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Contraceptive Methods
Complex Medical Problems and Contraception
1st trimester abortion
2nd trimester abortion
Early Pregnancy
100
This progestin is administered as a single 1.5 mg PO tablet intended to reduce the risk of pregnancy for up to 72 hours following an episode of unprotected intercourse.
What is levonorgestrel? (Plan B One step)
100
This document, adapted from the world health organization, outlines appropriate contraceptive practices for women with various medical conditions.
What is the CDC Medical Eligibility Criteria for Contraceptive Use?
100
These are the 2 most common complications of first trimester abortion.
What are 1) Infection 2) anesthesia complications
100
The method by which 2nd trimester abortions are now commonly performed in the United States?
What is Dilation and Evacuation?
100
This is the approximate number of days between fertilization and implantation.
What is 7 days?
200
This Long Acting reversible contraceptive method (LARC) PRIMARILY works by thickening the cervical mucus and thus preventing fertilization
What is the levonorgestrel-Intrauterine system (LNG_IUS)
200
These questions should generally be asked of women prior to initiation of combined hormonal contraceptive methods (ie: estrogen + progestin)
1) Smoker over age 35? 2) History of DVT/PE or known thrombogenic mutations? 3) Migraine headaches with aura < 35 or any migraine headache >35 4) High blood pressure uncontrolled? 5) 1st degree family relatives with history of blood clots? 6) Less than 21 days postpartum? 7) SLE with + APA 8) Diabetes for >20 years or evidence of end organ damage such as retinopathy or nephropathy
200
This synthetic prostaglandin E1 analog may be used to soften the cervix prior to a surgical abortion
What is misoprostol?
200
These dried, compressed seaweed tents are used to facilitate cervical dilation prior to a dilation and evacuation procedure?
What are laminaria?
200
In early pregnancy, the serum BHCG level is expected to double approximately every 48 hours. What is the minimum increase in BHCG one would expect to see in 2 days for a "normal" pregnancy?
What is at least a 53% rise in BHCG levels?
300
Name 2 mechanisms of action of the etonorgestrel subdermal implant (Nexplanon)
What is 1) Prevents ovulation for 2.5/3 years 2) Thickens cervical mucus
300
This highly effective contraceptive method should be used in women with a diagnosis of breast cancer, particularly if their tumor is ER and PR positive.
What is the copper T380A IUD?
300
List the common side effects a woman may experience following ingestion of misoprostol for a medical abortion in the first trimester.
What is 1) GI complaints (nausea/vomiting/diarrhea) 2) Abdominal cramping/bleeding 3) low grade fever
300
Name some complications of laminaria insertion?
What are 1) vasovagal symptoms during insertion 2) Pain during insertion 3) Cervical fracture/stretch induced injury of the internal os 4) Facilitate onset of labor/fetal expulsion prior to surgery
300
The length of the embryo (in millimeters) by which cardiac activity should be visualized on ultrasound for a normal pregnancy.
What is 5mm?
400
This contraceptive method, although highly effective, only has a 56% continuation rate at one year.
What is depo medroxyprogesterone acetate?
400
This contraceptive method has been shown in some case series, case reports, and certain small non-powered randomized trials to improve symptoms in patients with seizure disorder as well as sickle cell disease.
What is depo medroxyprogesterone acetate? (DMPA 150mg IM or subcutaneous every 3 months)
400
Following a medication abortion or first trimester surgical abortion, this is the amount of time required prior to safely initiating contraception.
No time at all.
400
The general "rule of thumb" when deciding how many laminaria to insert prior to D and E.
What is Gestational age-10= number of laminaria
400
The Mean gestational sac diameter at which a yolk sac should definitively be seen in a "normal" pregnancy.
What is 16 mm?
500
Of all the combined hormonal contraceptive routes of administration (ie pills, patch, ring), this method is associated with the least amount of unscheduled bleeding.
What is the ethinyl estradiol/etonorgestrel contraceptive vaginal ring?
500
Name an anticonvulsant drug that would be appropriate to use in combination with a combined hormonal contraceptive method and name one that could affect metabolism of this contraceptive method?
Appropriate drugs: 1) Clonazepam (Klonopin) 2) Ethosuximide (Zarontin) 3) Gabapentin (Neurontin), 4) Levetiracetam (Keppra) 5) Pregabalin (Lyrica) 6) Tiagabine (Gabitril) 7) Valproic acid (Depakote) 8) Vigabatrin (Sabril) 9) Zonisamide (Zonegran) Inappropriate drugs: 1) Carbamezepine (Tegretol) 2) Felbamate (Felbatol) 3) Oxcarbazine (Trileptal) 4) Phenobarbital 5) Phenytoin (Dilantin) 6) Topiramate (Topamax)
500
A paracervical block at the time of a first trimester abortion aims to provide local anesthesia to what nerve fibers?
What is S2-S4 parasympathetic fibers?
500
Name 2 potential agents used in the United States to induce fetal demise prior to performing a surgical abortion ( D and E)?
What is 1) Digoxin (1-1.5mg either intrafetal or intraamniotic) 2) Intracardiac KCL ( 10-20meq)
500
This equation may be used as an estimate of the gestational age using the mean sac diameter?
What is GA +/- 3 days= Mean Sac Diameter (mm) +30