Obstetrics Flashcards
(36 cards)
HR of pre-eclampsia
-1 of/2 of?
___________
Refer when?
Haemolysis (H) - polychromasia and schistocytes
Elevated liver enzymes (EL),
Low Platelets (LP).
Preggers/PP<4w: A/W - Clonus/HYPERreflexia >160/110 -HA -Eye dx -N+V -pain BELOW RIBS -Sudden SWELLING Dx? Tx? \_\_\_\_\_\_\_\_\_\_
- Mx @Pre Eclampsia HR
- @booking 8-12w + HR Pre-Ecl, do what?
- Refer when?
__________
What at each ANC?
If dipstix prot 1/+ - - >??
1 of: CKD HTN pre-existing AImmune DM
2 of: FFM 10 35 40
FHx/First/multiple
10yr interval / BMI 35/+ 40/+yrs
______________
Refer @
- 160/110 / ProtUria [2+]
- A:CR >8 / P:CR >30 = significant –> Refer obst
HELP syndrome - IV MgSO4
Preggers/PP<4w = HENPS
-Dx: Pre-Eclampsia -> Tx: 999
___________
@ Pre-Eclampsia HR:
1. Consultant-led @ PrEcl HR (1CHAD/2FFM10/35/40)
- @booking 8-12w
- Asp 75mg W12 –> birth @ HR Pre-Ecl - Refer @:
- 160/110 / ProtUria [2+]
-A:CR >8 / P:CR >30 = significant –> Refer obst
__________
Dipstix/BP @ each ANC
If dipstix prot 1/+ –> Renal Assx:
A:CR >8 /
P:CR >30 =
Significant –> Refer obst
Refer @ 160/110/ ProtUria [2/+]
gHTN VS
Pre-Eclampsia VS
Eclampsia?
MgSO4 induced respiratory depression?
____________________
Ix?
Tx?
gHTN >20 weeks w/ >140/90
Pre-Eclampsia : >20 weeks w/ >140/90 and 1/+: ProtUria OR Organ dx (Neuro/LF/RF/UtPlacent dx/TCP)
Eclampsia: as above + seizures –> Magnesium sulphate
CaGluconate @ MgSO4 induced respiratory depression?
____________________
Ix: Dipstix/BP @ each ANC
@ Pre-Eclampsia HR:
1. Consultant-led @ PrEcl HR (1CHAD/2FFM10/35/40)
- @booking 8-12w
- Asp 75mg W12 –> birth @ HR Pre-Ecl - Refer @:
- 160/110 / ProtUria [2+]
- A:CR >8 / P:CR >30 = significant –> Refer obst
Women < 30 years, YOUNG
‘breast mice’ = discrete, non-tender, HIGHLY MOBILE lumps
What to do if <3cm? >3cm?
___________
Most common in MIDDLE-aged women
‘Lumpy’ breasts which may be PAINful.
-syx ?worsen prior to menstruation
_____________
hard, irregular lump.
There may be associated nipple inversion or skin tethering
Most common Brest cancer?
_____________
Reddening and thickening (may resemble eczematous changes) of the nipple/areola
nipple START -> spreads OUTWARD involving the areola
_______________
Breast anatomy
NLM TLS
_____________
70+M a/w
gradual loss of voice / 6 m
DDx?
Ax?
Fibroadenoma
-W+W < 3cm
-Surgical excision @ >3cm
_____________
Fibroadenosis
-FibroadenoSISSSSSS - SISters !!!
(fibrocystic disease, benign mammary dysplasia)
_______________
Breast cancer
Ductal No Special Type>
Lobular >
DCIS > LobCIS
___________
Paget’s disease of the breast - intraductal carcinoma
_________
FROM USMLE BOOK 2019 p635
-NLM TLS
Nipple,
LACTIFerous duct_Major duct = Paget, Abscess, Mastitis, IntraDuct-Papilloma=bloody
TERMinal duct_LOBular unit = Cancers - DCIS etc
Stroma = Fibroadenoma/Phyllodes tumour
_______________
Aphonia = inability to speak.
- Ax:
1. Recurrent Laryngeal Nerve palsy (TT/Tumour)
2. PSYCHOgenic
Tender lump around the AREOLA+/-
-GREEN CREAMY nipple discharge
MENOPAUSE age #51yrs
?breast duct Dilatation
If ruptures –> local inflammation,
aka PLASMA CELL MASTITIS
____________
BLOOD stained discharge
HyperPLASTIC lesions #Epithelial prolife @ large mammary ducts
___________
Obese women, LARGE breasts
-TRAUMA
Initial inflammatory response, firm and round –> develop into a hard, IRREGULAR breast lump
___________
More common in LACTATING women
-Red, hot tender swelling
__________
HALO sign @ mammograms
MENSTRUAL cycle VARIATION
- Uncomfortable fluctuant breast mass
___________
Young SMOKER
-Mammillary duct FISTULA
-abscess Inflammation
__________
@BREASTFEEDING: bact enter skin-cracks -> RISK bacterial infection
Dx? Tx?
? is most common pathogen.
Mammary duct ectasia
-Dilatation of the LARGE breast ducts
__________
Duct papilloma
NOT malignant or premalignant
_________
Fat necrosis
Rare and may mimic breast cancer so further investigation is always WARRANTED!!!!!!
__________
Breast abscess
-LACTATING women
-Fluclox + I+D
________
Breast cyst
-HALO sign @ mammograms
Needs excision - risk of breast cancer!!!
-AS OPPOSED TO I+D cos the fkn shell stays in there which you need remove
__________
PERIDUCTAL mastitis
-ABx, I+Drain
___________
Lactational mastitis
- FLUCLOX and continue breastfeeding
- S Aureus is most common pathogen.
Pre-existing HTN - stop which antihypertensives?
Anti-HTN TX is not necessary if BP..??
chronic HTN >? / ? + NOT taking aHTN tx =
Start on which meds? Target?
METHYLDOPA during preg
stopped within ? days of birth
cos of ?
physiological dropORrise in BP
@EARLY pregnancy??
Ix + Tx after w12? \_\_\_\_\_\_\_\_\_\_\_\_\_ Physiologic changes @preggers -rises? -drops?
ACE/ARB/Thiazide
Stop anti-HTN tx if BP < 110/70/Syx low BP
chronic HTN >140/90 + NOT taking aHTN tx = LNM<135/85
labetalol > nifedipine > methyldopa –> Target < 135/85
METHYLDOPA during preg
stopped within 2 days of birth
cos of DEPRESSION
physiological DROP in BP
@EARLY pregnancy??
Ix: Dipstix/BP @ each ANC
@ Pre-Eclampsia HR:
- Consultant-led @ PrEcl HR (1CHAD/2FFM10/35/40)
- PRE-EXISTING PART OF CHAD mnemonic - @booking 8-12w
- Asp 75mg W12 –> birth @ HR Pre-Ecl - Refer @:
- 160/110 / ProtUria [2+]
-A:CR >8 / P:CR >30 = significant –> Refer obst
_____________
Physiologic changes @preggers
- rises: everything else
- drops: Hb + BP
- If >20w w/ NEW ProtUria + no HTN - Ddx?
- @PP:
had pre-Ecl + NOT had anti-HTN tx =
BP measured ??d after birth - @PP:
had pre-Ecl + HAD anti-HTN tx =
BP check/?-?d after birth for ?weeks - @PP BP > ? / ? start anti-HTN tx
postnatal period:
- not breastfeeding = ?? tx
- breastfeeding =
1. ? // ?/? @black
2. ? + ?
3. +/- ?/?
gHTN/chrHTN = BP check: check -day ? -day ? -days ?
R/V BP meds @ ? wks postnatally
Postnatal review ? weeks
Target BP: ? / ?
- probable UTI –> MSU –>
f/u 1wk + cephalex/amoxi/pivmecillinam - @PP:
had pre-Ecl + NOT had anti-HTN tx =
BP check 3–5d after birth - @PP:
had pre-Ecl + HAD anti-HTN tx =
BP check/1-2d after birth for 2 weeks - @PP BP > 150/100 start anti-HTN tx
postnatal period:
- not breastfeeding = normal HTN tx
- breastfeeding = E/NAm ENAtLab
1. enalapril // nifedipine/amlodipine @black
2. enalapril + nifedipine
3. +/- atenolol/labetalol
gHTN/chrHTN = BP check: check -day 1 -day 2 -days 3–5 (x1)
R/V BP meds @ 2wks postnatally
Postnatal review 6-8 weeks
Target BP: 140/90
TNM breast staging
What chemo you give to node +?
What chemo you give to node -?
I.e. If you just remember T2, T4c, T4d
__________
Preg woman >20w till 4w PP
w/ BP >140/90 has: HENPS (end organ dx)
HA Eye dx N+V pain BELOW RIBS Sudden SWELLING
Advice?
_______________
Intrahepatic cholestasis of preg increased risk of ??
Tx?
T1 <2cm
T2 2-5cm
T3 >5cm
T4a skin
T4b CW
T4c skin + CW
T4d INFLAMM
FEC-D chemo = for node +ve, and that
FEC chemo = for node -ve that requires chemo
______________
Hospital.
Refer @ 160/110 / ProtUria [2/+]
______________
Intrahepatic cholestasis of preg increased risk of PREMATURITY
Induce @ 37w +
USDA +
Vit K
Preggers -Rubella IgG not detected - advice?
12 week PREG meet f2f >15 mins relative with shingles.
PMH: chickenpox
12 week PREG meet f2f >15 mins relative with shingles.
PMH: NOOOO chickenpox
pregnant woman develops chickenpox >20w
pregnant woman develops chickenpox <20w
Keep away from anyone w/ rubella
Advise risks
MMR PoooooST-NATALLY
Reassure her. No further action
check varicella ABs + VZIG
> 20 w = ORAL Aciclovir <24hr of rash
< 20 w = ?consider ORAL aciclovir
Folate and Vit D doses @ preg?
GBS tx?
Folic acid 400 micrograms OD
Vit D 10 micrograms once a day
INTRApartrum IV BenPenG
1. Small: Brain, Eyes, Limbs micro: cephaly --> learning disabilities ophthalmia), limb --> hypoplasia
- Ear, Eye, Heart dx
- Ear: Sensorineural DEAF,
- Eye: Microphthalmia, SALT-pepp CHORIOret, Cataract
-CongenHD
HSM+Rash
- sBEL: Fetal Varicella - brain eyes limbs
-small limbs
LIKE A CHICKEN-(pox)
ha ha get it… - EEH: Congen Rubella - ear eye heart
sensorineural = cmv + rubella
Avoid which drugs @ breastfeed:
Post-term pregnancy definition? Mx?
- High Risk of?
____________
Preg:
ACEi ?
Cocaine ?
Valproate/Carbemaz = ?
Phenytoin = ?
Warfarin courmarins = ?
Di-Ethyl-Stil-BESTROL @mum = ?
Isotret = ?
Misoprostol = ?
Thalidomide - ?
V - Aspirin/Amiodarone I - chloramphen/Quinolone/Sulfonamide/Tetras/Fungals - selenium, flucon, itracon N - MTX/Cytotoxics D - LITHIUM/BENZOs I - LITHIUM/BENZOs C - LITHIUM/BENZOs A - MTX/Carbimazole TE - SUs
Post-term = beyond 42 w –>
INDUCE > WW
-High Risk of Meconium Asp
Preg:
ACEi = iuGR, iuRenal-Insuff, Oligohydramnios
Cocaine = small brain, limb dx, urine-tract dx
Valproate/Carbemaz = NTDs
Phenytoin = Hydantoin Syndrome = craniofacial dx
Warfarin courmarins = skeletal dx
Di-Ethyl-Stil-BESTROL @mum = vaginal adenocarcinoma in kid 14 yrs later
Isotret = CNS/Craniofacial/Cardiac dx
Misoprostol = Moebius Syndrome - cranial nerve dx
Thalidomide - limb dx
Oligohydramnios definition? Ax?
Shoulder dystocia tx?
Oligohydramnios
< 500ml @ T3
AFI < 5th centile
Renal agenesis / ACEi
IUGR
PROM/Pre-Ecl/Post-term>42w
Shoulder dystocia: MESZ
McRoberts’ - flexion and abduct
Episiotomy, Symphysiotomy,
Zavanelli / Rubin Wood’s Corkscrew
PPHemorrhage tx
_________________________
Premature labour tx?
After W?
symphysis-fundal
height in cm = ??
-BOE-CAB Bimanual uterine compression Oxytocin - stim ut contract Ergotamine( -5HT/Alpha-adr/Dop=vasc SM constrict -> reduce Uterus BF = less bleed)
Carboprost
Atony = Balloon tamponade
B-lynch UA/Iliac ligation/TAH
________________________
Premature labour:
Admit
Tocolytics and Steds
After W20, S-F height i=
-g.WEEKS +/- 2cm
Fetal defects:
- Smoking/cannabis AD
- Cocaine
- Heroin
- Alcohol
- Smoking
Alive: READING abiilty reduced /iuGR / Pre-term labour
Dead: miscariage, stillbirth, SUDS - Cocaine = small brain, limb dx, urine-tract dx
-mum = PreEcl / Pl.Abruption
-kid = Prem / Abstinence-syndrome - Abstinence syndrome
- Small: head circ / brain
-Neuro signs
PALPEBRAL fissures Short
VERMILLION border Thin
FILTRUM Smooth
< 10th growth centile
A nurse informs you
30F 38 weeks pregnant. BP 155/90
Prev BP 2 days ago was 152/85
24hr urinary prot excr of 0.7g / 24 hours
Tx?
Target DIASTOLIC BP?
___________________________
Temp > 38ºC <6w after delivery?
-Post-partum period = ?
___________________________
Breast-feeding
Sore nipple
White discharge - candida
Tx???
Labetalol
Deliver < 48hrs
Target DIASTOLIC bp = 80-100
_________________
Puerperal pyrexia - admit IVAbx
-Post-partum period = <6wks
__________________
Continue breast feeding + Tx BOTH:
- Mum - Miconazole cream
- Baby - Nystatin
A. Booking visit
B. 11 - 13 weeks
C. 28 wks –> 34wks
D. 36 wks
Positive serum AFP/Prev NTD -> USS -> Amniocentesis for AFP/AChi w12 16-20
@HIV, mum viral load < 50 @ w?
-what delivery recommended?
-what should be started 4 hrs b4 c-section?
After birth:
-mum CD4 < 50, what administered to neonate?
-mum CD4 > 50, what administered to neonate?
_____
Pros of BFeed
Abortion/Miscarriage >12w TransPlacentalHaemorrhageRisk(procedures) -procedures/abdo trauma/iuDeath Ectopic Evac after miscarriage
A. 8-12 wks -
- Booking
- overlap w/ Down’s nuchal scan
B. 11-13 -Down's + Nuchal scan -overlap w/ booking \_\_\_\_\_\_\_\_\_\_ C. 28 wks - 1st dose of anti-D prophylaxis @RhNEG - 2nd Anemia/AlloAB test @28w
34 wks: 2nd dose of anti-D prophylaxis @RhNEG \_\_\_\_\_\_\_\_\_\_ D. 36 wks: -BFeed / Blues / Vit K -Presentation (ext ceph version?)
@viral load < 50 @ w36: VAG > C-section - IF c-section, then b4 c-section: IV zidovudine After birth: < 50: PO zidovudine @neonate > 50: Triple ART @neonate \_\_\_\_\_\_\_\_
Mother:
- BabyBond
- Reduce BreastCancer / PPH-risk
Kid: i-AIRD
- Infections
- Allergy/ IBD / RA / DM 1
T1/2 bleed causes?
T3 bleed causes?
- Bleeding @T1/earlyT2
- exaggerated syx e.g. HyperEmesis.
- LARGE 4 dates uterus
- hCG = high AF!!! = HYPERthyroid
- ? @USS
Tx????????
Complete V Partial mole?
? % = develop choriocarcinoma
___________
Delayed 3rd stage labour
Pt w/ prev
-PMH: PID
-PSH: c.section / p.praevia
?-types - what invades what?
Tx: ?
_______________
@preggers
•shock OUT OF KEEPING w/ visible loss
•tender, tense, hard woody uterus #CONSTANT-pain
- lie /presentation - NORM
- fetal heart: absent/distressed
- coag dx=DIC / pre-eclampsia
- NO fetal distress + <36w
- NO fetal distress + >36w
- Fetal distress - tx?
___________
@preggers
•shock IN PROPORTION to visible loss
•painLESS
- lie /presentation - ABnormal
- fetal heart: FINE
- coag dx=none..
Ix? - what to avoid?!
- If low-lying placenta @16-20 week scan
- rescan at ?weeks - If still present @ ?-weeks and
grade 1/2 then ? - If high presenting at ?weeks then ?
- If high abnormal lie at ?weeks then ?
_____________
Rupture of membranes –>
- immediately get vaginal bleeding
- Fetal BRADYcardia #classically seen
T1/2 = Ectopic / Miscarriage-Molar preg
T3 = Praevia / Abruption
_________________
Complete HyDatiDiForm Mole (MOLAR)
Tx = EVAC -> CONTRACEP 12m
-EMPTY egg + 1 sperm –> DNA duplicates –>
COMPLETE=46 chromosomes =
ALL 23x2 male genes
-Honeycomb/Grapes/SNOWstorm @USS
PARTIAL=69 XXX/XXXY
- haploid egg (23) + 2 sperm (23x2)
- partial fetal parts
Around 2-3% = develop choriocarcinoma
___________
Accreta
- delayed labour #3rdstage
- prev c-sec/praevia/PID
3-types = chorionic villi:-
- invade PPerimetrium #PPercreta
- IInvade myometrium #IIncreta
- AAttach* 2 myometrium #AAccreta
*-instead of decidua basalis #accreta
Tx: hysterectomy w/ placenta left in-situ
___________
P.Abruption - PainFUL PV bleed
-OUT OF KEEPING w/ visible loss
- feta heart fucked + DIC/Pre-Ecl
____________
- NO fetal distress + <36w
- observe+steroids
- ?adjust delivery threshold - NO fetal distress + >36w
- vag delivery - Fetal distress - tx?
-immediate c-section
_____________
P.Praevia - PainLESS PV bleed
- IN PROPORTION to visible loss
- Lie = abnormal
Ix? - what to avoid?!
-TV-USS - avoid PV exam till praevia excluded!!
LLP @W-16-20 = Rescan @w34
-34 + G1/2 = TVUSS/2w
-37 = high-presenting-part/abnormal life = C-SECTION
- If low-lying placenta at 16-20 week scan
- rescan at 34 weeks - If still present at 34 weeks and grade 1/2 then
- scan every 2 weeks - If high presenting part at 37 weeks then
- C-section - If abnormal lie at 37 weeks then
-C-section
_______________
Vasa praevia
-ROM - >PVbleed + BradyBaby
T3 preggers
Pruritic ABDO Striae –> spread
____________________
Pruritic
Umb –> Spread-2-trunk
BLISTERINGGGG
Polymorphic - emollients, top/PO steroids -Pruritic -3rd trimester -ABDO Striae --> spread -ACE \_\_\_\_\_\_\_\_\_\_\_
PemphigOOOOOid gestation - PO steds
O looks like fkn belly-button!!!
-and blisters too!!!
When take folic acid 5mg instead of 400 mic?
Baby blues - anxious tearful < 1wk
Puerperal Psychosis - mood swings/auditory hallucinations < 2-3 wks
PNDepression tx? < 4-12 wks
Screenin tool measure?
NTD pmh/fhx/prevpreg
BMI 30/+, Coeliac, DM, Epilepsy, Thalassaemia
RACE
Reassure - Blues < 1 wk
ADMIT - Psychosis < 2-3 wks
CBT + Sertraline/Parox V Fluox - PND < 4-12 wks
- Sertraline + Fluoxetine @preg
- Sertraline @BFeed
Edinburgh Scale is a screening tool for postnatal depression
3. Brain CALCification/ SMALL SENSORI-neural deafness -ChorioRetinitis (white + RED) -TCP -iuGR
- Seizures -HSM
- Blueberry muffin rash
________________
- Brain CALCification,
-HYDROcephalus
-Chorioretinitis (white, overlying VIT inflamm)
-Seizures -HSM
-Blueberry muffin rash
?erythema multiforme
Tx?
__________
- Ear, Eye, Heart dx
a-EARRR: Sensorineural DEAF,
b-EYEEE: Smaaaall-Eyes
CATARACT/ ACAG
——‘SALT-pepp’ CHORIOret
c-HEARTTT: CongenHeartDx - ?WHICH one?
- NOOOO Seizures -HSM
- Blueberry muffin rash
- CMV
SEEEE-MV
Sensorineural
SMALL brain / plts
sensorineural = cmv + rubella
- ganciclovir
________________
- Toxo
-spiramycin
-pyrimethamine + sulfadiazine
_______ - Rubella
- ears, eyes, heart - PDA
If baby breech, by when till it turn spontaneously?
What to do if still not turn?
What to do if STILL not turn?
< 36 w turn spontaneously
AFTER 36 w = ECV
C-section/Vaginal delivery
Summary: W36 spont -> ECV -> C-sec/Vag
Questions about POP - If: miss
- Cerazette > ? hrs late
- The rest > ? hrs late
WTF to do?
_____________________
POP cons?
Depot cons?
HRT cons?
Tamoxifen cons?
___________________
Young people - LARC iDIP
Long Acting Reversible Contracep
_________
For breast cancer past/current, what UKMEC + contraceptive legit?
For young, what Long-Acting Reversible Contraceptive is legit? - iDIP
Contraceptives UNaffected by Enzyme-Inducing Drugs?
Despite prog preps leading to obesity,
which prog prep
legit for obesity?
__________
Contraceptive mechanisms
Inhibit ovulation > Thicken cervical mucus < Endomet proliferation
Inhibit ovulation > Thicken cervical mucus
- ?
Endomet proflif > Thicken cervical mucus
- ?
Inhibit ovulation:
- ?
__________________
Copper-IuD mechanism?
Condom latex allergy?
Young people - LARC i-DIP
Long Acting Reversible Contracep
________
Post-pill amenorrhoea stop when?
Contraceptions UNaffected by enzyme inducing drugs?
Contraceptions that work #Time2Action:
- Now
- 2d
- 7d
Contraception for obese ppl?
Sterilisation failure rate:
Female (on top hehe giggity..)
Male
_________
3 Emegency contracep | UPSI | CI? - LIE
@Post-partum - when is emergency contracpetive NOT needed IF have UPSI?
Cerazette > 12 hrs late
The rest > 3 hrs late
POP miss = 2UP TC -2d condom + -UPSI < 2-3 days = Emerg contracept -Preg Test -take last pill (even if taking 2 pills) -cont pills OD \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
POP cons: i-WOAH
- Irreg periods,
- Weight gain, Obesity, Acne, Headache
Depot cons: DOB
- delayed return 2 fertility
- obesity
- BMD low
HRT cons BEV-i
-Breast/Endomet/VTE/incFIBROIDsize
Tamoxifen cons? LEV
LF/Hypertriglyc, Endomet dx, VTE
______________________
yLARC - Implant > Depot / IuS / POP = Low BMD!!
_____________
BC past = 3, current = 4
-Barrier/Copper only
yLARC - Implant > Depot / IuS / POP = Low BMD
Contracept UNaffected by Enzyme-Ind Drugs?
E I D:
IuS - Depot
IuD - Depot
Obesity - POP
_________
Contraceptive mechanisms:
Inhibit ovulation > Thicken cervical mucus < Endomet proliferation
Inhibit ovulation > Thicken cervical mucus
- Depot/Implant/POP
Endomet proflif > Thicken cervical mucus
- IuS
Inhibit ovulation:
- Levonorgestrel / Ella1Ullipristal (CI: BF 1wk wait, Asthma) / COCP
_______________________
Cu-IuD -
Sperm motility / Implantation / TOXIC
Latex allergy - PolyUreThane
yLARC - Implant > Depot / IuS / POP = Low BMD!!
Depot - weight gain / delayed return 2 fertility
____________
Post-pill amenorrhoea - periods return about 6m
Depot
IuS/D
Contraceptions that work:
Now - IuD
2d - POP
7d - COCP / Depot / IuS Implant
Contraception for obese ppl?
-POP
Sterilisation failure rate:
Female - 1/200
Male - 1/2000
_________
- Levenorgestrel - < 3d UPSI
- IuD - < 5d UPSI / AFTER ovulation
- IuD > EllaOneUllipristal!!!!! - EllaOneUllipristal - < 5d UPSI
EllaOneUllipristal
BFeed 1 week WAIT
CI = Asthma
< 21d PP - - > UPSI - - >
Not need emerg contra if
When contraceptive patch applied and not?
@W1 or 2 end what to do if contraceptive patch change DELAY > 48hrs
If had UPSI during >48hr delay/last 5 days then..??
_________________
@W3-end, patch removal DELAY?
@W4 patch-FREE week END, delay new patch application?
If combined patch started after day 5??
W1-3 patch ; W4 = patch free
W1-2: 7UP TC -7d Barrier -UPSI @ >48 delay/last 5 days = EMERG CONTRACEP -Preg test -Take off patch -Change ASAP \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
@W3-end, patch removal DELAY?
- Remove ASAP
- Cont as normal - new patch @next cycle start
@W4 patch-FREE week END, delay new patch application?
7 DAYS condom
_____________________
Condom 7 days
LMP | @MP = contracep till…
< 50
> 50
_____________________
Still bleeding: COCP/Combo | Depot | …
< 50
> 50
IuS - POP - Implant
< 50
> 50
LMP | @MP = contracep till…
< 50 - 2 years AFTER LMP
> 50 - 1 years AFTER LMP
_____________________
Still bleeding: COCP/Combo | Depot | …
< 50 - cont till 50
> 50 - NH / IuS - POP / Implant
FSH - check if ?stop <55
FSH > 30 = 1 yr IuS - POP - Implant
FSH - recheck 12 m @ Preeee-MP
IuS/pop/Implant
< 50 - cont till 55
> 50 - cont till 55 / check Bleed Pattern dx –>
