A 36-year-old female sees you for a 6-week postpartum visit. Her pregnancy was complicated by gestational diabetes mellitus. Her BMI at this visit is 33.0 kg/m² and she has a family history of diabetes mellitus.
This patient’s greatest risk factor for developing type 2 diabetes mellitus is her:
Correct Answer D:
A history of gestational diabetes mellitus (GDM) is the greatest risk factor for future development of diabetes mellitus. It is thought that GDM unmasks an underlying propensity to diabetes. While a healthy pregnancy is a diabetogenic state, it is not thought to lead to future diabetes. This patient’s age is not a risk factor. Obesity and family history are risk factors for the development of diabetes, but having GDM leads to a fourfold greater risk of developing diabetes, independent of other risk factors (SOR C). It is thought that 5%-10% of women who have GDM will be diagnosed with type 2 diabetes within 6 months of delivery. About 50% of women with a history of GDM will develop type 2 diabetes within 10 years of the affected pregnancy.
Which one of the following represents an advantage of injectable medroxyprogesterone acetate (Depo-Provera)?
Correct Answer B:
Injectable medroxyprogesterone acetate is not causally linked with thromboembolic events. The most common side effect is menstrual irregularities; weight gain is also a bothersome side effect. There may be a decrease in HDL cholesterol and an increase in LDL. The cost is similar to that of combination oral contraceptives.
A 25-year-old white female comes to your office for counseling regarding birth control. She has had compliance problems with oral contraceptives and asks about alternatives. You discuss various options including the vaginal contraceptive ring (NuvaRing), and she asks for more information.
Which one of the following is true regarding the advantages and disadvantages of this form of contraception?
Correct Answer E:
The vaginal ring works by releasing etonogestrel and ethinyl estradiol intravaginally (etonogestrel is a progestin and ethinyl estradiol is an estrogen). Because it is not a barrier method of contraception, it does not protect against STDs. It is currently recommended that the ring be left in place for 3 weeks and then removed for 1 week so that withdrawal bleeding occurs. A new ring is then inserted. The vaginal ring has a lower incidence of breakthrough bleeding than levonorgestrel/ethinyl estradoil oral contraceptives. In a 1-year study, the majority of women who used the vaginal ring considered insertion and removal of the device easy, and 90% used the device correctly. If for some reason the ring is out of the vagina for more than 3 hours, back-up contraception should be used until the device has been back in place for 7 days.
Which one of the following is true regarding the use of a diaphragm for contraception?
Correct Answer A:
The diaphragm is an effective method of contraception if used correctly. A weight change of more than 15 lb (6.8 kg), pregnancy, or pelvic surgery may necessitate refitting. If used with nonoxynol-9, a diaphragm may actually increase the risk of HIV transmission. Diaphragms are made of latex, but a wide seal rim model made of silicon is available for those who are latex sensitive. Diaphragm use is contraindicated in women with a history of toxic shock syndrome. The diaphragm should remain in place for 6-24 hours after intercourse.
After fitting a 30-year-old gravida 2 para 2 for a diaphragm, you advise her not to leave the diaphragm in place for longer than 24 hours because of the risk of which one of the following?
Correct Answer C:
Much like with tampons, leaving diaphragms in place for more than 24 hours is associated with toxic shock syndrome.
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