Contraception, Sterilization & Infertility PDF

Complications/ Risks: - (HDFN) Hemolytic disease of fetus/ newborn → Immune hydrops fetalis (severe tissue hypoxia from RBC destruction)...

Complications/ Risks: - (HDFN) Hemolytic disease of fetus/ newborn → Immune hydrops fetalis (severe tissue hypoxia from RBC destruction) To dx fetal anemia or do exchange transfusion you will need to perform PUBS procedure (percutaneous umbilical blood sampling) PROM & PPROM PROM = >37 wks; PPROM= 35yrs - H/O thromboembolism (DVT, PE, etc) - H/O CAD, CHF, CVA - H/O migraine w/ or w/o aura Disc. if pt has: - Increased BP (esp w/ hx of HTN) - Worsening migraines Progestin only pills Used esp. For women who can’t have estrogen: Aka “mini pill” - Lactating - Women >40 (clot risks)  *Take @ same time daily, if 3 hours late, + another contraceptive method Side effects: TRANSDERMAL Combination of E + P; Lasts 1w (replace weekly, 4th week patch free→ Withdrawal bleed) contraception - Start during 5th day of menses patch - Note: DECREASED EFFICACY > 198 lbs Contraception - Same amts of hormones released daily RINGS - Used 1x/M - Placed in vagina @ start of menses → Left for 3W - Withdraw bleeding when removed (1W) Barrier Overall have higher failure rates contraceptives Benefits: - Cheaper/ available - Some protection ag. STIs (G, C, Herpes, HIV, HPV) Condoms: Diaphragms: - 2 types: - Dome latex device → o/ ant vag wall + cervix 1) Sheaths over penis - Use w/ jelly/cream 2) Sheaths inside vagina (left 6-8 hrs - Insert 6hrs prior to intercourse + left 6-8hrs aft. post intercourse) - But NOT >24hrs - Only latex prevent ag. HIV - AVOID talcum powder (inf., cancer, etc) - Seek medical care w/i 120hrs of condom slip up - Requires fitting from health provider - Re-fit w/ weight cxs/vag birth/pelvic surg. Cervical Caps: - Cover cervix ONLY - Harder to fit/ easier to displace - Must remain 6hrs post intercourse - Not > 48hrs → TSS / Cervicitis Sponges: - Small/ pillow shaped → Over cervix - Contains spermicide (kills sperm) - Can remain for 24hrs - More effective in Nulliparity - If left in >30 hrs… ↑ risk of TSS - Off market most places Long acting - Higher costs but 99% effective Hormone-eluting subdermal reversible - Good option for: implants contraceptives - Pts who cant take estrogen, & desire rapid return to fertility (Nexplanon/Implanon) - Placed in inner upper IUD (intrauterine device) arm → Must be - Adolescents ideal candidate trained on removal - All must be checked in 4 weeks (ensure placement stayed) - Place w/i 5d of LMP - CI: → Approved for up to - Uterus distortions (congenital abn/ scaring) 3 yrs  - Abn uterine bleeding / Active pelvic inf. - Good for pts w/ - Pregnancy dysmenorrhea from - Risks: endometriosis or pts - Increased risk of PID (from insertion) → Or embedded in uterine wall that can’t use IUD (10-16%) - CI: Pts w/ hormone - Spontaneous expulsion responsive - Uterine perforation conditions (ex breast - Higher ectopic risk cancer) - Types: - Hormonal - Release levonorgestrel → Thickens cervical mucus (harder for sperm entry) - Insert during menses - SI: Irregular spotting, amenorrhea, incr. risk of ovarian cyst - Copper IUD (para-gard) - Non-hormonal → Safe for breastfeeding - Won’t cause amenorrhea - Prevents implantation by creating a toxic inflammatory response to sperm/egg IM injection (depot Injectable progsetrin → IM e/ 3M w/i first 5d of menses provera) - Lasts at least 14w → “safe margin” - FDA warning: Concern over BMD → Now 2 year max limit Other methods - Calendar method - Basal body temp method - During ovulation, increases by 0.5°F – 1°F - Cervical mucus method - During ovulation its thicker and >white Emergency PLAN B (“morning after pill”) contraception - Must be used w/i 72hrs; Found OTC; MC SI = N/V x 1/2d - Work by inhibiting ovulation or preventing fertilization - Can’t be used as form of abortion → Do not a ect implantation Progesterone only regimens (Levonelle) - Can be taken up to 72hrs - Similar to plan B → Except its 2 doses instead of 1 Copper IUD (paragard) - Most effective option → Must be inserted w/i 5d of unprotected sex - Works even after ovulation → causes inflammatory response in uterus → Toxic to sperm & eggs - Requires prescription EllaOne (“morning after pill”) - Selective progesterone receptor modulator (SPRM) - THEY DO NOT prevent implantation & will not terminate an existing pregnancy - Less effective than PLAN-B → But could be better for overweight pt - A ective up to 5d after unprotected sex - Requires prescription Sterilization Technically not permanent → But outcomes have poor success rates + expensive MALE → Vasectomy → Occludes vas deferens - Very effective - Complete azoospermia not obtained until 10wks post procedure - Complications (~10%): - Bleeding, hematoma, acute & chronic pain, local skin inf. - Depression, changes in body image FEMALE → Minilaparatomy (MC) - Electrocautery - Clips → Filshie or Hulka (most reversible) - Rings → Falope ring → Hysteroscopy - Ensure system → Stainless steel & nickel inserted into each FT - Complications: Infection, bleeding, ectopic Pre Sterilization counseling: - Permanence, alternative methods, reason for choosing sterilization - Screen for risks, Indicators of regret, procedure details, possible failure, need for condoms Infertility Inability to conceive after: (affects 1 in 6 couples)  - 12M of frequent, unprotected intercours - 6M if women >35yrs Steps to conception: 1. Ovulation of competent oocyte + production of competent sperm 2. Patent repro tract & fertilization 3. Creation of viable embryo → transported into uterus 4. Successful implantation into endometrium Causes of infertility: - Female (65%) - Ovulatory dysfunction (MC) → Ex PCOS - Fallopian tube obstruction → Ex scaring - Endometriosis - Male (20%) - Low sperm count, oligospermia, azoospermia - Varicocele - Sperm motility/ morphology issues - Unexplained (15%) Assessing infertility: - H&P: - Menstrual hx, ovulation predictor test, basal body temp - PE: - F: Uterine & tubal evaluation → US, Hysteroscopy, hysterosalpingography, laparoscopy - M: Semen analysis ART (Assisted repro technology): 1. IUI (artificial insemination) - Ovarian stimulation → Clomiphene citrate boosts egg production - Controlled ovarian hyperstimulation → Exogenous gonadotropins stimulate follicular dev. - Intrauterine insemination → Washed semen introduced via catheter 2. (IVF) In vitro analysis (MC) - Ovarian stimulation - Retrieval of oocytes from ovaries - Oocyte fertilization in vitro (lab) - Embryo incubation (lab) - Transfer of embryos to uterus through cervix