Chronic Conditions
Definition of migraine with aura
Migraine- a headache that lasts up to 4-72 hours accompanied by nausea, vomiting, or photophobia and at two of the following: unilateral location, pulsating quality, moderate to severe pain, and aggravation by routine physical activity.
Aura- reversible focal neurological sensory event that precedes or accompanies the headache and lasts no more than an hour.
IUDs increase the risk of ectopic pregnancy.
T/F and explain?
Risk of getting pregnant with an IUD is around 2% over 10 years. However, if someone does become pregnant with an IUD in place, the risk of the pregnancy being an ectopic is higher than if the IUD weren't in place.
This material makes the etonogestrel implant radiopaque and allows for localization via 2-D X-ray, CT, MRI or fluoroscopy.
Barium
The mechanism by which combined hormonal contraceptives inhibit ovulation
Through the hypothalamic-pituitary inhibition of gonadotropin secretion (FSH, LH)
Name two non-fertility related benefits of laparoscopic sterilization.
Decrease in PID, decrease in ovarian cancer, ability to survey the pelvic anatomy.
Obese women using combined hormonal contraception are at a small increased risk of VTE and therefore it should be avoided.
T/F?
F, limited evidence demonstrates that obese women who use CHCs don't have increased risk for acute MI or stroke compared to non CHC users and despite the small increased risk of VTS, the advantages of CHCs generally outweigh the risks.
If a hormonal IUD is found to be in the lower uterine segment position, above the level of the cervical os, and contraception is desired, this is a next logical step.
leave IUD in place OR remove and replace.
Migration of the etonogestrel implant into the pulmonary vasculature is a rare event (1 in every million insertions) and is likely a result of unintentional placement into the _________ vein.
Brachial
Name 3/5 clinical benefits of combined oral contraception
menstrual regulation
acne treatment
PMS treatment
reduction in ovarian cysts
reduction in endometrial and ovarian cancer
Although the 5-year cumulative failure rate from LSC sterilization is less than 1%, around _____ % of those pregnancies are ectopic in location.
33
People with diabetes and vascular disease or duration of diabetes for >20 years have restrictions around these two methods of contraception.
CHC and DMPA
The risks that can be decreased when removing an IUD from the uterus with a desired pregnancy (3/4) ?
What are spontaneous abortion, septic abortion, preterm delivery and chorioamnionitis.
Nexplanon is more effective than permanent contraception at preventing pregnancy.
T/F?
T
Describe "post-pill amenorrhea" (mechanism, duration)
Amenorrhea for more than one year after cessation of CHC method (pill, patch, ring) with a 1% frequency
LARC methods may be more effective at preventing pregnancy than LSC sterilization, T or F?
T
Name 5 diagnoses considered US MEC Category 4 for CHC
Unacceptable risk, method should not be used
current breast cancer; PP<21d; chronic kidney disease; VTE- current, hx of with high risk of recurrent; migraine with aura; HTN with systolic > 160/diastolic >100 or vascular dx; ischemic heart disease; liver adenoma or liver malignancy; peripartum cardiomyopathy >6mo; moderately to severely impaired cardiac function; sickle cell disease; smoking age ≥35, ≥15cigarettes/day; solid organ transplant graft failure; hx of CVA; surgery with prolonged immobilization; SLE with +APLA; thrombophilia; valvular heart disease
What should be done when an IUD in located in the uterus with a desired pregnancy and there are no visible strings and the IUD is above the level of the cervix.
nothing
Mechanism of action of levonorgestrel IUDs (2) to prevent pregnancy
Thickening cervical mucous to prevent passage of sperm and thinning the lining of the endometrium
Recommendation for women undergoing minor surgery and major regarding continuation of combined hormonal contraceptives
Minor surgery (short, LSC) can be continued due to low VTE risk
Major surgery- weigh discontinuation against risk of unintended pregnancy- it takes up to 6 weeks for procoagulant changes that come with COC to return to baseline
Sterilization is best performed during the ___________ phase of the menstrual cycle so as to avoid the risk of a ___________ phase pregnancy.
follicular and luteal, respectively
The one medical condition that is considered category 4 CDC MEC for all progestin containing methods
Current breast cancer
Mechanism of action of copper IUD (2) to prevent pregnancy
Copper in IUD is toxic to sperm, inhibiting fertilization. Copper also creates a less favorable endometrial environment which makes a fertilized egg difficult to implant.
Potential delay in fertility return (in months) after last DMPA injection
10-18 months
The circumstance under which the benefit might outweigh the risk for a person to take COC with a prior VTE
A person with a single VTE episode, with non-recurring risk factors (surgery, trauma) and no additive risk factors (PP)
In California, hundreds of inmates had been sterilized in prison as late as 2010 without proper consent.
T/F?
T
See Belly of the Beast documentary, history of coercion into sterilization and non-consent