Update on Contraception Quizmasters: Dr Hariharan C Dr Ajay SDNO EXIT!!!
• “We want far better reasons for having children than not knowing how to prevent them.”
Round I• True or False• 8 questions• 10 marks each• No Bonus marks
• 1. Levonorgestrel Emergency Contraception has no absolute medical contraindications
• TRUE!• EC has no evidence-based absolute contraindications, because pregnancy for women who have concurrent medical problems (including thromboembolic and liver disease) would pose a greater threat than 1-day doses of estrogen or progestin (Medical eligibility criteria for contraceptive use. 3rd edition. Geneva (Switzerland): World Health Organization; 2004.
2. If ECPs failed to prevent pregnancy, a woman has a greater chance of that pregnancy being an ectopic pregnancy.
• False• To date, no evidence suggests that ECPs increase the risk of ectopic pregnancy. Worldwide studies of progestin-only ECPs, including a United States Food and Drug Administration review, have not found higher rates of ectopic pregnancy after ECPs failed than are found among pregnancies generally.
• 3. Subcutaneous DMPA (DMPA-SC) is not as effective as IM DMPA
• False.• A formulation of DMPA has been developed specifically for injection into the tissue just under the skin (subcutaneously).• The hormonal dose of the new subcutaneous formulation (DMPA-SC) is 30% less than for DMPA formulated for injection into the muscle— 104 mg instead of 150 mg. Thus, it may cause fewer side effects, such as weight gain. Contraceptive effectiveness is similar.• Like users of intramuscular DMPA, users of DMPA-SC have an injection every• 3 months. DMPA-SC will be available in prefilled syringes, including the single-use Uniject system. These prefilled syringes will have special short needles meant for subcutaneous injection. With these syringes, women could inject DMPA themselves. DMPA-SC was approved by USFDA in December 2004 under the name “depo-subQ provera 104.”
• 4. DMPA permanently decreases the bone mineral density
• False• Although DMPA use decreases bone density, Research has not found that DMPA users of any age are likely to have more broken bones.• When DMPA use stops, bone density increases again for women of reproductive age.• Among adults who stop using DMPA, after 2 to 3years their bone density appears to be similar to that of women who have not used DMPA.
5. Efficacy of LAM method is 98% in first six months postpartum
• True.• As commonly used, there will be about 2 pregnancies per 100 women using LAM in the first 6 months after childbirth. This means that 98 of every 100 women relying on LAM will not become pregnant• The lactational amenorrhea method (LAM) requires 3 conditions. All 3 must be met: 1. The mother’s monthly bleeding has not returned 2. The baby is fully or nearly fully breastfed and is fed often, day and night 3. The baby is less than 6 months old• “Fully breastfeeding” includes both exclusive breastfeeding (the infant receives no other liquid or food, not even water, in addition to breast milk) and almost-exclusive breastfeeding (the infant receives vitamins, water, juice, or other nutrients once in a while in addition to breast milk).• “Nearly fully breastfeeding” means that the infant receives some liquid or food in addition to breast milk, but the majority of feedings (more than three-fourths of all feeds) are breast milk.
6. Condoms do not have any absolute contraindications for their use
• False• Know Latex allergy is an absolute contraindication for use of condom
• 7. While calculating fertile period, the woman should subtract 18 from her shortest cycle and 11 from her longest cycle in the last six months
• True• The woman should update these calculations each month, always using the 6 most recent cycles.• Example:• If the shortest of her last 6 cycles was 27 days, 27 – 18 = 9. She starts avoiding unprotected sex on day 9.• If the longest of her last 6 cycles was 31 days, 31 – 11 = 20. She can have unprotected sex again on day 21.• Thus, she must avoid unprotected sex from day 9 through day 20 of her cycle.
• 8. Spermicides increase the risk of transmission of HIV
• “It would be a service to mankind if the pill were available in slot machines and the cigarette were placed on prescription.”
Round II• Medical disorders and contraception• 4Questions, 10 marks each• Bonus marks: 5
1. In a woman on ATT for pulmonary tuberculosis, the best form of contraception would be:• A. Second generation COC• B. POPs• C. Progesterone implant• D. DMPA
2. All of the following are contraindications to COCs EXCEPT• A. Migraine with aura• B. varicose veins• C. age more than 35 yrs and smoker• D. Hypertension
3. Contraceptive of choice in Ischemic heart disease isa. Cu-Tb. Drospirenone containing OCPsc. Progesterone Implantsd. Depo- Provera
4. Which of the following are safe in benign breast diseasea. COCsb. Mini-pillsc. Implantsd. All of the above.
• “I want to tell you a terrific story about oral contraception. I asked this girl to sleep with me and she said "No." ~Woody Allen”
Round IIIMale and female sterilization6 questions10 marks each5 marks bonus points
1. Request for reversal of tubal sterilization is seen ina. 1%b. 3%c. 5%d. 10%
2. Which of the following is a permanently irreversible method of sterilization?a. Madlener’sb. Irving’sc. Kroner’sd. Parkland
3. In laparoscopic sterilization, which of the following is associated with highest failure ratesa. Hulka clipsb. Falope ringsc. Bipolar coagulationd. Monopolar coagulation
4. Which of the following methods are associated with highest rates of ectopic pregnancy in case of failurea. Electrocauteryb. Silastic bandsc. Tubal resectiond. Hysteroscopic occlusion
• Approximately half (50%) of pregnancies that follow a failed electrocoagulation procedure are ectopic, compared with only 10 percent following failure of a ring, clip, or tubal resection method (Hatcher and colleagues, 1990; Hendrix and associates, 1999)
5. All of the following are known complications of male sterilization excepta. Anti sperm antibody formationb. Wound granulomac. Erectile dysfunctiond. Scrotal pain.
6. Typically it takes around______ ejaculations before a man becomes azoospermic after vasectomya. 10b. 20c. 30d. 40
• “A birth control pill for men, thats fair. It makes more sense to take the bullets out of the gun than to wear a bulletproof vest.”
Round IV• Rapid fire• 3 min• 10 marks per correct answer
1. Efficacy of COCs on typical use is___2. Commonest cause of failure of tubal ligation is______3. What should be done if a woman on COCs misses 3 pills?4. Prolonged use of COCs has been associated with ________ cancer5. The life of Implanon is ________6. The life of NET-EN is______7. Commonest side effects of the Yuzpe regimen is____8. Enlist two non contraceptive benefits of condoms9. What is the pearl index if no contraception is used?10. A potential problem with Drospirenone containing OCPs is________
1. Efficacy of DMPA on typical use is______2. After male sterilization, an alternative method should always be used for a period of____ months3. Commonest cause of discontinuing DMPA is _____4. Alternative method should be considered if a woman on Cerazette delays her daily dose by____ hours5. The life of Cu T 380A is________ years6. The life of Jadelle is_______7. Commonest side effect of LNG for EC is______8. Enlist two non contraceptive benefits of Mirena apart from AUB.9. The efficacy of the cervical diaphragm on typical use is_____10. Most important problem with use of progestasert is_______
Life of contraceptives• Norplant- 5 years• Jadelle- 5 years• Implanon- 3 years• CuT 380A- 10 years• Nova T- 5 years• Multiload 375- 5 years• Multiload 250- 3 years
• “We all worry about the population explosion, but we dont worry about it at the right time.”