CC September 2015 Postpartum Contraception

echoecho's version from 2016-05-26 02:26


Question Answer
A 2004-2006 population study on postpartum contraceptive use in 12 states and NYC found that in 2001, ___% of all pregnancies were unintended and ____% of women gave birth within 24 months of a prior birth?49; 21
Unintended pregnancy remains a major US public health issue,w ith around ____% of these pregnancies ending in abortion?21
The ____ abortion rate is the highest of all Western developed nations and Japan?US
Healthy People 2020 objectives include increasing intended pregnancy to ____% of all pregnancy (from 51%) and reducing the % of births within ____ months of a previous birth to 29.8% (from 33.1%)?56; 18
A 2011 systematic review fround that the mean day of first ovulation varied from ___ to ____ days postpartum?45; 94
Ovulation preceded ___ to ____% of first menses, and up to ___% of these ovulations were potentially fertile?20-70; 60
One-quarter of women ovulate between ___ to ____ days postpartum, with younger women returning to fertility more quickly than older women?25; 39
20% of women resume sexual activity before ____ weeks postpartum?4
These women are at risk of becoming pregnant agian if postpartum contraception is not initiated in a ____ fashion?timely
Why are the benefits of lenthening interpregnancy interval for the mother and her infant debated?causation is difficult to determine and studies are affected by study design
A population study in Utah found increased adverse perinatal outcomes with short interpregnancy interval (<6 months). List examples?1) low birth weight 2) preterm birth 3) small for gestational age
Also long interpregnancy intervals may be also associate with adverse outcomes, list these?1) low birth weight 2) prematurity 3) preeclampsia 4) neonatal morbidity
*** On the basis of currently available evidence, the WHO and the USAID recommend an interpregnancy of > ____ years but < ____ years?2; 5
Women are traditionally seen at 6 weeks postpartum, alothough the majority need protection from pregnancy no later than ____ weeks postpartum?3
Prior to delivery, physicians should counsel and offer postpartum contraception based on what?patient's preferences and specific personal/medical needs
List the 4 categories of contraception type?1) permanent 2) reversible (non-hormonal) 3)reversible (hormonal) 4) emergency
List the contraceptive options under the permanent category?1) female (b/l tubal ligation) 2) male vasectomy
List the contraceptive options under the reversible (non-hormonal) category?1) barrier methods (condoms; cervical cap; diaphragm) 2) behavioral / abstinence 3) natural procreative technology (NapPRO) 4) lactational amenorrhea
List the contraceptive options under reversible (hormonal) category?1) oral (combined hormonal contraceptives like pills, patch or ring) OR Progestin-only contraceptives (Micronor) 2) Implant (levonorgesterel (Nexplanon) 3) Intrauterine (copper IUD ParaGard or Levonorgestrel like Mirena, Skyla)
List the contraceptive options under emergency category?1) Oral (estrogen containing like Yuzpe method (COC); Preven) OR Progestin only (Plan B Selecive progesterone receptor modulator like Ulipristal acetate (Ella) 2) Intrauterine (IUD-Cu ParaGard)
One of the major considerations when recommending methods of contraception to postpartum women is whether or not they are what?breastfeeding
Longer duration of breast feeding increases the ______?benefits
The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for the first ____ months?6
List the 6 maternal benefits of breastfeeding?1) bonding to newborn 2) lower cost than formula 3) lower risk of ovarian and premenopausal bresat cancer. Lower risk of breast cancer recurrence and mortality from breast cancer especially hormone-receptor-positive, HERS2-negative disease 3) quicker return to prepregnant weight 4) decrease risk of cardiovascular disease possible related to decreased likelihood of obesity, diabetes, HTN, MI and hyperlipidemia 6) reduction in stress response possible related to prolactin and oxytocin
List the 4 infant benefits of breastfeeding?1) bonding to the mother 2) balanced nutrition 3) reduction of newborn infections (otitis media, gastroenteritis) and allergies 4) lower rate of obesity
For both the CDC and WHO, contraceptive methods are classified as safe for use among women with a particular condition or characteristic using 1-4 categories based on benefits and harm, list these 4 categories?1) Category 1 (considered safe to use without restriction) 2) Category 2 (usually acceptable because benefits outweigh theoretical or proven risks) 3) Category 3 (generally not acceptable unless more appropriate methods are either unacceptable or unavailable) 4) Category 4 (not acceptable in any circumstances)
*** Postpartum women, lactating or nonlactating SHOULD NOT take combined hormonal contraceptives during the first ____ days after delivery due to what?21; unacceptable high risk of VTE (venous thromboembolism).
VTE risk among postpartum woemn during this time is estimated as ____ to ___ fold greater than amongh nonpregnant or non-postpartum reproductive-age women?21.5 to 84
Risk rapdily declines after ___ weeks postpartum?3
Combined hormonal contraceptive use during this vulnerable period potentially increases what?postpartam VTE risk
In one study, combined estrogen contraceptive in the postpartum period increased the risk of VTE by ___ to ____ fold over the already elevated postpartum baseline risk?3; 7
Recommendations further state that between ___ to ____ days postpartum, non-lactating women WITHOUT risk of factors of VTE may initiate combined hormonal contraceptives (Category 2)? Women with VTE reisk factors should avoid these methods (Category 3)?21; 42
After ____ days postpartum, combined hormonal contraceptives can be used without restriciton for nonlactaing women (Category 1)?42
List the 10 risk factors for venous thromboembolism (VTE)?1) age > 35 y.o. 2) previous VTE 3) thrombophilia 4) transfusion at delivery 5) BMI > 30 6) postpartum hemorrhage 7) cesarean delivery 8)preeclampsia 9)smoking 10) immobility
According to the CDC MEC (Medical Eligibility Criteria), for lactating women between ____ to < ____ days postpartum, combined hormonal contraceptives are category 3 with or without risk factors for VTE?21; 30
Between ____ to ____ days, it is Category 3 with risk factors for VTE?30; 42
After ____ days, use of combined hormonal contraceptive remains Category 2?42
Use of daily ASA ______ (does vs. does not decrease VTE risk in the postpartum period?does not
The WHO MEC states that combined hormonal contraception in breastfeeding women < ____ weeks postpartum is category 4?6
____ weeks to < _____ months postpartum is category 3?6; 6
> ____ months postpartum is category 2?6
In addition to VTE risk, concerns exist regarding the potential negative effective of combined hormonal contraceptives on what?1) breast milk quality and quanitity 2) duration of breastfeeding 3) infant growth 4) hormonal exposure
A 2010 systematic review found limited evidence to support an influence of combined oral contraceptive on what?breastfeeding
*** A 2015 Cochrane review (n = 11 trials) found inconsistent results, with only 6 trials of moderate quality evidence. These showed no significant between group differences in breast feeding duration when what three medications were compared?combined hormonal contraceptive, progestin-only (Micronor) and lovonorgestrel (LNG)-IUD were compared
PROGESTIN-ONLY CONTRACEPTIVES (Pills Micronor), Injection (Depo-Provera), Implant (Implanon, Nexplanon)
Question Answer
According to the CDC MEC, progestin-only contraception (pill, implant, injection) was generally safe and effective in the postpartum period; all are category ____ for nonlactating women?1
For breastfeeding women, progestin-only contraception (pill, implant, injection ) is Category 2 in the first ____ days and Category 1 after _____ days postpartum?29; 30
Progestin-only contraceptive has no significant effect on breastfeeding or breast milk quality, true or false?true
The WHO MEC states that for breastfeeding women, progesting-only methods except injectables are category 2 in the first ____ weeks postpartum?6
Injectable progestin is category ____ during this time?3
After 6 weeks, all progestin-only methods are category ____?1
Can progestin-only methods be initiated immediately postpartum?yes
Generally, lactating mothers do not experience what type of bleeding that an occur with progesting-only methods?irregular bleeding
Use of progestin-only pills is usually reserved for _____ mothers?nursing
A retrospective study found a high continuation rate after immediate postpartum insertion of what, for up to 3 years' duration?etonogestrel implant (Nexplanon)
The most frequent reasons for implant removal included what?bleeding and weight gain
Question Answer
Postpartum IUD insertion (LNG-IUD (Mirena;Skyla), Cu-IUD (ParaGard) is an effective option but is ______ for various reasons?underutilized
One US study estimated postpartum IUD insertion to be _____ per 10,000 deliveries?0.27
Studies demonstrate lower IUD _____ rates with insertion performed less than 10 minutes after placental delivery (category 2 for LNG-IUD; Category 1 for IUD-Cu)?explusion
Both IUDs are category 1 when inserted > ____ weeks postpartum?4
Women with postpartum IUD placement have a similar continuation rate at ___ months as compared to delayed insertion?6
*** The authors of a 2015 Cochrane review concluded that immediate insertion following delivery may outweight the disadvantage of the increased risk of what?expulsion
What is an absolute contraindication for immediate postpartum IUD insertion?puerperal sepsis
Some health insurances may not cover the cost of immediate postpartum IUD insertion (i.e. in the delivery room), although most will pay for it at the ___ week visit?6
Question Answer
Condoms can be used anytime (Category ___)?1
Use of diaphragms and cervical caps can be initiated after ____ weeks postpartum (category 1)?6
Lactational amenorrhea provides only ____ months protection in women who exclusively breast feed and have no return of menses?6
Other fertility prediction methods (natural procreative (NaPRO) technology) can only be used after what has resumed?menses
Permanent contraception should be discussed and offered to couples that are sure that they desire no more children, list 3 options?1) tubal ligation 2) tubal occlusion 3) vasectomy
What is simpler, faster, safer, less expensive and more effective in preventing pregnancy than tubal ligation?vasectomy
However, tubal ligations are ___ to ___ times more frequently performed in the US?2; 3
More than _______ vasectomies are performed annually int he US; only ___% are done by family physicians?50,000; 13
Question Answer
For women who decline postpartum contracption, providers should discuss and offer what?emergency contraception (EC) options
List EC options?1) progestin only pill (Plan B) 2) ulipristal acetate (Ella) 3) IUD-CU (ParaGard)
Do you need a prescription for Progestin-only EC? for ulipristal? Both are underutilized in the US? 1) no 2) yes
How does Ulipristal work?it delays ovulation and is more effective when unprotected intercourse occurs around the time of ovulation
Which of the 3 options is the most effective EC?IUD-Cu
A review of 42 studies of 7,034 women receiving IUDs upt to 10 days after unprotected sex, showed a ____% pregnancy rate?0.09%
IUD-Cu additionally provides ongoing contraception up to ___ years?10
List the barriers to IUD-Cu EC?1) high up-front insertion charge 2) out-of-pocket cost 3) lack of awareness among women and providers 4) in-office insertion requirements
As noted in the discussion, the WHO just released the 5th edition of Medical Eligibility Criteria, list the web sites to compare current CDC MEC with 2015 WHO MEC?1) current CDC MEC ( 2) 2015 WHO MEC ( health/publications/family_planning/Ex-Summ-MEC-5/en/
*** SUMMARY = What is necessary postpartum to prevent unintended pregnancy and to optimize the interpregnancy interval?effective and appropriate contraception
*** SUMMARY = The WHO recommends an optimal interpregnancy interval of > ___ years but < ____ years?2; 5
*** SUMMARY = In the postpartum period, the appropriateness of various forms of contraception depends on what?1) interval from delivery 2) whether or not the women is breastfeeding
*** SUMMARY = What procedures may be appropriate for individuals who are sure that they do not desire any more children?sterilization