Podcast
Questions and Answers
What is the complication of uterine perforation with IUCD that leads to inflammatory reaction?
What is the complication of uterine perforation with IUCD that leads to inflammatory reaction?
What is the risk of abortion if the IUCD threads are accessible and removed immediately?
What is the risk of abortion if the IUCD threads are accessible and removed immediately?
What is the highest risk factor for expulsion of IUCD?
What is the highest risk factor for expulsion of IUCD?
What is the presentation of uterine perforation with IUCD in some cases?
What is the presentation of uterine perforation with IUCD in some cases?
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What is the primary mechanism of action of Lactation Amenorrhea Method (LAM) in preventing pregnancy?
What is the primary mechanism of action of Lactation Amenorrhea Method (LAM) in preventing pregnancy?
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What is the primary advantage of Lactation Amenorrhea Method (LAM)?
What is the primary advantage of Lactation Amenorrhea Method (LAM)?
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What is the diagnosis of pregnancy in IUCD users?
What is the diagnosis of pregnancy in IUCD users?
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What increases the risk of preterm labor in IUCD users?
What increases the risk of preterm labor in IUCD users?
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What is the criteria for using Lactation Amenorrhea Method (LAM)?
What is the criteria for using Lactation Amenorrhea Method (LAM)?
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What is the method failure rate of a contraceptive method calculated by?
What is the method failure rate of a contraceptive method calculated by?
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What type of contraceptives are Progesterone only pills (POPs) and Progesterone only injectable contraceptives (PICs)?
What type of contraceptives are Progesterone only pills (POPs) and Progesterone only injectable contraceptives (PICs)?
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What is the purpose of the WHO Medical Eligibility Criteria (MEC) wheel?
What is the purpose of the WHO Medical Eligibility Criteria (MEC) wheel?
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What should be done if a woman misses one pill and has more than seven pills left in the pack?
What should be done if a woman misses one pill and has more than seven pills left in the pack?
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What is a non-contraceptive use of combined estrogen and progesterone therapy?
What is a non-contraceptive use of combined estrogen and progesterone therapy?
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What is an advantage of combined estrogen and progesterone therapy as a contraceptive method?
What is an advantage of combined estrogen and progesterone therapy as a contraceptive method?
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What should be done if a woman misses two pills and has less than seven pills left in the pack?
What should be done if a woman misses two pills and has less than seven pills left in the pack?
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What is a contraindication for the use of combined estrogen and progesterone therapy as a contraceptive method?
What is a contraindication for the use of combined estrogen and progesterone therapy as a contraceptive method?
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What is a possible side effect of combined estrogen and progesterone therapy?
What is a possible side effect of combined estrogen and progesterone therapy?
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What is the primary mechanism of action of progesterone-only pills?
What is the primary mechanism of action of progesterone-only pills?
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When can progesterone-only pills be initiated in a breastfeeding woman?
When can progesterone-only pills be initiated in a breastfeeding woman?
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What is the schedule for taking progesterone-only pills?
What is the schedule for taking progesterone-only pills?
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What should a breastfeeding woman do if she misses a pill within the first 6 months?
What should a breastfeeding woman do if she misses a pill within the first 6 months?
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What is an advantage of progesterone-only pills?
What is an advantage of progesterone-only pills?
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Which method of emergency contraception is highly effective when inserted within 5 days after intercourse?
Which method of emergency contraception is highly effective when inserted within 5 days after intercourse?
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What is the total dose of LNG taken in the POPs regimen of emergency contraception?
What is the total dose of LNG taken in the POPs regimen of emergency contraception?
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What is the effect of progesterone-only pills on tubal motility?
What is the effect of progesterone-only pills on tubal motility?
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What is the mechanism of action of Mifepristone (RU486) in emergency contraception?
What is the mechanism of action of Mifepristone (RU486) in emergency contraception?
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What is the primary concern for delaying COCs until 3 weeks after birth in non-breastfeeding women?
What is the primary concern for delaying COCs until 3 weeks after birth in non-breastfeeding women?
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What is the recommended timing for taking the first dose of emergency contraception in the POPs regimen?
What is the recommended timing for taking the first dose of emergency contraception in the POPs regimen?
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What is the first choice method of contraception for breastfeeding women?
What is the first choice method of contraception for breastfeeding women?
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Study Notes
Risks Associated with IUCD
- Abortion occurs in 50% of IUCD cases, often complicated by septic abortion.
- Preterm labor risk increases, being four times higher than normal.
- Possible complications include premature rupture of membranes (PROM) and antepartum hemorrhage (APH).
Diagnosis of Pregnancy
- Confirm pregnancy through a combination of a pregnancy test and ultrasound.
Management of IUCD Complications
- Accessible threads: Remove IUCD immediately to lower abortion risk to 25%.
- Inaccessible threads: Retain IUCD and monitor as a high-risk pregnancy.
Uterine Perforation with IUCD
- Risks factors include:
- Provider inexperience and improper insertion techniques.
- Insertion within 48 hours to 4 weeks postpartum.
- Nulligravidas and presence of uterine scars.
- Complications can lead to perforation into surrounding organs, pelvic abscesses, and intestinal obstruction.
Clinical Picture of Uterine Perforation
- May be asymptomatic and detected during routine exams.
- Symptoms can include acute abdominal pain during insertion and missed IUCD loop.
Expulsion of IUCD
- Risk factors include provider inexperience, immediate postpartum insertion, and device type (e.g., Lippes loop).
- Young age and nulliparity also increase expulsion rates.
Contraceptive Methods
- Options include:
- Progesterone-only pills (POPs or minipills).
- Injectable contraceptives (both progesterone-only and combined).
- Subdermal implants and vaginal rings.
- Voluntary surgical contraception.
Contraceptive Efficacy
- Failure rates consist of:
- Method failure (ideal use failure rate).
- Use failure (incorrect use).
- Pearl index is used to calculate unintended pregnancies per year among users.
- Life table analysis provides a more accurate failure rate over time.
Lactational Amenorrhea (LAM)
- High prolactin levels suppress ovulation by inhibiting LH secretion.
- Effective within the first 6 months postpartum for fully breastfeeding women.
Advantages of LAM
- Universally available to breastfeeding women.
- Provides natural contraception without hormonal interference.
Mechanism of Action for LAM
- Peripheral action includes thick cervical mucus and maintenance of an atrophic endometrium.
- Central action inhibits ovulation via reduced pulsatile GnRH secretion.
Initiation and Schedule for Progesterone-Only Pills (POPs)
- Begin during the first 7 days of the menstrual cycle or any time if pregnancy is excluded.
- Non-breastfeeding women may start immediately, breastfeeding women should wait 6 weeks postpartum.
Missed Pill Guidelines for POPs
- If late >3 hours, take as soon as possible.
- No backup needed for breastfeeding if taken within 6 months; backup advised otherwise for 48 hours.
Advantages of Combined Hormonal Contraception
- Highly effective and reversible.
- Reduces risks of endometrial and ovarian cancers, benign breast disease, and ectopic pregnancies.
Non-Contraceptive Benefits of Combined Therapy
- Addresses conditions like dysmenorrhea, PMS, hirsutism, acne, and endometriosis.
Emergency Contraception Methods
- Emergency contraceptive pills (ECPs) and copper IUCD can be used within days after unprotected intercourse.
- Yuzpe regimen includes combined oral contraceptives; effectiveness and side effects vary based on timing of administration.
Postpartum Contraception Options
- Non-breastfeeding women can use all methods except LAM, with COCs delayed for 3 weeks to reduce DVT risk.
- Preferred methods for breastfeeding women include LAM, barrier methods, IUCD, and female sterilization.
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Description
Test your knowledge on various types of contraceptive methods, including hormonal pills, injectables, implants, and surgical contraception. Understand the differences between method failure and use failure, and assess your understanding of contraceptive efficacy.
