A collection suite of final obstetrics and gynaecology MD notes to ace your penultimate and final year exams!
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-Talley and O�...
Contraception Advice:
Reason for contraceptive Ideas Absolute CI for contraception pills
usage Ø “Have you heard of the combined oral contraceptive Ø Pregnancy, CAD, HTN, impaired liver
Ø Acne pill?” Ø Migraines with auras
Ø Irregular periods Ø “What do you already know about the combined oral Ø Personal Hx of clots, VTE/PE
Ø Pre-menstrual contraceptive pill?”
Ø FHx or PHx of breast cancer
symptoms (e.g. fatigue, Concerns
mood swings, irritable, Ø “Is there anything that worries you about the combined
food cravings) oral contraceptive pill?” Relative CI for contraception pills
Ø No Potential Pregnancy Expectations Ø Age > 35 + smoker
plans Ø BMI > 35
Ø “What are you hoping the combined oral contraceptive
pill can do for you?” Ø BF
Ø “Why do you think the combined oral contraceptive pill is Ø DM
the best choice for you?” Ø Depression
Important things to ask: (DKA, EMPIRE FS) STERILISATION (permanent contraception)
Gillick’s competence (13-16 yo girls) • Male – vasectomy (99% effective)
Ø Diagnose (Test semen 12 wks after to check)
Ø Knowledge
Ø Attitude
• Female = laparoscopic tubal occlusion (> 99%
effective)
Ø Educate ® vomiting/diarrhoea + Vit C, Abx will reduced OCP effectiveness
® using “FIlshie clips”
o Stop pill 4 wks before major operation ® complete as elective or during LCSC
(i.e. lasting > 30 mins or lower limb needs immobilisation)
Ø Mx (pills, LARCs, barriers)
Ø Px (safe sex, STI screen yearly – most are asymptomatic, CST screen every 5 years)
Ø Info booklets ® Jean Hailes, org.au
Ø Re-evaluate understanding Discuss after ED contraception (SAFEGUARDING)
Ø Follow Up - 3-4 wks time (check on A/E) • Reassure about confidentiality
Ø Safety net ® missed pills, ED
• Sexually transmitted infections
• Future contraception plans
• Safeguarding, rape and abuse
Major concerns about missed pills
Missed pills What do I do? Additional Measures
Starting the pill • Start pill at any time if you are sure you are not pregnant condoms for first 7 days of taking the pill
One pill missed < 24hrs • Take missed pill immediately and take rest of pack normally None
e.g > 36 hrs for last POP
≥2 pills missed or new • Take most recent pill ASAP (i.e. 2x pills on same day) Condoms/abstain from sex in next 7
pack started ≥2 day late days ED Contraception if sex in past 7
• For 28-pack – don’t take placebo + finish pack normally
days
• For 21-pack – skip hormone free period + finish pack normally
Other Issues Why important?
Switching COCP ® POP Can start POP immediately if: Condoms/abstain from sex in next 7
days
Ø Taken COCP consistently for > 7 days (week 2/3 of pack)
Ø Days 1-2 of hormone free period in full pack of COCP
If on day 3-7 of hormone free period OR day 1-7 of taking COCP
Ø NO UPSI since day 3 ® start POP + condoms
Ø YES UPSI since day 3 ® take COCP for 7 days then switch to POP
Medication interactions epilepsy medication, rifampicin (ABx), HIV medication and St John’s Wort can reduce level of contraceptive hormones (preventing their
effectiveness). Always check w/ doctor when starting new meds
Removing coil • Abstain from sex or use condoms for 7 days = risk of pregnancy
Stopping Pill ASAP for • Advise to finish the pack + wait until 1st normal period before pregnancy
pregnancy • Pre-pregnancy advice = smoking/EtOH cessation, folic acid (elevit), vit D, 150mg iodine
Taking pill while • If sick within 2 hrs of taking pill ® take another one once better
sick/diarrhoea • If severe diarrhoea > 24 h ® take pill as if they missed pill until diarrhoea no longer severe
Breastfeeding • BF is NOT a reliable contraceptive ® Avoid having sex or inserting tampons prior to 6 wks as still fertile
• Avoid COCP post-birth ® inhibits lactation (negative feedback)
High-risk LSCS • Consider 1 year COCP ® have next baby in 18/12
• Allow LSCS to heal to prevent uterine rupture
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