Final Exam Study Guide.docx

Final Exam Study Guide: LAST EXAM for school!!!! Monday, Tuesday, Wednesday **Goal is 100% recall!!!** **Module 1: Contraceptives, Pregnancy Options, Cervical Cancer Screening** **Module 2: Preconception Counseling, Infertility, Antepartum Care** **Module 3: Substance Use in Pregnancy, High Ris...

Final Exam Study Guide: LAST EXAM for school!!!! Monday, Tuesday, Wednesday **Goal is 100% recall!!!** **Module 1: Contraceptives, Pregnancy Options, Cervical Cancer Screening** **Module 2: Preconception Counseling, Infertility, Antepartum Care** **Module 3: Substance Use in Pregnancy, High Risk Pregnancy** **Module 4: Postpartum, Abnormal Uterine Bleeding** **Module 5: HIV, Lactation** **Module 6: Breast Disorders, Menopause** **Module 7: Development of Gender Identity and Sexual Orientation** Module 1: - Pregnancy associated mortality is 32.9 per 100,000 live births; there are higher rates among BIPOC per 100,000 live births for black non-Hispanic women - The evidence says that pregnancy associated mortality is higher in states with abortion restrictions - 7 million women are admitted to hospitals every year because of unsafe abortion - Use all options counseling to create a safe space and using active listening to explore someone's pregnancy decisions, feelings, and experiences, with curiosity and empathy, and without an agenda - Pregnancy options: end the pregnancy, continue the pregnancy, medication abortion, procedural abortion, parenthood, adoption - If patient continues pregnancy: start prenatal vitamin (PNV), refer for prenatal care, education including warning signs/symptoms, screen patient for needs (nutrition/food/housing security, financial resources for prenatal care/parenting, doula services, childbirth education classes or resources) - Abortion: 92.7% of abortions performed under 13 weeks gestation, 7.2% of abortions performed after 13 weeks gestation - There are two types of abortion: medication and aspiration done in the 1^st^ trimester - First trimester abortions do not increase risk of: infertility, ectopic pregnancy, miscarriage, birth defects, preterm or low birth weight delivery, breast cancer, and mental health disorders - Medication abortion: advantages are that can be done up to 77 days from LMP, 95% effective, can be performed without delay, greater autonomy and privacy, less invasive, telehealth option - Medication abortion disadvantages: take 1-2 days to complete, bleeding and cramping can be heavier and more intense and may last longer (1-2 weeks), baseline U/S or quantitave hCG is recommended, may need aspiration abortion if medication fails. - Medication abortion uses mifepristone (Mifeprex) and misoprostol (Cytotec); Give Mifepristone 200 mg first. Misoprostol 800 mcg is given to patient after mifepristone usually 24-48 hrs after (for pregnancies 9-11 weeks would give 2^nd^ dose 3-6 hrs after1st dose). - Mifepristone causes the progesterone blockade which causes cervical ripening and decidual necrosis leading to detachment. Misopristol causes uterine cramping, contractions, and expulsion. - Instruct patient to expect cramping and bleeding within 4-24 hrs of misopristol placement and provide pain medications (NSAIDs or opiates as needed) - The medication abortion process: need to confirm the positive urine pregnancy test, estimated gestation age should be less than 77 days, counsel on process - Contradindications for medication abortion: IUD in place, allergy to meds, chronic adrenal failure, long-term systemic corticosteroid use, ectopic pregnancy, anemia, concurrent anticoagulant therapy - Labs (only if indicated): H and H for greater than 10 weeks or h/o anemia, Rh status, quant B-hCG - Determine if U/S is required: concerned for ectopic, uncertain LMP, irregular menses, vaginal bleeding, size/date discrepancy, LMP estimates gestation age is 77 days (11 weeks) - Would do a quantitative B-hCG if the initial ultrasound doesn't show intrauterine pregnancy - When to initate contraception after medication abortion: 1. Implant at the time of mifepristone (day one) 2. Pills/patch/ring and depo: the day after mifepristone 3. IUD: after confirming abortion completion at follow-up visit - Assess completion of abortion: optional in-office visit or phone visit after 1-2 weeks; history of abortion completion is appropriate bleeding after misoprostol and no further symptoms of pregnancy; if bleeding is heavy and symptomatic thinking continued pregnancy vs. retained POC (will then need to do aspiration) declining quant B-hcg, 80% decline in B-hcg after 1 week ultrasound to verify that prior gestation sac is no longer present negative home urine pregnancy test (4 weeks after mifepristone), if positive home urine pregnancy test then need evaluation for ongoing pregnancy and possible aspiration abortion - Aspiration abortion: advantages are that it is 99% effective, take minutes to complete and no follow-up needed, multiple anesthesia options, shorter bleeding period, can be performed later in pregnancy (up to 14 weeks) - Aspiration abortion: disadvantages are that it requires pelvic instrumentation, less patient control, potential medication adverse effects - Aspiration abortion: analgesia and anxiolytic options include NSAIDs and local, moderate, or deep sedation - Additional comfort measures for aspiration abortion include: heat packs, music, patient-centered language vs triggering language - Aspiration abortion: procedure lasts about 5-10 minutes - Contraception post aspiration abortion: IUD can be inserted immediately after aspiration as well as other contraceptives