OB Block 3 Flashcards
What is the MC form of contraception in US?
What has more detrimental impacts for morbidity and mortality, pregnancy or contraception?
When is the use of copper IUDs indicated and what PT population is this preferred?
COCs
Pregnancy
Birth control is safer
Emergency, <5d after intercourse
Migraine w/ aura (no estrogens)
C-section delivery is a proxy for ?
What are the three leading causes of infant death?
Delivery mortality increase
Congenital malformations
LBW- 14% <500g survive infancy
SIDS
What country in the industrialized world has the highest rates of unintended pregnancy?
Why is this unique?
USA
Half use contraception
One third on OCPs
How much money is saved from teenage mother/pregnancy?
What are the three goals of preconception counseling?
$1445/mother/yr x 15yrs
Education
Preconceptional care
Reduced disparities/risks
When is preconception counseling conducted?
Future mothers w/ ? BMIs need counseling
Routine well visits
Neg preg tests
Planning future pregnancy
Prescribing birth control
> 30kg/m2
<18.5kg/m2
Inc of autistic baby if father is above ? age
4 risks of second hand smoke exposure
What is one simple thing that can promote/increase baby/mother health and outcomes?
40y/o at conception
SIDS Preterm IUGR LBW
Father present at birth
Highest form of BC in US?
What is the most effective?
Only contraceptive for PTs w/ breast cancer?
Combo pill
IUD/Implant
Copper IUD
What are the tiers of birth control
What is a commonality across the tiers??
1: Implant IUD Sterilization
2: Injection Pill Patch Ring
3: Barrier Behavior
4: Spermicide Sponge
No: Abortion Plan B
None have estrogen alone
What are the reasonably certain ways to determine female is not pregnancy
<7d after menses start
No intercourse since start of last menses
Consistent contraception use
<7d post-abortion
<4wks postpartum
> 85% fully breastfeeding, amenorrhic, and <6mon postpartum
What is the only form of birth control that doesn’t require back up protection immediately after installation?
What three types need exams/tests prior to initiations?
Copper
Cu IUD- Biman/cervical exam
LRIUD- Biman/cervical exam
CHC- BP measurement
What are the two times additional follow up is needed after birth control installation?
What BP measurements are concerning for PTs on birth control
IUD- exam for strings
CHC- BP after starting
> 160/>100= avoid COC/Depo
When are smokers and contraception used or avoided?
When are COCs and migraines used
What are the recommendations w/ DM
<35, ok
+35, <15 smokes/day= caution
+35, +15 smokes/day, avoid
No aura, COC ok
Aura, any age- No COC, Depo ok
Controlled- all ok
End organ Dz/vascular/>20yrs w/ DM- no COC, caution w/ Depo
How are PTs w/ RA managed w/ birth control
PTs w/ DVT/PE Hx can’t get ?
PTs w/ HIV can have ? methods?
SLE, no Abs- COCs ok
SLE, +Abs- avoid hormones
Caution w/ Depo, osteoporosis risk
No COCs
All ok
Spermicide inc transmissions
What methods can breast feeding moms use?
What are the indications a PT should use an IUD?
<1mon post partum- no COCs
Use progesterone
Stable, monogamous
Hormone avoidance, Cu
Nulliparous/adolescent
Levo IUD- dysfunctional bleeds
Cu IUDs are particularly good for ? 3 PT populations and ow long does it stay in?
What do non-Cu IUDs contain and how long do they stain in?
What is it’s MOA
CA Antiphospholipid Abs Thromboembolic dz
10yrs
Progestin
M, K- 5yrs
L, S- 3yrs
Prevents fertilization and implantation via endometrium inflammation
No impact on ovulation
What adverse effect happens w/ Cu IUD
How long does it take for fertility to return after removal
Common in 1st 3mon:
Dysmenorrhea/heavier
Tx w/ NSAIDs
Immediately
How long does LNG IUD stay in and what is the MOA
What is a s/e
What is a benefit
5yrs w/ progestin release
Dec implantation/sperm motility
Inconsistent ovulation inhibition
Infection 1mon after placement
Irregular/spot bleed x6mon
Amenorrhea
Improves dysmenorrhea
When are LVN IUDs placed
How long after placement do PTs need to f/u?
If lost/invisible what is the next step?
> 7 days after menses started, use back up x7 days
6wks
Exclude pregnancy
Cytologic brush to bring string into vagina
No string= US
What is the increased risk if PT becomes pregnancy w/ IUD?
Nexplanon
MOA of Nexplanon
Ectopic pregnancy
2nd trimester miscarriage
Etonogestrel rod subdermal implant- 3yrs suppressed ovulation
Progestin inhibits LH release, implantation, sperm motility
What is a benefit of Nexplanon?
Adverse effects
What are two absolute c/i for this method
Efficacy not affected by obesity
ALL progestin contraceptives- irregular/heavy bleeding
Current breast Ca
Pregnancy
When is Nexplanon placed
What back up is needed
How long for fertility to return
W/in 5 day onset of menses
x7 days
6wks, up to 12mon
Nexplanon is an option for ? PTs
Depo
MOA of Depo
Postpartum
Spot/Induced abortions
150mg IM q3mon delt/glut
Suppress LH
Inhibit sperm motility
Inhibits implantation
What are non-contraceptive benefits of Depo?
What are C/is?
What is the absolute c/i?
Improves menorrhagia, dysmenorrhea and endometriosis pain
Dec endometrial hyperplasia Ca risk
Recent breast Ca
Progesterone pos Ca
Prior ectopic pregnancy
Pregnancy
Current breast Ca
What needs to be added in diet for PTs on Depo
What is an adverse risk?
Vit D/Ca, Depo block endogenous estrogen secretion
Functional ovarian cyst
