Contraception And Abortion

Front 1

What is the proportion of unintended pregnancies in the US? How many of these are aborted?

Back 1

Half of all pregnancies are unintended, and almost half of these are aborted. In teens, 78 % of pregnancies are unintended, and half are aborted.

Front 2

What's the difference between method-effectiveness and use-effectiveness?

Back 2

method-effectiveness: correct (ideal) (supervised? how do you get that job?) use of the contraceptive
use-effectiveness: normal unsupervised use of contraceptives

Front 3

What are the method and use failure rates for the pill, IUD, Condoms, Depo, and sterilization?

Back 3

Pill: method: 0.1%, use: 3 %
IUD: 0.1 %, 0.1 %
Condoms: 3 %, 14 %
Depo: 0.3 %, 0.3 %
Male sterilization: 0.1 %, 0.1 %
Female sterilization: 0.05 %

Front 4

What are the method and use failure rates for no method, the diaphragm, rhythm, and withdrawal?

Back 4

No method: method: 85%, use: 85%
Diaphragm: 6 %, 20 %
Rhythm: 9 %, 25 %
Withdrawal: 4 %, 19 %
(All more than 15 % use failure rate)

Front 5

What's the most common contraceptive used by women from 15-29 years old? What about women 40-44 years old?

Back 5

15-29 yo: 36 % on the pill, ~25 % condoms
40-44 yo: 47 % sterilized, 20% sterilized partners

Front 6

What are the methods of hormonal contraception talked about in the previous lecture?

Back 6

Oral contraceptives, NuvaRing, OrthoEvra (patch), Depo-Provera (IM, progestin-only), Emergency contraception

Front 7

How do IUDs work?

Back 7

They provoke a sterile inflammatory response in the endometrium, which is toxic to sperm and blastocysts. They also decrease tubal motility and have adverse effects on cervical mucus

Front 8

What are the advantages and side effects of an IUD?

Back 8

adv: needs no action at time of coitus, reduced blood lost during menses (if with progestins)
AE: dysmenorrhea, menorrhagia, intermenstrual bleeding, expulsion, uterine perforation (1/1000), low incidence of pregnancy (but often ectopic), PID (less now)

Front 9

What is the difference between the two types of IUD available?

Back 9

Copper-T: no hormones, lasts 10 years
Levonorgestrel-IUD (Mirena): releases levonorgestrel, lasts 5 years, suppreses endometrium (progestin). adv: protects from endometrial hyperplasia, reduced endometrial cancer, less progestin than progestin-only pill, amenorrhea in 20%.

Front 10

What are the contraindications to IUD use?

Back 10

uterine anomalies, blood dyscrasias, undiagnosed uterine bleeding, acute PID (or hx + risk factors), untreated acute vaginitis or cervicitis, pregnancy, carcinoma of cervix or endometrium, Wilson's disease (copper allergy), multiple sex partners, deficient immunity, genital actinomycosis

Front 11

How does a male condom work?

Back 11

Barrier method.
~80% efficacy (3-14% failure rate).
adv: inexpensive, no hormones, protects from STIs, best w/ spermicide.
disadv: use every time, latex

Front 12

How does a female condom work?

Back 12

Barrier method.
~80% efficacy (5-25% failure rate).
adv: inexpensive, no hormones, STI protection, used by female, best with spermicide.
disadv: use every time, discomfort, latex.

Front 13

How does a diaphragm work?

Back 13

Barrier method.
Fill with spermicide and insert before each coitus, leave in vagina at least 6 hrs post-intercourse, then remove, wash and reuse. ~80% effective (6-20% failure rate)
adv: used by female, no hormones, protects from STIs, private.
disadv: use every time, needs fitting by doc, replace every year, refit after wt gain or loss

Front 14

How does spermicide work?

Back 14

disrupts the sperm cell membrane and affects motility. ~80% efficacy.
adv: many delivery systems, nonoxynol-9 kill HIV, inexpensive, no prescription, combine with barrier method.
disadv: use every time, cytotoxic effect on vaginal mucosa (irritiation --> increased risk for STIs if used alone)

Front 15

How does the rhythm method (fertility awareness) work?

Back 15

Effective when used correctly, 25 % of women get pregnant w/in a year. Must be very committed.
Methods: calendar method, basal body temperature, cervical mucus testing, symptothermal method (2 or more, usually BBT and cervical mucus)
adv: no side affects, acceptable by all, low cost

Front 16

What is female sterilization?

Back 16

surpical partial slapingectomy, tubal electrocautery or application of clips/elastic rings. Usually laparoscopic or immediately post-partum. Considered major surgery.
up to 10% of women regret it.
Failure rate: 0.5 %, up to 5 %, and many of these are ectopic.

Front 17

What is male sterilization?

Back 17

vasectomy, surpical occlusion of the vas deferens, under local anesthesia. Much safer than for females.
AE: local hematoma. Rarely reversible.
Less expensive than tubal ligation.

Front 18

How are most early abortions done in the US?

Back 18

vacuum aspiration aka dilation and evacuation (D&E). local/gen anesthesia, dilate cervix, insert suction curette, empty uterus.

Front 19

How is a medical abortion performed?

Back 19

Mifepristone then misoprostol, or methotrexate then misoprostol. Practitioners must be able to perform a D&E in case this fails. 96 % efficacy.

Front 20

How are second-trimester abortions performed?

Back 20

Dilation and evacuation or induction of labor to deliver a nonviable fetus. Misoprostol can help in dilating the cervix.

Front 21

What are the complications for therapeutic abortions and what is the rate?

Back 21

1/200 cases (lower than pregnancy and most other elective surgery).
risk increases with gestational age and comorbidities.
AEs: anesthesia-related problems, infection, intrauterine blood clots, incomplete abortion, continuing pregnancy, cervical/uterine trauma, hemorrhage.
Impaired fertility and psychological trauma are rare.