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in what population is the rate of unintended pregnancies the highest?
young, low income, minority women
What are the different methods for accessing how effective the contraception is and which is the best?
- Perfect use method rate: this is how many people will get pregnant if they are using the medications exactly as stated
- Typical failure rate: This is what works in real life and this is due to the adherence to the contraceptive method
What determined the selection and adherence to the contraceptive?
- availability and accessibility such as cost and insurance coverage and prescription vs over the counter
- Behavioral factors take an influence also such as: risk of pregnancy, safety and side effects of the method, frequency of intercourse, and the participation of the partner
In what categories depending on effectiveness can we put different contraceptives and what are they?
- Most effective (>99%): sterilization, IUD/IUS implants
- Very Effective ( 91-99%): pills, shot, patch, ring
- Mod Effective (81-89%): condoms, sponge, diaphram
- Effective (Up to 80%): fertility awareness, cervical cap, spermicide
What is the most common form of contraceptive use in couples?
vasectomy what is it?
surgical interruption of the vas deferens and usually only done under local anesthetic
What are the contraindications and complications that come from a vasectomy?
- Complications: hematoma
- painful sperm granuloma
- Contraindications: large varicocle bc increased risk of hematoma
- scrotal abnormalities
So a patient that has a vasectomy can expect to be able to have sex with no protection right after coming out of sx?
Not really, they need a post operative semen analysis bc sperm stored in the genital tract must be resorbed or expelled so they should have back up methods.
What is the difference between early and late failure of vasectomy?
- Early failure: persistence of motile sperm after 4 months or 20 ejaculations
- Late failure: reappearance of sperm after being absent due to recaniculation of vas deferens
What is tubal ligation?
blockage of the fallopian tubes and it usually done postpartum or in outpatient surgery and done under regional anesthesia. These basically cause necrosis to part of the tube and permanent interruption
What are the contraindications and the complications of tubal ligation?
- contraindications: medical contradiction for sx
- known tubal pathology
- Complications: 1-2 fatalities in 100,000. and rates are increased because of general anesthesia, diabetes, previous abdominal sx and obesity
What is transcervical sterilization?
it is a hysteroscopic procedure in which the hysteroscope is inserted into the uterus and the uterine cavity is inflated with saline ansn the the device is throated into the proximal tubule from the osteum. The device icistes an inflammatory action that leads to scar formation and eventually tubule obstruction and corn mill or interstitial seq of the tubule.
What are the complications of transcervical sterilization?
- well not a complication but you do need backup contraception for 3 months and HSG
- Complications: perforation, expulsion and failure to place.
What are the differences in the IUDs?
- Levonorgestrel: progesterone thickens the cervical mucus, thins endometrium and inhibits follicular development
- Copper: causes an inflammatory reaction that is lie a spermicidal
What are the side effects of copper IUD?
heavier menses and dysmenorrhea
What are the side effects of levonosteregel?
iregular bleeding and less menstrual flow thats why it is also used for heavy menses
What are the different hormonal pill contraceptions?
- Progestin only: implant of etonorgestel that inhibits ovulation
- depo shot: prevents ovulation- given every 12 wks
- pill: norethindrone thickens cervical mucus
- Combined E/P: pill
- vaginal ring, topical absorption
What are some o the side effects of the progestin only methods?
irregualr bleeding but it has high safety and can be used with woman with medical disorders.
What are the contraindications to combo of contraceptive meds?
- migraine with aura
- smoker over 35
- MI, CVA and hypertension
What are the advantages of hormonal contraceptives?
- lowers the risk for ovarian and endometrial cancer
- less blood loss with menses and lowe rate of anemia
- decreased dysmenorrhea
- less benign breast disease
What are the side effects of hormonal contraceptives?
- breast changes
- skin changes such as increased pigmentation dn decreased acne
What are some of the barrier contraceptives?
condome and diaphram
What has to be done to a diaphragm?
it needs to be used with a spermicide and they have to be left in place for 6 hours after intercourse
What are the 2 methods to see the fertile phase of menstrual cycle?
- Rhythm: charting menstual cycle lengths
- Billings: mucus and temp change
What is periodic abstinence?
It is abstince from intercourse during the fertile phase of the cycle.
So why is periodic abstinence only effective ~80%
Its not that it isn't a good method, its that there is a high failure rate due to non-compliance
What are the different types of emergency contraception? and what is it?
- So it is the delay of ovulation and stops 75% of pregnancies
- the different types are: insertion of copper IUD
- Levonorgestrel (plan B)- up to 3 days after
- Ella- progesterone receptor antagonist- up to 3 days after
- Low dose OCP eq- 4 pills of loOvral, nordette or levelen
So what percentage of women have an abortion?
- 2% of women in US every year
- 22% of all pregnancies end in abortion
What are the options for abortion in the first trimester?
- Medical: Mifepristone progesterone receptro antagonist with misoprostol with it Mife given first and then miso given 2 days after and abortion is confirmed by ultrasound of series of beta hcg measurements
- surgical: suction dilation and curettage
Why do some people prefer medical vs surgical abortion?
Medical is just a pill and you abort after and follow up with an ultrasound. It avoids the invasive procedure, anesthesia. However, surgical is preferred by some since it only requires one visit, one day and no follow up needed with less bleeding.
What are the second trimester abortion techniques and what are the reasons for doing this so late?
- So the reasons are: delay in care, late dx of fetal or genetic abnormalities and maternal medical complications
- Techniques: dilatation and evacuation (requires type of forceps) , labor induction, hysterotomy (like C-Section)