A 39-year-old female presents for emergency contraceptive advice after having unprotected intercourse last night. She has had two previous normal deliveries. Six months ago, she had a lower leg deep venous thrombosis.
Which one of the following would be appropriate advice for this patient?
Correct Answer C:
Postcoital insertion of IUDs is highly effective and one of the most effective methods of emergency contraception if placed within 5 days after unprotected intercourse (failure rates < 0.1%).
→ Hormonal emergency contraception has no known medical contraindication. Likewise, no risk to a fetus or any adverse pregnancy outcome has ever been shown to result from the inadvertent use of postcoital contraceptives.
→ High-dose estrogens for 5 days was one of the earliest methods of emergency contraception, but because of severe side effects is seldom used anymore.
→ Emergency contraception (Plan B) is beneficial if used within 72 hours of intercourse in the case of hormonal therapy, and within 5 days in the case of the copper IUD. If taken within 72 hours of unprotected sex, it is up to 89% effective at preventing pregnancy and most effective if taken within 24 hours.
Which one of the following is seen in patients receiving injectable depot medroxyprogesterone acetate (DMPA)?
Depot medroxyprogesterone acetate (DMPA) is useful in women with contraindications to estrogen use (migraines, deep-vein thrombosis, cigarette smoking in those over age 35). Amenorrhea and irregular bleeding are the most common adverse effects of DMPA. Other side effects include irritability, depression, weight gain, hair loss, and acne. Acne and other skin problems are related to the drug’s androgenicity. DMPA is associated with an increase in bone resorption and a significant reduction in bone mineral density, presumably due to the induction of estrogen deficiency. In women of normal weight, DMPA has been shown to cause no statistically significant change in weight; however, in obese adolescents using DMPA there is an increased likelihood of weight gain compared to oral contraceptives and non-hormonal contraception.
A 31-year-old sexually active woman comes to your office requesting a cervical cap for contraception.
You advise her that the maximum number of hours that the cervical cap may be left in place is:
Correct Answer E:
The cervical cap, more popular in Europe than in the North America, has a similar failure rate to the diaphragm (2 year pregnancy rate of 15-20%). It is much more effective in nulliparous than in parous women. About two-thirds of the failures are user related. It should only be used on women with normal Pap smears and should not be left in place more than 48 hours because of the possibility of ulceration, unpleasant odor, and infection.
A 37-year-old woman who complains of heavy painful menses requests contraception. She smokes a pack of cigarettes a day.
Which of the following woud be the best choice of contraceptive for this patient?
Any smoker over the age of 35 has a significantly increased risk of myocardial infarction, stroke, and death if they are on oral contraceptive pills. Since she has heavy and painful menses, she is not an ideal candidate for the IUD. Progesterone-only contraceptive implant has no estrogen component; so it will not increase her risk of thromboembolic phenomena. Etonogestrel implant (choice C) is a single-rod progestin contraceptive placed subdermally in the inner upper arm for long-acting (three years) reversible contraception in women.
→ Due to her heavy, painful menses, she would not be a good candidate for the copper t380a intrauterine device (IUD) (choice A).
→ Smokers over 35 have an increased risk of MI and death when using estrogen-containing oral contraceptives (choice B).
→ Endometrial ablation (choice D) may lessen her menorrhagia, but it is not an accepted form of contraception.
→ Although hysterectomy (choice E) will successfully prevent pregnancy, contraception alone is not an acceptable indication for hysterectomy.
When magnesium sulfate is given to a woman in pregnancy all of the following are monitored for potential toxicity, except:
During magnesium sulfate administration to a woman, usually given for eclampsia, it is important to keep in mind the potential clinical signs of magnesium toxicity. These include loss of patellar reflexes, slurred speech, somnolence, flushing, muscle paralysis, decreased renal function and respiratory arrest. Therefore the respiratory rate, creatinine level and knee (patellar) reflexes must be checked.
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