FAMILY PLANNING 1.2 (CompreGyne)

Question 1

What contraceptive methods are classified as Tier 3 (least effective, ≥18 pregnancies per 100 women per year)?

Answer 1

Barrier methods, lactational amenorrhea, periodic abstinence, coitus-related methods.

Question 2

What is the diaphragm and how does it work?

Answer 2

A thin, dome-shaped latex or silicone membrane with a flexible rim that creates a barrier between the vagina and cervix.

Question 3

What is the cervical cap and how does it work?

Answer 3

A cup-shaped silicone or rubber device that fits around the cervix, creating a barrier to sperm.

Question 4

What should be used with the diaphragm and cervical cap for optimal effectiveness?

Answer 4

Spermicide.

Question 5

How long should the diaphragm or cervical cap be left in place after intercourse?

Answer 5

At least 8 hours after the last coital act.

Question 6

What is the failure rate of the diaphragm with typical use?

Answer 6

13-17% in the first year, but as low as 4-8% with perfect use.

Question 7

What additional benefit might the diaphragm and cervical cap provide?

Answer 7

Possible reduction in risk of cervical dysplasia and cancer.

Question 8

What is the only contraceptive method with FDA-approved labeling for pregnancy and STI prevention?

Answer 8

Male condom (latex and polyurethane).

Question 9

What are key steps in proper male condom use?

Answer 9

Apply to erect penis before any contact, leave half an inch at the tip, withdraw while erect, grasp base to prevent spillage.

Question 10

What is the typical-use failure rate of male condoms?

Answer 10

Around 15%.

Question 11

What is the female condom and how does it work?

Answer 11

A soft, loose-fitting polyurethane sheath with two flexible rings, inserted into the vagina before intercourse.

Question 12

What is the typical-use failure rate of female condoms?

Answer 12

0.21

Question 13

What are the key criteria for effective use of lactational amenorrhea method (LAM)?

Answer 13

Continuous amenorrhea, exclusive breastfeeding (no supplements), up to 6 months postpartum, frequent night nursing.

Question 14

What is the failure rate of LAM when used correctly?

Answer 14

Less than 2% in the first 6 months postpartum.

Question 15

What are the three key assumptions of the calendar rhythm method?

Answer 15

Ovum is fertilizable for ~24 hours, sperm can fertilize for 3-5 days, ovulation occurs 12-16 days before menses.

Question 16

What is the symptothermal method of periodic abstinence?

Answer 16

A combination of temperature, cervical mucus, and other physiologic signs to track ovulation.

Question 17

What is the typical failure rate of periodic abstinence methods?

Answer 17

Around 24%.

Question 18

What is the active ingredient in spermicides and how does it work?

Answer 18

Nonoxynol-9, a surfactant that immobilizes or kills sperm by destroying the sperm cell membrane.

Question 19

What is the contraceptive sponge and how long is it effective?

Answer 19

A polyurethane sponge with spermicide, effective for 24 hours.

Question 20

What is the failure rate of spermicides and the contraceptive sponge?

Answer 20

15-25%.

Question 21

What is coitus interruptus and what is its major drawback?

Answer 21

Withdrawal before ejaculation; it does not protect against STIs.

Question 22

What is the failure rate of coitus interruptus?

Answer 22

4% with perfect use, 22% with typical use.

Question 23

What is emergency contraception (EC) and when can it be used?

Answer 23

Prevents pregnancy after unprotected intercourse; can be used up to 120 hours after sex.

Question 24

What is the Yuzpe method of emergency contraception?

Answer 24

A high-dose combined oral contraceptive method taken in two doses 12 hours apart.

Question 25

How effective is the Yuzpe method in preventing pregnancy?

Answer 25

Reduces risk by about 75%.

Question 26

What is the most common form of emergency contraception today?

Answer 26

Levonorgestrel (Plan B One-Step and generics).

Question 27

How does levonorgestrel emergency contraception work?

Answer 27

Delays or inhibits ovulation.

Question 28

What is ulipristal acetate (Ella) and how does it compare to levonorgestrel?

Answer 28

A selective progesterone receptor modulator that delays ovulation for 5 days; 42% more effective than levonorgestrel.

Question 29

What is the most effective form of emergency contraception?

Answer 29

Copper IUD, with 99% effectiveness if inserted within 5 days.

Question 30

What is a key benefit of the copper IUD beyond emergency contraception?

Answer 30

It provides long-term contraception.

Question 31

What are two major concerns regarding emergency contraception effectiveness?

Answer 31

May be less effective in heavier women and when used with long-term hormonal contraception.

Question 32

What percentage of unintended pregnancies end in elective abortion?

Answer 32

About 40%.

Question 33

What percentage of abortions occur in the first 12 weeks of pregnancy?

Answer 33

0.9

Question 34

What is the most common method of abortion before 9 weeks' gestation?

Answer 34

Medication abortion with mifepristone.

Question 35

What is the predominant method of performing abortion in the first trimester?

Answer 35

Curettage by vacuum aspiration.

Question 36

What is the manual technique for early pregnancy aspiration called?

Answer 36

Manual vacuum aspiration (MVA).

Question 37

Up to what gestational age can MVA be performed?

Answer 37

Up to 10 weeks and sometimes later.

Question 38

What type of vacuum aspiration is used after 10 weeks of gestation?

Answer 38

Electric vacuum aspiration (EVA).

Question 39

What is required before performing vacuum aspiration?

Answer 39

Dilation of the cervix and anesthesia (local or IV sedation).

Question 40

What should be done after vacuum aspiration to ensure complete evacuation?

Answer 40

Examine the tissue for the gestational sac, placenta, and fetal parts.

Question 41

What can be used to confirm complete abortion if products of conception are not visualized?

Answer 41

Sonogram, serial hCG evaluation, or repeat ultrasound in 1 week.

Question 42

What is the surgical technique used for abortion beyond the first trimester?

Answer 42

Dilation and evacuation (D&E).

Question 43

What percentage of mid-trimester abortions in the U.S. are performed via D&E?

Answer 43

More than 90%.

Question 44

Why is cervical preparation often needed before D&E?

Answer 44

To reduce the risk of uterine trauma, such as perforation and cervical injury.

Question 45

What is the most commonly used cervical dilator for D&E?

Answer 45

Laminaria japonica (sterilized seaweed).

Question 46

What drug can be used with laminaria to reduce the number of dilators needed?

Answer 46

Mifepristone.

Question 47

What prostaglandin is used for cervical preparation before vacuum aspiration or D&E?

Answer 47

Misoprostol.

Question 48

What is the mechanism of action of mifepristone?

Answer 48

It is a competitive inhibitor of the progesterone receptor, preventing progesterone from binding.

Question 49

When combined with a prostaglandin, how effective is mifepristone for abortion?

Answer 49

More than 95% of early pregnancies terminate.

Question 50

What is the FDA-approved regimen for first-trimester medication abortion?

Answer 50

600 mg mifepristone followed by 400 μg oral misoprostol 48 hours later.

Question 51

What is the evidence-based regimen recommended by the Society of Family Planning?

Answer 51

200 mg mifepristone orally, followed by 800 μg misoprostol intravaginally or buccally 24-72 hours later.

Question 52

Up to what gestational age is the evidence-based medical abortion regimen effective?

Answer 52

Up to 63 days gestational age.

Question 53

What is the typical duration of bleeding after medication abortion?

Answer 53

7 to 14 days.

Question 54

What is the most common method for second-trimester medical abortion?

Answer 54

Induction of uterine contractions with prostaglandins.

Question 55

What is the dosage of prostaglandins used for second-trimester abortion?

Answer 55

400 mg intravaginally every 6 hours.

Question 56

What is a key advantage of medical induction over D&E?

Answer 56

Avoidance of surgery and the opportunity to view or hold the fetus.

Question 57

What is a disadvantage of medical induction compared to D&E?

Answer 57

Longer hospitalization and higher risk of retained products requiring further intervention.

Question 58

What role does ultrasound play in abortion procedures?

Answer 58

It verifies gestational age and confirms intrauterine pregnancy.

Question 59

What is the most common complication of surgical abortion?

Answer 59

Infection (~1% of cases).

Question 60

What reduces the risk of infection in surgical abortion?

Answer 60

Perioperative antibiotic prophylaxis.

Question 61

What is the overall mortality rate of elective abortion in the U.S.?

Answer 61

Less than 1 per 100,000 procedures.

Question 62

What two factors are the most important determinants of abortion complications?

Answer 62

Gestational age and method of abortion chosen.

Question 63

Why is early abortion safer than later procedures?

Answer 63

Complication rates increase progressively with gestational age.

Question 64

What is the safest surgical method of abortion?

Answer 64

Suction curettage.

Question 65

What is the most effective method of emergency contraception?

Answer 65

Copper IUD.

Question 66

What is the second most effective method of emergency contraception?

Answer 66

Oral ulipristal acetate (Ella).

Question 67

What is the failure rate of coitus-related contraceptive methods in the first year?

Answer 67

Highest among all methods.

Question 68

What are the most effective reversible contraceptive methods?

Answer 68

IUDs, implants, and sterilization (failure rate <1%).

Question 69

What is the primary mechanism of action of the LNG-IUS?

Answer 69

Thickening of cervical mucus.

Question 70

How does the contraceptive implant prevent pregnancy?

Answer 70

It inhibits ovulation and may cause irregular bleeding.

Question 71

What is a common side effect of the DMPA injection?

Answer 71

Amenorrhea and potential weight gain.

Question 72

What is a major risk of combined hormonal contraceptives?

Answer 72

Increased risk of venous thromboembolism (VTE).

Question 73

What group of women should avoid estrogen-containing contraceptives?

Answer 73

Women with multiple risk factors for VTE or cardiovascular disease.

Question 74

How does delaying abortion access affect maternal safety?

Answer 74

Increases the risk of complications by pushing abortion to later gestational ages.