All of the following are considered possible indications for cesarean section, except:
Correct Answer D:
Abnormal placentation (as in the presence of a placenta previa), nonreassuring fetal heart rate, genital herpes infections and a prior urethropexy are all indications for a Cesarean section. Carcinoma in situ of the cervix is not.
Complications of cesarean section include each of the following, except:
Correct Answer E:
Cesarean complications, although rare, include infections, blood clots, and abdominal adhesions. While bleeding after section is normal, uncontrollable bleeding is not, and needs immediate treatment. An infection after cesarean section occurs in about 1 to 2 out of every 20 surgeries. Fetal injury during a c-section is rare but possible, such as nerve damage or lacerations. Although rare, uterine rupture after cesarean section can occur, especially if a scar is already present.
Oral contraceptive pills have been shown to raise the risk of which of the following?
Correct Answer D: Possible side effects of oral contraceptive pills (OCP’s) include vaginal discharge, changes in menstrual flow, breakthrough bleeding, unusual build-up of the uterine lining, nausea, headaches, depression, vaginitis, urinary tract infection, changes in the breasts, changes in blood pressure, skin problems, skin improvements, and gum inflammation. Cautions and contraindications for OCP use are: coagulation, increasing the risk of deep venous thrombosis (DVT) and pulmonary embolism (PE), stroke and heart attack.
Combined oral contraceptives are generally accepted to be contraindicated in women with pre-existing cardiovascular disease, in women who have a familial tendency to form blood clots (such as familial factor V Leiden), women with severe obesity and/or hypercholesterolemia, and in smokers over age 35.
Evidence shows that long-term use of OCPs (5 or more years) may be associated with an increased risk of cancer of the cervix.
The relationship between exogenous hormone use (OCP), and risk of breast cancer (choice B) is not conclusive. Oral contraceptive pills decrease chance of getting endometrial cancer (choice C), ovarian cancer (choice A), and ovarian cysts (choice E).
The estrogen component of oral contraceptives has the capability of activating the blood clotting mechanism (choice D). Use of low-estrogen oral contraceptives is associated with a lower risk of thromboembolism than use of oral contraceptives with higher levels of estrogen.
A 38-year-old widow consults you 2 years after her husband’s accidental death. She is planning to remarry and asks about the possibility of resuming the low-dose oral contraceptives she took before she was widowed.
Which one of the following may contraindicate resumption of oral contraceptives?
Correct Answer C:
Oral contraceptives increase the risk of venous thromboembolic phenomena. The combination of oral contraceptives and smoking substantially increases the risk of cardiovascular disease. In general, oral contraceptive use is considered absolutely contraindicated in women older than 35 who are heavy smokers. Women who smoke fewer than 15 cigarettes a day and patients with mildly elevated blood pressure and elevated lipid levels are not at increased risk for cardiovascular disease when oral contraceptives are used.
A 19-year-old white female presents for an initial family planning evaluation. Specifically, she is interested in oral contraception. She is not presently sexually active, but has a steady boyfriend. She has no contraindications to oral contraceptive use. She has mild acne vulgaris.
You discuss possible side effects and benefits of combined oral contraceptives, including improvement of her acne.
Which one of the following is also associated with oral contraceptive use?
Correct Answer B:
Women who take combination oral contraceptives have a reduced risk of both ovarian and endometrial cancer. This benefit is detectable within a year of use and appears to be persistent for years after discontinuation. Other benefits include a reduction in dysfunctional uterine bleeding and dysmenorrhea; a lower incidence of ovarian cysts, ectopic pregnancy and benign breast disease; and an increase in hemoglobin concentration. Many woman also benefit from the convenience of menstrual regularity. Some combination oral contraceptives raise sex hormone-binding globulin and decrease free testosterone concentrations, which can lead to improvement in acne.
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