Gyn-Ics-12-Contraception & Preg Termination

Front 1

method effectiveness vs.
use effectiveness (Obj 1)

Back 1

method effectiveness=
effectiveness when method always used correctly

use effectiveness=
effectiveness in actual use

Front 2

MC contraception? (Obj 2)

Back 2

sterilization of one of the partners

Front 3

types of contraception (MC to least common)

Back 3

1. sterilization of one of the partners
2. OCP's
3. condoms
4. periodic abstinence
5. withdrawal
6. Diaphragm
7. IUD
8. spermicide alone

Front 4

1st year failure rates of contraception

Back 4

1st year failure rates (highest to lowest):
1. Chance (85%)
2. spermicide alone
3. Natural Family Planning
4. Withdrawal
5. diaphgram with spermicide
6. condom
7. OCP's

Very effective:
8. IUD
9. female sterilization
10. Depo-provera
11. male sterilization
12. Norplant: *Most effective

Front 5

Sterilization (Obj #3)

Back 5

1. Male sterilization
*outpt, takes <30 min
*cut and ligate vas deferens

2. Female sterilization
a. Postpartum tubal ligation:
*after childbirth
*sub-umbilical incision, access peritoneal cavity
-remove part of isthmus of fallop tube

b. interval steriliztion
*does not have to be right after childbirth
*ligate fallop tubes

Front 6

most effective method of preventing STD's, including viral and bacterial?

Back 6

condoms

Front 7

Benefits of OCP

Back 7

Combination pill:
1. decr risk of endometrial and ovarian cancer; decr risk of ectopic pregnancy

*d/t anovulatory action of OCP's and positive effects of progestins on endometrium

2. decr risk of PID d/t:
-incr viscosity of cervical mucus
-decr menstrual flow

3. decr ovarian cyst formation (b/c OCP's inhibit formation of ovarian follicles)

Front 8

risks of OCP

Back 8

1. incr risk of cervical neoplasia
2. thrombosis (and even MI) and HTN--risk greatly increased in smokers b/c nicotine increases clotting==>decr ATIII==>inhibit PG==>incr platelet agg
*However, this is based on old studies when pills contained more steroid

Note: No significant diff in chol/lipoprotein levels in OCP's than normal b/c:
progestins have adverse effect on lipoprotein metabolism==>incr LDL, decr HDL & TG
-but estrogen has opp effect: decr LDL, incr HDL & TG

Front 9

Do not use OCP's if:

Back 9

-previous Hx of CV dz like thromembolism
-systemic dz, like sickle cell anemia and lupus
-cigarette smokers >35 y/o
-minor: DM w/o vascular complications, smokers <25 y/o

Front 10

Long acting steroids

Back 10

1. Depo-medoxyprogesterone acetaate (DMPA)
-given every 3 months
-pts eventually become amenorrheic b/c prevents gonadotropin surge and thus prevents ovulation
-unlike OCP, no incr risk of thromboembolism or HTN

2. Norplant
-subdermal implant of capsules, lasts 5 years
-major S/E=irregular bleeding
-like DMPA, inhibits ovulation and alters cervical mucus and endometrium

3. Postcoital Contraception
-"morning after pill"
-give within 72 hours of coitus
-high does estrogen prevents implantation

4. Mifepristone=RU486
-given within 6 weeks of amenorrhea, terminates 85% pregnancy
-when combined with PGE, terminates 96% preg

Front 11

IUD

Back 11

2 types:
1. Copper T (Cu T)
2. Progestasert (IUD contains progesterone)

-main MOA is spermicidal: creates sterile inflammatory environment for sperm
-lower risk of ectopic pregnancy than non-contraceptive users (by preventing pregnancy in general), but if pregnancy does occur, incr risk of ectopic preg
-S/E= abnl bleeding (main), spontaneous abortion, septic abortion

Front 12

S/E of IUD

Back 12

-S/E= abnl bleeding (main), spontaneous abortion, septic abortion

Front 13

Preg Termination in 1st and 2nd trimester

Back 13

Roe v Wade:
-State cannot interfere w/abortion in 1st trimester.
-State can regulate in 2nd trimester.
-In TX, abortion is legal for 1st 24 weeks (=6 mo= first two trimesters)

Surgery and Medical Tx for Preg Term:
3 main methods of preg termination:
1. Uterine Curettage (via suction apparatus) [first dilate cervix w/osmotic dilator]
2. Beyond first trimester, may use mechanical means of evacuating the uterus
3. Second trimester: may induce labor (often w/cervical dilator)

*Mifepristone (RU486) in 1st 6 weeks after amenorrhea