Graded A+
Gravidity + parity
G: # total pregnancies
P: # of births (TPAL):
# term deliveries (37+ weeks)
# preterm deliveries (20-37 weeks)
# abortions, miscarriages, ectopic (deliveries < 20 weeks)
# living children
Use appropriate size speculum
-Petersen for most patients
-Grave's for multiparous women
-pediatric speculum for young patients or virginal women
Rectal exam
helpful if suspect mass in cul-de-sac, otherwise not routinely done
Risk of thromboembolism w estrogen vs. progestin
-estrogen: 3-4x risk (lower than risk with pregnancy)
-progestin: small increased risk, since its converted to estrogen
**norethindrone < 2.5 mg/day has 0 risk
Progestin only methods like pill and IUD
considered to have NO risk of VTE
Contraindications to hormonal BC
-women > 35 who smoke > 15 cigarettes/day
-complicated organ transplant
-liver problems: cirrhosis, hepatic adenoma, hepatitis
-breast cancer
, -pregnancy, early postpartum, breastfeeding
-migraine w aura, SLE
CV Contraindications to hormonal BC
-known ischemic heart disease
-risk factors for CV disease
-acute DVT, previous thromboembolic event
-stroke
-valvular heart disease
-peripartum cardiomyopathy
HTN > _____ Contraindications to hormonal BC
160/100
How is contraceptive efficacy measured?
# women who get pregnant in one year using a specific method
Most effective BC method?
vasectomy:
-highly effective, irreversible (think this was a typo in slides)
-mild discomfort for 24 hours, local anesthetic only
-need semen analysis 3 months after
Methods of female sterilization
-tubal ligation, tubal cauterization
-B/L salpingectomy (lower risk of ovarian cancer)
-irreversible, requires anesthesia, intra-abd procedure
-can be done immediately postpartum
IUD mech of action
-impedes sperm migration
-inhibits implantation
-progestin IUD also thickens cervical mucus + impedes ciliary action of fallopian
tubes