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52 Cards in this Set

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What is contraception?
The temporary avoidance of pregnancy.
What is method effectiveness?
Method, or theoretical, effectiveness is the effectiveness of the contraceptive method when it is used correctly and with perfect consistency. In other words, it takes account only technical failures of the contraceptive method (eg, sperm leaking through a hole in a defective condom).
What is use effectiveness?
Use effectiveness is the efficacy of the method in actual use, taking into account both technical failures and users' failures to use the method consistently correctly.
After male sterilization, when is the patient actually considered sterile?
When he has had two azoospermic ejaculates (after about 15-20 ejaculations).
What is the most common contraceptive method available, and what is its first year failure rate?
Sterilization. Male sterilization has a 1st year failure rate of 0.15%. Female sterilization has a 1st year failure rate of 0.4%.
How is postpartum tubal ligation normally performed?
By making a small sub-umbilical incision to gain access into the peritoneal cavity.
What is interval sterilization?
It is ligation of the fallopian tubes using a laparascope; the tube is interrupted using elect current, a silastic ring, or spring loaded clips.
What are the two spermicides available for use in the US? How do they work?
Nonoxynol-9 & Octoxynol. They are surfactants and destroy sperm cell membranes.
How long should a diagphragm be left in place after intercourse?
It should be left in place for at least 8 hours, and should be removed by 24 hrs to prevent vaginal ulceration.
What is a cervical cap?
It's a rubber/plastic device that is smaller than the diaphragm and fits around the cervix. It may be left in place for up to 48 hrs.
What is the most effective method for preventing STDs?
The condom
What is periodic abstinence?
It is avoidance of intercourse during the itme that the ovum can be fertilized.
What are the various methods of periodic abstinence?
The calendar method, the temerature method, and the cervical mucous method.
What is the calendar method?
A form of periodic abstinence where intercourse is avoided during a time period calculated by subtracting 18 days from the shortest cycle to 11 days from the longest cycle.
What is the temperature method?
A form of periodic abstinence that invoves avoidance of intercourse until the basal body temperature has been elevated for 3 days.
What is the cervical mucous method?
A form of periodic abstinence that involves checking the consistency of cervical mucous and avoiding intercourse from the time that thin, slippery mucous is identified.
What enhances the oral activity of all synthetic estrogens and progestins?
They have an ethinyl group at the 17th carbon to enhance their oral activity.
What is the combination pill OC?
It contains ethinyl estradiol and progestin. This pills are taken for 21 consecutive days followed by a 7 day pill-free interval.
How does the progestin only pill work?
It works the same as the combination pill, but there is no 7 day pill free interval.
What is the MOA of combination OC's?
They interfere w/ GnRH release and suppress gonadotropins, and inhibit ovulation. They also increase cervical mucous viscosity and alter the endometrium making it hostile to blastocyst implantation.
What is does the progestin pill do?
It suppresses GnRH w/ subsequent reduction of FSH/LH, leading to an anovulatory state.
All FDA approved progestins are a derivative of what?
17 nor-testosterone
Which type of OC's can cause oily skin and acne?
The progestins b/c they are related to androgens.
What are the CV effects of ethinyl estradiol?
It increases hepatic production of several globulins incluing those involved in clotting and angiotensinogen. This leads to an increased risk of arterial and venous thrombosis and blood pressure in some women.
What are the lipid profile effects of progestins?
They have an adverse effect on lipoprotein metabolism leading to an increase in LDL and decrease in HDL and triglycerides.
What are the lipid profile effects of estrogen?
It decreases LDL and increases HDL. It also increases triglyceride level
What are the neoplasia risks of OC's?
There is increased risk of cervical cancer, but decreased risk of endometrial and ovarian cancer.
What are three life-threatening conditions that OC's can reduce?
Ectopic Pregnancy, Ovarian Cancer, and Endometrial Cancer.
What are some other eneficial reproductive tract benefits of OC's?
Decreased:
1. Ovarian Cyst Formation
2. Menstrual Disorders
3. Anemia
4. PID
5. Benign Breast Dz
When should OC's NOT be used?
In smokers greater than 35 yrs, pts w/ lupus or Sickle-Cell, pts w/ Hx of CV dz.
What are the long-acting steroid contraceptives?
Depo-medroxyprogesterone acetate (DMPA) and Norplan
What does DMPA do?
It prevents the midcyle gonadotropin surge, preventing ovulation.
What is the major side-effect of DMPA?
Disruption of the menstrual cycle.
How is DMPA administered?
IM injection every 12 weeks.
What is the lipid profile of DMPA?
No change in LDL, but decreases HDL and triglycerides.
What benefits besides use as a contraceptive does DMPA offer?
Protecction against endometrial/ovarian cancer, anemia, and PID.
How is norplant administered?
It's a seubdermal implant of six silastic capsules inserted under local anesthesia as an office procedure.
What is the time period for the effectiveness of Norplant?
Five years
What is the major S/E of norplant?
Irregular bleeding.
What is the MOA of Norplant?
It prevents the midcycle gonadotropin surge, preventing ovulation.
What is postcoital contraception? When must it be
It is the "morning after pill." It is estrogen, given in a very high dose. Doing this in the periovulatory period prevents embryo implantation.
When must postcoital contraception be given to be effective?
Must be given w/in 72 hrs of coitus?
What is Mifepristone?
An antiprogestin (aka RU 486 or abortion pill). It blocks progesterone receptors.
What is the rate of pregnancy termination w/ Mifepristone?
96% when combined w/ a prostaglandin.
What are the two IUD's available in the US?
Copper T (Cu T or TCu380) and Progestasert (progesterin containing IUD)
What is the main MOA of IUD's?
They are spermicidal. They create a sterile inflammatory enfironment in the uterus. Addition of Cu greatly increases inflammatory rxn.
How long are the IUD's effective?
Cu T is effective for 10 yrs. Progestasert must be replaced yearly.
What's the major S/E for IUD's?
Abnormal bleeding
What happens if a pregnancy does occur while the IUD is in the uterus?
Most likely spontaneous abortion.
Is there an increased risk of infection from an IUD?
Yes, but limited to the first few weeks after insertion. The inc rate of infection seems to be due to the multifilament tails of the devices which can promote bacterial growth.
What are the three main methods of pregnancy termination?
1. Uterine Curettage
2. Labor Induction
3. Hysterectomy
What is uterine curretage?
A method of pregnancy termination where the fetus is sucked out. Performed during the 1st trimester.