
happens 5-6 days after fertilization
A
implantation
5
Q
contraception methods that have the possibility of stopping implantation by primary or secondary MOA
A
-ALL hormonal methods
including Skyla + Mirena
-Emergency Contraception
copper IUD
UPA
-Progestin Only Pills (Plan B/Next Choice)
-Combined Oral Contraceptives (COCs) “Yuzpe” Method
6
Q
using everyday BC pills as EC by combining pills in specific order
-estrogen + progestin in BC pills work to prevent implantation
A
Yuzpe Method of EC
7
Q
Yuzpe method is most effective within ____ hours after sex
A
72
8
Q
B.R.A.I.D.E.D. for Informed Consent
A
B- benefits of the method
R- risks of the method - all major, common minor, related uncertainties & unanswered questions, consequences of method failure
A- alternatives to the method - including abstinence and no method
I- inquiries about the method are the patient’s right and responsibility
D- decision to withdraw from using the method without penalty is the patient’s right at any time
E- explanation of the method is owed to the patient, in a format that is understandable to the patient
D- documentation that the caregiver has ensured understanding of each of the above 6 points usually by consent form use
9
Q
potential complications of female condom/diaphragm/cervical cap/sponge
A
increased UTI risk
superficial cervical erosion (spotting/discomfort)
TSS possible if left too long
10
Q
more complications arise from this method of female sterilization
A
minilaparotomy
11
Q
conditions for LAM to be effective
A
- Must be exclusive or nearly exclusively breastfeeding - for both day and night feedings (at least 90% of feeds)
- Spotting in first 56 days postpartum not regarded as menese
- Infant is less than 6 months old
12
Q
continue back-up method of BC for ___ months after vasectomy
A
3
13
Q
effectiveness of spermicides
with typical use: ____%
with perfect use: ____%
A
with typical use: 72%
with perfect use: 82%
14
Q
spermicides offer zero protection from:
A
STIs
15
Q
frequent sex with multiple partners while using ___________ can increase risk of HIV
A
spermicides
16
Q
vaginal barrier methods that protects against gonorrhea and chlamydia
A
sponge, cervical cap, diaphragm, female condom, male condom
17
Q
only vaginal barrier method that reduces risk of HIV
A
male condom
18
Q
most effective vaginal barrier method
A
male condom
19
Q
least effective vaginal barrier method
A
spermicides
20
Q
is diaphragm or cervical cap less effective?
A
cervical cap
21
Q
Health Benefits of ___________ and ____________:
- Prevention of endometrial cancer in women w/PCOS, obese, or perimenopausal
- Decreased risk for developing or dying from colorectal cancer and should be offered to all women w/ strong family history
- Decreased risk for ovarian cysts
A
Combined Oral Contraceptives
and
Progestin Only Pills
22
Q
Combined Hormonal Contraceptive Methods
A
COCs
patch
ring
23
Q
Progesterone Only Methods
A
DMPA (shot)
mini-pills
Nexplanon implant
24
Q
Contraindications of ______________:
- active gallbladder or liver disease - hepatitis, severe cirrhosis, and liver tumors
- multiple RF for CVD - HTN >/= 160/100, vascular dx, current DVT and PE and MOST w/ hx of known thrombogenic mutations (Factor V leiden)
- current breast cancer
- migraines w/ aura at any age and w/o aura >35
- Hx of stroke
- diabetes >20 yrs w/ retinopathy, nephropathy, neuropathy or other complications
- major surgery w/ prolonged immobilization
- before 3 weeks postpartum
A
Combined Hormonal Contraception
25
Contraindications of ______________:
* current or recent hx of breast cancer
* DMPA: category 3 includes multiple CVD risk factors and active liver disease
Progestin Only Methods
26
```
SE of ____________:
Nausea
Headache
Bloating
Mood changes
Decreased libido
Period changes
Decreased acne
```
Combined Hormonal Contraception
27
```
SE of ____________:
Nausea
Headache
Bloating
Mood changes
Decreased libido
Period changes
Decreased acne
```
Combined Hormonal Contraception
28
SE of _____________:
Changes in periods
Amenorrhea or oligomenorrhea
Progestin Only Methods
29
Teaching for ___________:
ACHES
A: abdominal or pelvic pain ~ heralds a hepatic clot, liver or hepatic clot, liver/gallbladder disease, ectopic pregnancy
C: chest pain~ PE, MI, angina, breast lump
H: Headaches ~ stroke, migraine, new onset HTN
E: Eye problems ~ CVA, vision changes, migraine, clots in the eyes, corneal changes
S: severe leg pain ~ DVT or phlebitis
* Still at risk for STIs
* Miss >2 doses → need backup method
Combined Hormonal Contraception
30
A.C.H.E.S for Combined Hormonal Contraception
A: abdominal or pelvic pain ~ heralds a hepatic clot, liver or hepatic clot, liver/gallbladder disease, ectopic pregnancy
C: chest pain~ PE, MI, angina, breast lump
H: Headaches ~ stroke, migraine, new onset HTN
E: Eye problems ~ CVA, vision changes, migraine, clots in the eyes, corneal changes
S: severe leg pain ~ DVT or phlebitis
31
Teaching for _____________:
* mini pill MUST be taken at the same time every day
* depo will cause period changes
* still at risk for STIs
* miss one day, need backup for 2 days
Progestin Only Methods
32
Use a condom as back up for ___ days when starting COCs and ____ days when starting POPs
7 for COC
| 2 for POP
33
If you miss a COC pill, use:
a condom
34
If you are 3 ours late for POP pill, use:
a condom
35
Use a condom if you have sex within 1 hour before or after taking _____
POP
36
COC with same amount of hormones in each pill
monophasic
37
COC with varying amounts of progesterin/estrogen in pills
multiphasic
38
COC differ in amount of ______ pills
active/inactive
39
```
therapeutic benefits besides BC of ___________:
Heavy menstrual bleeding
Acne
Hirsutism
Other androgen excess/sensitivity states
Pain and frequency of sickle cell crisis
```
Combined Hormonal Contraception
40
Never Rx _________ during 1st 2 weeks PP regardless of feeding method
Combined Hormonal Contraception
41
Don't start Combined Hormonal Contraception until ___ days PP
30
42
Don't start Combined Hormonal Contraception during PP weeks 3-6 if _______ risk factors are present
DVT
43
```
Use ___________ instead of CHC in these:
Women who can’t use estrogen
Smoker
Over 35
Hx of thromboembolic events
Breastfeeding
```
POPs
44
Progestin Only Methods
Depo
mini-pills
Mirena/Skyla/Kyleena
Implant
45
thickened cervical mucus EXCEPT Depo)
Primary MOA of POPs
46
```
thinned endometrium
inhibit ovulation (EXCEPT Depo)
```
Secondary MOA of POPs
47
inhibiting ovulation
Primary MOA of CHCs
48
thinned endometrium
| thickened cervical mucus
Secondary MOA of CHCs
49
P.A.I.N.S. for IUDs
P - Period late (pregnancy); abnormal spotting or bleeding (pregnancy, infection)
A - Abdominal pain, pain with intercourse (infection)
I - Infection exposure (STI); abnormal vaginal discharge (infection)
N- Not feeling well, fever, chills (infection)
S - String missing, shorter or longer (expulsion of IUD or change in position)
50
Non-contraceptive health benefits of _______:
Probable prevention of endometrial cancer and possible prevention of cervical cancer
Progestin for endometrial protection in women undergoing menopausal estrogen tx
IUDs
51
Contraindications of ______________:
Copper Allergy
Known or suspected uterine/endometrial or cervical cancer at insertion cat 4, continuation cat 2, MEC cat 4
Pregnancy
Puerperal sepsis or immediate post septic abortion
Distorted uterine cavity esp fibroids - this is why you do a bimanual
Unexplained uterine bleeding if suspicious for serious cause
Current breast cancer
Current or recent PID
Current or high risk for STI - initiation
IUDs
52
Does IUD increase risk of ectopic pregnancy compared to no contraception?
No, it lowers risk by 70-80% -->less likely to get pregnant at all with IUD
decreased PID, endometritis, and cervicitis
53
Complications of __________:
Infection during first 20 days after insertion - 1/1000 will get PID
No STI protection
Uterine perforation- 1/1000, usually only w/insertion
Expulsion- may not be aware (risk factors: insertion on menses, immediately postpartum, poor insertion, nulliparous...may cause pregnancy)
Vasovagal or fainting w/insertion
IUDs
54
Forms of ___________:
Copper IUD - paragard
Ulipristal acetate (ella) - newest pill form of EC
Progestin-only pill regimens - most common is levonorgestrel - plan b and next choice
COC regimens - rarely used in US, only form in much of the world
Emergency Contraception
55
most effective EC (more effective than any pill...Failure rate under 1 in 1000)
**Especially most effective for overweight
Copper IUD
56
EC with slightly higher effectiveness than LNG regimen - 1.3% pregnancy rate after 1 act
- 10 pregnancies in 1000 uses
- Most effective oral agent
- Reduced risk of unintended pregnancy after unprotected intercourse about 90%
Ulipristal Acetate (Ella)
57
EC with 2.6% pregnancy rate after 1 intercourse act
- Reduced risk of unintended pregnancy after unprotected intercourse about 89%
- 12 pregnancies per 1000 uses
Progestin-Only Pill regimens (Levonorgestrel - Plan B and Next Choice)
58
EC with 2-3% failure rate
- -Reduced risk of unintended pregnancy after unprotected intercourse about 74%
- -20-32 pregnancies per 1000 unprotected acts
COC regimens
59
Side Effects of ___________ EC:
If pregnant - must r/o ectopic - overall rate is reduced vs. no IUD
Avg blood loss may ↑ by 50%
May ↑ dysmenorrhea - removal rates for bleeding/pain in 1st yr is 11.9%
Spotting and cramping w/ insertion/intermittently in weeks following insertion
Some uncomfortable w/ a “foreign body” inside
Strings palpable
Infection during first 20 days after insertion - 1/1000 will get PID
Uterine perforation- 1/1000, usually only w/ insertion
Expulsion- may not be aware (risk factors include insertion on menses, immediately postpartum, poor insertion, nulliparous, may cause pregnancy)
Vasovagal or fainting w/insertion
Copper IUD
60
increased bleeding caused by Copper IUD (as BC or EC) can be subsided with:
NSAIDs
61
```
Side Effects of ___________ EC:
Headache
Nausea
Abdominal pain
Breast tenderness
Fatigue
Dizziness
```
Ulipristal Acetate (Ella)
62
```
Side Effects of ___________ EC:
N/V (less than COCs)
Breast tenderness
Fatigue
Headache
Abdominal pain
Dizziness
```
Progestin-Only Pill regimens (Levonorgestrel - Plan B and Next Choice)
63
```
Side Effects of ___________ EC:
N/V (give prophylactic antibiotic)
Breast tenderness
Fatigue
Headache
Abdominal pain
Dizziness
```
COC regimens
64
Advantages of __________ EC:
* most effective
* may be used 3 days later than pills
* can remain in place for ongoing contraception
* same as IUD for normal contraception use
Copper IUD
65
Advantages of __________ EC:
* more effective than LNG methods
* longer window - 120 hrs after sex
Ulipristal Acetate (Ella)
66
Advantages of __________ EC:
* available OTC for all ages
* prevent pregnancy anxiety
* may increase long term contraception use
* more effective than COC, less n/v
Progestin-Only Pill regimens (Levonorgestrel - Plan B and Next Choice)
67
Advantages of __________ EC:
* prevent pregnancy anxiety
* may increase long term contraception use
COC regimens
68
Disadvantages of ___________ EC:
* same as when using for contraception
* expensive if placed and removed for EC - but still less expensive than unintended pregnancy
Copper IUD
69
Disadvantages of ___________ EC:
*prescription only
*menses delayed avg 2 days can → anxiety/stress
*some uncomfortable w/ post-fertilization techniques and need reassurance that in follicular phase it is consistent w/ beliefs
~if taken after ovulation - may work as interceptive
*headache, nausea, abd pain
*no STI protection - tx if there is exposure
*not recommended to start hormonal method immediately
*barrier method needed for next 7 days or remainder of cycle
*less effective BMI >30
Ulipristal Acetate (Ella)
70
```
Disadvantages of ___________ EC:
*embarrassment getting it OTC
*less effective in overweight and obese
*nausea and vomiting common
*no STI protection
*next menses may be altered in timing
*notable flow changes
*some uncomfortable w/ post-fertilization techniques and need reassurance that in follicular phase it is consistent w/ beliefs
~if taken after ovulation - may work as interceptive
```
Progestin-Only Pill regimens (Levonorgestrel - Plan B and Next Choice)
71
Disadvantages of ___________ EC:
*least effective and w/prescription only
*common nausea and vomiting
*breast tenderness, fatigue, headache, abd pain, dizziness
*next menses may be altered in timing w/notable flow changes
*some uncomfortable w/ post-fertilization techniques and need reassurance that in follicular phase it is consistent w/ beliefs
~if taken after ovulation - may work as interceptive
*no STI protection
*DVT
COC regimens
72
Contraindications of ___________ EC:
* copper allergy
* anatomic abnormalities
* cervical, endometrial cancer, PID, current purulent cervicitis, pelvic tuberculosis, unexplained vaginal bleeding - initiation
* gestational trophoblastic disease
* post-septic abortion
* puerperal sepsis
Copper IUD
73
Contraindications of ____________ EC:
* pregnancy
* repeat use in single cycle
```
PRECAUTIONS:
*ectopic pregnancy
*hypersensitivity to product compounds
8undx abnormal uterine bleeding
*drug interactions
```
Ulipristal Acetate (Ella)
74
this EC has no medical contraindications...if pregnant, it won't work
Progestin-Only Pill regimens (Levonorgestrel - Plan B and Next Choice)
75
Contraindications for ___________ EC:
pregnancy
COC regimen
76
progestin agonist antagonist
Longer window 120 hrs vs 72 hrs of POP regimen LNG EC
Slightly higher effectiveness than POP regimen LNG EC
Still works even after LH surge has already started
Ulipristal Acetate (Ella)
77
ECs that delay LH surge which delays ovulation
Progestin-Only Pill regimens (Levonorgestrel - Plan B and Next Choice)
and
Ulipristal Acetate (Ella)
78
ECs do not disturb an ________ pregnancy
implanted
79
Copper IUD prevents ____________
implantation of fertilized egg
80
the only EC method that may cause birth defects to a developing embryo
Copper IUD
81
EC Pills taken before ___________ disrupt follicular phase, blocking LH surge and inhibiting ovulation
- may also create a deficient luteal phase and thicken cervical mucus
- --If taken after ovulation they have limited effect on hormone production and limited effect on endometrial maturation
ovulation
82
if no period in ____ days after taking EC - return for pregnancy test
21
83
EC pills don't prevent pregnancy from intercourse:
had after EC pills taken
84
Ongoing use of ___________________ is more effective than repeated EC use
effective contraception
85
N/V is common with COC regimen EC due to:
high dose
86
EC only _______ ovulation, it does not ______ it
delays; inhibit
87
Mifeprostone may be taken for abortion up to ___ days after LMP
70
