normal changes during pregnancy

Question 1

does demand on the heart increase or decrease

Answer 1

increase the load on the hard due to higher O2 demand.

Question 2

Cardiac output up or down

Answer 2

cardiac output increases. there is hyper trophy and heart chambers enlarge. increasing cardiac output by 40 percent

Question 3

does BP go up or down

Answer 3

Bp reduced by mid-pregnancy

Question 4

why are woman prone to uti

Answer 4

because uterer walls become relaxed and bigger- sometimes stasis occurs– profillation of bacteria can occur

Question 5

what happens to respiratory function

Answer 5

increase of tidal volume by 40 percent. compression of the diaphragm also leading to an increase in RR and compression of the alveoli.

Question 6

renal system

increased in progesterone

Answer 6

increase in vasodilation, increase in GFR.

renal

Question 7

what happens with increased GFR

Answer 7

increase in urine production. increase in urine output. increase of urine means increase of fluid in the ureter..

Question 8

decrease in ureter mobility

Answer 8

bacterial colinisation, nephritis, UTI

Question 9

decrease smooth musle in GI system

Answer 9

• increased progesterone causes.
  -decrease in smooth muscle tone, which causes a decrease in GI motility and a decrease in the lower oesophageal sphincter. increase in gastric pressure, this causes an increase in reflux

Question 10

decrease in gallbladder mobility

Answer 10

this causes bile to become stagnant.
there is also an increase in estrogen and cholesterol increasing the risk of choleostasis

Question 11

What does CHC stand for?

Answer 11

Combined Hormonal Contraceptive

CHC contains an estrogen and a progestogen.

Question 12

What are the forms in which CHC can be delivered?

Answer 12

• Pill (COC)
• Transdermal patch (CTP)
• Vaginal ring (CVR)

Question 13

What is the risk of contraceptive failure with perfect use of CHC?

Answer 13

<1%

Question 14

What is the estimated percentage of women experiencing unplanned pregnancies with typical use of CHC in the first year?

Answer 14

9%

Question 15

What factors can affect the effectiveness of CHC?

Answer 15

• Drug interactions
• Malabsorption (COC only)
• Weight (CTP less effective in women >90 kg)

Question 16

What serious health risks are associated with current or recent use of CHC?

Answer 16

• Venous thromboembolism
• Arterial thromboembolism
• Breast cancer
• Cervical cancer

Question 17

Which COC formulations are associated with a lower risk of venous thromboembolic events?

Answer 17

• Levonorgestrel (LNG)
• Norethisterone (NET)
• Norgestimate

Question 18

What is the relationship between estrogen dose and arterial thrombotic events in CHC?

Answer 18

Higher EE doses may be associated with greater risk than lower EE doses.

Question 19

What are some health benefits associated with ever-use of CHC?

Answer 19

• Reduced risk of endometrial cancer
• Reduced risk of ovarian cancer
• Reduced risk of colorectal cancer
• Predictable bleeding patterns
• Reduction in menstrual bleeding and pain
• Management of PCOS, endometriosis, and PMS

Question 20

What side effects can be associated with CHC use?

Answer 20

• Mood changes
• Headache
• Unscheduled bleeding

Question 21

Is there a CHC formulation that has the fewest unwanted nuisance effects?

Answer 21

No

Question 22

What is the traditional CHC regimen?

Answer 22

21/7 regimen with a monthly withdrawal bleed

Question 23

What potential problem can arise during the hormone-free interval (HFI) in the traditional CHC regimen?

Answer 23

Risk of escape ovulation

Question 24

What are ‘tailored’ CHC regimens?

Answer 24

Regimens with fewer or no HFIs to avoid withdrawal bleeds and symptoms.

Question 25

What is the recommendation for women aged over 50 regarding CHC?

Answer 25

Generally use safer alternative contraception.

Question 26

What could reduce the contraceptive effectiveness of all CHC methods?

Answer 26

Hepatic enzyme-inducing drugs

Question 27

What should women using teratogenic medications be encouraged to use?

Answer 27

The most effective long-acting reversible contraception (LARC) methods.

Question 28

What should women requesting CHC be informed about?

Answer 28

* Contraceptive effectiveness of CHC * Alternatives including LARC

Question 29

What is a reasonable first-line option for CHC to minimize venous thromboembolism risk?

Answer 29

A COC containing ≤30 µg EE in combination with LNG or NET

Question 30

What should be done during annual follow-up for women using CHC?

Answer 30

* Review medical eligibility * Check for drug interactions * Assess compliance * Consider alternative contraception including LARC

Question 31

Is CHC use associated with a delay in return to fertility after stopping?

Answer 31

No

Question 32

What should be discouraged due to thrombotic risk?

Answer 32

Repeated stopping and starting of CHC

Question 33

What benefit may CHC provide for perimenopausal women under 50?

Answer 33

Management of menopausal symptoms and maintenance of bone mineral density (BMD)