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Y4 Obs and Gynae > Gynaecology: Contraception and Abortion > Flashcards

Gynaecology: Contraception and Abortion Flashcards

(43 cards)

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1
Q

Why is contraception important?

A
  • Reduces high risk pregnancies

- Allows for family planning/spacing which in turn reduced infant mortality, reduced impact of low SES

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2
Q

What are some important barriers to achieving adequate contraception to be aware of?

A
  • Lack of knowledge
  • Poor communication from health care providers
  • Poor quality of service from HCPs
  • Improper use
  • Fear of side effects
  • Cultural or religious opposition
  • Language barriers
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3
Q

What is the most commonly prescribed method of contraception in the UK?

A

Combined Hormonal Contraception.

Most commonly a second gen COCP pill (e.g. Levonorgestrel), but can give 1st/3rd/4th gen if bad reactions to past pills, can also give rings or patches but rare in UK.

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4
Q

What are some health risks associated with CHC?

A

Rare, but can cause increased risk of:

  • Breast cancer
  • Cervical cancer
  • VTE (however effect is mediated by other RFs, little to no increased risk if normal BMI, BP etc)
  • CVD and stroke
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5
Q

What are some crucial contraindications for CHC?

A

UK MEC category 4:

  • Cardiovascular disease (IHD, Stroke)
  • Multiple RFs for arterial disease e.g. over 35+ smoking
  • Hypertension (160/95)
  • VTE current or past
  • Major surgery w/ prolonged immobilisation
  • Complicated valvular and congenital heart disease
  • Migraine with aura
  • SLE

Also important to know drugs which can react with CHC:

  • Anti-epileptics
  • Rifampicin
  • HIV drugs
  • Lamotrigine
  • UPA
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6
Q

Outside of contraception, what are some benefits from CHC?

A

Reduces:

  • Menstrual bleeding
  • Menstrual pain
  • PID risk
  • Ovarian, endometrial and colorectal cancer risk
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7
Q

What is the most commonly given POP and how does it work?

A

Cerazette.

Cervical mucus alteration AND inhibits ovulation

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8
Q

In what conditions is the POP safe but the COCP unsafe?

A

Women with:

  • Migraine
  • DVT
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9
Q

What are some side effects of the POP?

A
  • Headaches
  • Breast pain
  • Acne
  • Nausea
  • Changes in libido
  • Changes in bleeding patterns are reasonably common
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10
Q

What is the most important UKMEC category 4 contraindication for the POP?

A

Current breast cancer!

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11
Q

Give an example of a progesterone only injectable?

A

Depo Provera, given IM in GP clinics every 3 months.

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12
Q

When can progesterone injections be given when COCP or POP may not?

A

If the patient is on a complex drug regimen (e.g. TB or HIV), effectiveness is not affected by enzyme inducing drugs

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13
Q

What are some downsides to the Depo injection contraception?

A
  • Delayed return to fertility (can take up to a year)
  • Weight gain!!!
  • Can cause a small loss in Bone Mass Density, but no evidence of increased fracture risk (still best to avoid in peeps with osteoporosis risk e.g. FH or wheelchair bound)
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14
Q

What is the main contraindication for depo injections AND subdermal infections according to UKMEC?

A

Current breast cancer!

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15
Q

What is an aternative to the depo injection in terms of long term progesterone contraception?

A

Nexplanon subdermal implant. Effective for 3 years (4 in Covid).

Implanted in the skin above the tricep of the non dominant arm.

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16
Q

What are the benefits to the subdermal implant?

A
  • Long acting reversible contraception
  • No adverse effect on BP, VTE risk, CV disease
  • No effect on bone mass density (issue with depo)
  • Rapid return to ovulation and fertility following removal
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17
Q

What are some drawbacks to the implant as a method of contraception?

A

Risks associated with insertion: Infection, Bledding, Bruising, Scarring, Deep implant and subsequent difficulty with removal.

Bleeding issues: Irregular for first 3 months, long term some get amenorrhoea, some get infrequent periods and some get prolonged bleeding.

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18
Q

What are the main forms of Intrauterine Contraception?

Study These Flashcards
A
  • Copper bearing IUD

- Levonorgestrel releasing IUS (e.g. Mirena)

19
Q

What is the most effective form of emergency contraception?

Study These Flashcards
A

Copper IUD, but only really used in situations when pills are not appropriate.

20
Q

What are some benefits of the Copper IUD?

Study These Flashcards
A
  • Very low failure rate
  • Effective for 5-10 years
  • If a woman is in her 40s she can have one device until menopause.
21
Q

How does the Mirena coil work?

Study These Flashcards
A
  • Releases oestrogens into the womb
  • This keeps the womb lining thin
  • Preventing implantation
  • Effective for 3 or 5 years
22
Q

What checks need to be made prior to insertion of Intra uterine contraception?

Study These Flashcards
A
  • No chance of pregnancy

- No risk of infection (ask about recent unprotected sex, consider testing and consider prophylactic antibiotics)

23
Q

What are some risks associated with IUC?

Study These Flashcards
A
  • Pain and discomfort on insertion
  • Infection or PID
  • Bleeding
  • Perforation is rare but possible
  • Expulsion is more common
  • Slight risk of failure and ectopic pregnancy

Copper coil can cause HMB, painful periods.

Mirena can cause acne, breast tenderness, irregular bleeding

24
Q

What are some contraindications for intrauterine contraception?

Study These Flashcards
A
  • Pregnancy
  • PID, NG, CT
  • Pelvic TB
  • Postpartum sepsis
  • Shouldn’t give in women with unexplained vaginal bleeding due to risk of cervical or endometrial cancer
25
When is emergency contraception indicated?
Contraception failure: - Condom not used or condom accident - Missed COCP (2+ pills) - Late POP (more than 36 hours) - Late Depo (more than 14 weeks since last injection) - Impalpable implant or more than 3 years since insertion - IUD expulsion, lost threads
26
What are the three most common methods of emergency contraception?
EllaOne - Selective progesterone receptor modulator - 30mg single dose - Up to 120 hours after UPSI or contraceptive failure Levonelle - Progesterone - 1.5mg single dose - Up to 72 hours since UPSI or contraceptive failure LICENCED - UNLICENCED up to 120 hours Copper coil - Copper is toxic to sperm and ovum - Has to be after 5 days of USPI AND within 5 days from earliest estimated day of ovulation - 99% effective
27
What counselling should be given to women after taking emergency contraception?
- Know it can fail - Should consider pregnancy test in 3 weeks if abnormal periods - Nausea, headaches, breast tenderness, abdominal pain al common - Small number will vomit and must repeat dose - Reiterate importance of contraception - Take drug history; if on liver inducers need double dose.
28
Define abortion?
Abortion is the removal or expulsion of an embryo or foetus from the uterus before viability, be it spontaneous or medically induced.
29
What does the Abortion Act of 1967 state?
Under UK law, an abortion can be carried out during the first 24 weeks of pregnancy as long as certain criteria are met. A pregnancy can be terminated by a medical practitioner if TWO medical practitioners feel that: - Continuation of the pregnancy would involve risk to the physical or mental health of the woman - Continuation of the pregnancy involves a risk to the life of the woman - There is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped.
30
What are the two methods of performing an abortion?
Medical: - Mifepristone (an anti-progesterone) and Misoprostol (a prostaglandin) - If 22 weeks or beyond, add Fetocide agent such as Potassium Chloride Surgical: - Suction evacuation (1st trimester) - Dilatation and evacuation (2nd trimester)
31
What are some benefits of medical abortion?
- Avoids surgery | - If early can be performed in the home (9 weeks or earlier)
32
What are some drawbacks of medical abortion?
- Takes time (hours to days) - Women experience bleeding and cramping, potentially nausea and vomiting - May require more clinic visits and therefore actually more time with HCP than surgery
33
What are some benefits of surgical abortion?
- Quick procedure - Complete abortion is easily verified - Takes place in a healthcare facility - Sterilisation/long term contraception ca be inserted at the same time.
34
What are some drawbacks of surgical abortion?
- Requires instrumentation of the uterus | - Small risk of uterine or cervical injury
35
In what cases would you always recommend medical abortion over surgical?
- Very obese women - Uterine malformation or fibroids - If the woman wants to avoid surgical intervention - If a pelvic examination is not feasible or unwanted - Contraindications for anaesthetic
36
What medical abortion regime is recommended for a woman at 9 weeks pregnancy (63 days gestation)?
Mifepristone 200mg orally, can be taken at home. *24-48 hour delay* Misprostol 800 micrograms given vaginaly, or sublingually.
37
What medical abortion regime would you recommend for a woman beyond 9 weeks but before 14 weeks gestation
Mifepristone 200mg orally *24-48 hour delay* Micoprostol 800 micrograms given vaginally, or sublingually. Followed by an additional 400 micrograms of Micoprostol every 3 hours until abortion occurs.
38
What surgical abortion regime would you recommend for a woman below 14 weeks gestation?
Manual or vacuum aspiration
39
What medical abortion regime would you recommend for a woman beyond 14 weeks gestation?
Above 14 weeks should always be done in a medical facility. Mifepristone 200mg orally, 12-48 hours later, Misoprostol 800 micrograms vaginally, then again 400mg every 3 hours If no abortion after 24 hours repeat entire cycle again
40
What surgical abortion regime would you recommend for a woman beyond 14 weeks gestation?
Vacuum aspiration using large bore cannulae OR Dilatation and evacuation (rarer, tend to be in specialised centres)
41
What form of abortion do women in the second trimester tend to get?
Medical, surgical becomes notably more difficult in the second trimester whereas medical remains as effective.
42
What are the common complications of abortion?
- Failure to end pregnancy (1-2%) - Need for further intervention to complete the procedure - Haemorrhage requiring transfusion - Uterine rupture (second trimester medical abortions) Surgical TOP: - Cervical trauma - Uterine perforation
43
What after care advice is offered to women post abortion?
- How much bleeding to expect in the next few days and weeks - How to recognise potential complications - How to recognise signs of ongoing pregnancy - When they can resume normal activities (including sexual intercourse) - How and where to seek help if needed - Women who want to conceive again soon should be advised to have at least one normal period before getting pregnant again (multiple if anaemic) - Give Anti-D if appropriate - Offer contraception, method of their choice.

Y4 Obs and Gynae (13 decks)

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