Download Free Medical U.S. Selected Practice Recommendations for Contraceptive Use PowerPoint Presentation

U.S. Selected Practice Recommendations for Contraceptive Use PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Check out this medical presentation on sexual health, which is titled "U.S. Selected Practice Recommendations for Contraceptive Use", to learn about US Selected Practice Recommendations for Contraceptive Use, 2013 (US SPR), identify intended use and target audience, understand how to use the US SPR, and apply the guidance in specific situations, based on clinical scenarios.

Tags : medical presentation, sexual health, contraceptive use, recommendations, us spr

Published on : Jun 20, 2022 | Views : 1596 | Downloads : 0

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

U.S. Selected Practice Recommendations for Contraceptive Use, 2013 Division of Reproductive Health Centers for Disease Control and Prevention August 1, 2013 National Center for Chronic Disease Prevention and Health Promotion Division of Reproductive Health
Slide 2-

Learning Objectives Participants will be able to: Describe the US Selected Practice Recommendations for Contraceptive Use, 2013 (US SPR) Identify intended use and target audience Understand how to use the US SPR Apply the guidance in specific situations, based on clinical scenarios
Slide 3-

ppt slide no 3 content not found
Slide 4-

ppt slide no 4 content not found
Slide 5-

US Selected Practice Recommendations for Contraceptive Use, 2013 Follow-up to US Medical Eligibility Criteria for Contraceptive Use, 2010 (US MEC): Recommendations for who can safely use contraception Adapted from World Health Organization (WHO) SPR Intent: Evidence-based guidance for common, yet controversial, contraceptive management questions When to start Missed pills Bleeding problems Exams and tests Follow-up How to be reasonably certain that a woman is not pregnant
Slide 6-

US Selected Practice Recommendations for Contraceptive Use, 2013 Target audience: health-care providers Purpose: to assist health care providers when they counsel patients about contraceptive use Selected Recommendations NOT comprehensive textbook NOT the US MEC NOT rigid guidelines NOT well-woman care
Slide 7-

US Adaptation of WHO SPR October, 2010, Small expert meeting Chose which existing WHO recommendations to adapt Chose new clinical questions to add Systematic reviews for each topic Peer reviewed October 4-7, 2011, Expert meeting 36 experts from US For each topic: Systematic review presentation Discussion Draft recommendation Research gaps
Slide 8-

US Adaptation of WHO SPR Much of the guidance is the same as or very similar to the guidance in the WHO SPR Adaptations include: length of the grace period for progestin-only injectable contraceptives (DMPA), differences in some of the examinations and tests recommended prior to contraceptive method initiation, differences in recommendations for management of bleeding irregularities based on new data and drug availability in the US, simplified missed pill algorithms
Slide 9-

US Adaptation of WHO SPR The US SPR includes additional guidance: Recommendations on patch and ring How to start regular contraception after taking emergency contraceptive pills Management of bleeding irregularities among women using extended or continuous combined hormonal contraceptives (CHCs) When a woman can rely on female sterilization for contraception When a woman can stop contracepting
Slide 10-

US Adaptation of WHO SPR Format Arranged by method For each recommendation: Recommendation itself Comments and evidence summary Simplified text of actual recommendations Bullets, tables, flowcharts, algorithms
Slide 11-

ppt slide no 11 content not found
Slide 12-

ppt slide no 12 content not found
Slide 13-

ppt slide no 13 content not found
Slide 14-

Resources CDC evidence-based family planning guidance documents: http://www.cdc.gov/reproductivehealth/unintendedpregnancy/USMEC.htm http://www.cdc.gov/reproductivehealth/unintendedpregnancy/USSPR.htm Sign up to receive alerts! WHO evidence-based family planning guidance documents: http://www.who.int/reproductivehealth/publications/family_planning/en/index.html
Slide 15-

CLINICAL SCENARIOS
Slide 16-

Clinical scenario 1: When to start a contraceptive method 24 y.o. female comes to office desiring contraception and wants to start pills Q: When can she start?
Slide 17-

When to start a contraceptive method Barriers to starting Filling a prescription Starting during menses Coming back for a second (or more) visit Starting when woman requests contraception (“Quick start”) May reduce time woman is at risk for pregnancy May reduce barriers to starting
Slide 18-

Evidence for Risk of Pregnancy Two types of risk: Risk of already being pregnant Risk that woman already pregnant with “Quick start” of CHCs low Risk of becoming pregnant Risk of pregnancy with “Quick start” of CHCs low Brahmi, Contraception, 2013.
Slide 19-

Other findings Starting CHCs on different days of the cycle does not affect bleeding changes or other side effects “Quick start” may increase continuation of combined oral contraceptives (COCs) and patch in the short term; this difference disappears over time Brahmi, Contraception, 2013.
Slide 20-

Exposure in early pregnancy No increased risk for adverse outcomes (congenital anomalies, neonatal death, infant death) among infants exposed in utero to COCs Bracken, Obstet Gynecol. 1990;76:552-7.
Slide 21-

Need for back-up contraception Later start days are associated with greater follicular activity, but not ovulation, through day 5 (implications for back up) Brahmi, Contraception, 2013.
Slide 22-

US SPRWhen to start a contraceptive method
Slide 23-

Guidance for Special Considerations Amenorrheic Postpartum Breastfeeding Not breastfeeding Postabortion Switching from another contraceptive method
Slide 24-

Clinical scenario 1: When to start a contraceptive method ? 24 y.o. female comes to office desiring contraception and wants to start pills Q: When can she start? A: Anytime, if reasonably certain she is not pregnant. If it has been more than 5 days since menstrual bleeding started, she will need to abstain from sex or use additional contraceptive protection for the next 7 days
Slide 25-

ppt slide no 25 content not found
Slide 26-

Evidence: Pregnancy test limitations Pregnancy detection rates can vary based on sensitivity of test and timing with respect to missed menses Pregnancy test not able to detect pregnancy resulting from recent intercourse Pregnancy test may remain positive several weeks after pregnancy ends Cervinski, Clin Chem Lab Med. 2010;48:935-42. Cole LA, Expert Rev Mol Diagn. 2009;9:721-47. Wilcox, JAMA. 2001;286:1759-61. Korhonen, Clin Chem. 1997;43:2155-63. Reyes, Am J Obstet Gynecol. 1985;153:486-9. Steier, Obstet Gynecol. 1984;64:391-4.`
Slide 27-

ppt slide no 27 content not found
Slide 28-

Evidence on Pregnancy Checklist (PC) Stanback, Lancet, 1999;354:566. Stanback, J Fam Plann Reprod Health Care, 2006;32:27. Stanback, Rev Panam Salud Publica, 2008;23:116. Torpey, BMC Public Health, 2010;10:249.
Slide 29-

Clinical scenario 2: How to be reasonably certain that a woman is not pregnant 24 y.o. female comes to office desiring contraception and wants to start pills Q: How can you be reasonably certain she is not pregnant? A: If she has no signs or symptoms of pregnancy and fulfills one of criteria, a provider can be reasonably certain that the woman is not pregnant.
Slide 30-

ppt slide no 30 content not found
Slide 31-

US SPRExams and tests prior to initiation Unnecessary tests may be barrier to starting Women (adolescents) may not be comfortable with pelvic exam Coming back for a second (or more) visit to receive test results Recommendations address exams and tests needed prior to initiation Class A = essential and mandatory Class B = contributes substantially to safe and effective use, but implementation may be considered within the public health and/or service context Class C = does not contribute substantially to safe and effective use of the contraceptive method
Slide 32-

US SPR Exams and tests prior to initiation
Slide 33-

US SPR Exams and tests prior to initiation
Slide 34-

Evidence: BP measurement 6 case-control studies Women who did not have blood pressure check prior to COC initiation had higher odds of acute myocardial infarction and ischemic stroke than women who had blood pressure check No increased risk for hemorrhagic stroke based on whether or not blood pressure measured No evidence identified on other hormonal methods Tepper, Contraception, 2012.
Slide 35-

US SPR Exams and tests prior to initiation
Slide 36-

ppt slide no 36 content not found
Slide 37-

ppt slide no 37 content not found
Slide 38-

ppt slide no 38 content not found
Slide 39-

Clinical scenario 4: Management of IUD in woman with PID Evidence 3 RCTs and one cohort study, copper-IUD or non-hormonal IUD Compared PID outcomes among women who had the IUD removed compared with those who retained IUD Overall, similar outcomes between groups 3 studies found that women with IUD removal had no difference in clinical or lab outcomes 2 of these showed women with IUD removal had longer hospitalization times 1 study found that women with IUD removal experienced improved recovery in clinical signs of PID Tepper et al., Contraception 2013.
Slide 40-

US SPR Recommendation Treat the PID according to the CDC STD Treatment Guidelines. Provide comprehensive management for STDs, including counseling about condom use. The IUD does not need to be removed immediately Reassess in 48-72 hours If not improvement, continue antibiotics and consider IUD removal If woman does not want to keep the IUD, remove it after antibiotic treatment has been started. If the IUD is removed, consider using emergency contraceptive pills and counsel on alternative methods US Selected Practice Recommendations, 2013. http://www.cdc.gov/std/treatment
Slide 41-

ppt slide no 41 content not found
Slide 42-

ppt slide no 42 content not found
Slide 43-

Clinical scenario 5: When to stop contracepting 46 y.o. female with a history of hypertension has been using progestin-only pills and wants to know when she can stop her contraception. Q: When can a woman stop contracepting?
Slide 44-

Evidence There are no reliable tests to confirm a woman’s definitive loss of fertility FSH levels may not be accurate The median age of menopause is approximately 51 years in North America with a range of 40-60 years Hillard, American College of Obstetricians and Gynecologists, 2007. The North American Menopause Society, 2010. TeVelde, Hum Reprod Update, 2002.
Slide 45-

ppt slide no 45 content not found
Slide 46-

ppt slide no 46 content not found
Slide 47-

Evidence Most pregnancies after hysteroscopic sterilization occurred when there was deviation from FDA directions: Early follicular phase placement Imaging at three months Effective alternative contraception until documented occlusion Hysterosalpingogram confirmation necessary for contraceptive reliance Very few pregnancies occurred among women with confirmed bilateral occlusion Cleary et al, Contraception 2012.
Slide 48-

Clinical scenario 6: When to rely on Female Sterilization A 38 y.o. obese female with three prior cesarean deliveries has completed childbearing and decided she wants hysteroscopic sterilization to replace her DMPA. Q: When can she rely on her sterilization for contraception? A: She can rely on her hysteroscopic sterilization when hysterosalpingogram at 3 months confirms bilateral tubal occlusion. Continue DMPA till then.
Slide 49-

ppt slide no 49 content not found
Slide 50-

Evidence Anticipatory counseling decreases method discontinuation from bleeding irregularities with DMPA Hormone-free Interval (HFI) of 3-4 days improves bleeding after 2 weeks Doxycycline has not been shown to improve bleeding
Slide 51-

ppt slide no 51 content not found
Slide 52-

ppt slide no 52 content not found
Slide 53-

Four options for EC available in the US Intrauterine device copper intrauterine device (Cu-IUD) Emergency contraceptive pills (ECPs) ulipristal acetate (UPA) available in a single dose (30 mg) levonorgestrel (LNG) in a single dose combined estrogen/progestin in 2 doses
Slide 54-

SPR Recommendation on Effectiveness Large systematic review of 42 studies showed that the pregnancy rate among emergency IUD users is 0.09% UPA and LNG ECPs have similar effectiveness when taken within 3 days after unprotected intercourse UPA has been shown to be more effective than the LNG formulation between 3 and 5 days after unprotected intercourse. UPA may be more effective than LNG for women who are obese. The combined estrogen/progestin regimen is less effective than UPA or LNG and is associated with more frequent side effects
Slide 55-

Clinical scenario 8 : Emergency Contraception 38 y.o. obese female had unprotected intercourse 4 days ago and is worried about pregnancy. Q: What are her emergency contraception options? A: Copper IUD Ulipristal acetate Levonorgestrel ECPs Combination estrogen/progestin pills
Slide 56-

Clinical scenario 8 : Initiation of regular contraception after emergency contraception pills 38 y.o. obese female had unprotected intercourse 4 days ago and is worried about pregnancy. She has chosen to take UPA Q: When can she start regular contraception after ECPs?
Slide 57-

Evidence Data limited to expert opinion and product labeling. Theoretical concerns for decreased effectiveness of systemic hormonal contraception after UPA use. The resumption or initiation of regular hormonal contraception following ECP use involves consideration of the risk of pregnancy if ECPs fail.
Slide 58-

US SPR Recommendation:When to initiate regular contraception after emergency contraception pills Any regular contraceptive method can be started immediately after the use of ECPs. Advise the woman to have a pregnancy test, if she does not have a withdrawal bleed within 3 weeks. UPA The woman will need to abstain from sex or use barrier contraception for 14 days or her next menses, whichever comes first. LNG and combined estrogen/progestin formulations The woman will need to abstain from sex or use barrier contraception for 7 days.
Slide 59-

ppt slide no 59 content not found
Slide 60-

ppt slide no 60 content not found
Slide 61-

ppt slide no 61 content not found
Slide 62-

ppt slide no 62 content not found
Slide 63-

Provider tools and learning aids Summary tables and clinical algorithms E-book and other electronic versions Continuing Education Activities Speaker-ready slides Contraceptive Effectiveness Chart
Slide 64-

Continuing Educationhttp://www.cdc.gov/mmwr/
Slide 65-

Take Home Messages Most women can start most methods anytime Few, if any, exams or tests are needed Recommendations for anticipatory counseling for potential bleeding problems and proper management provided Routine follow-up generally not required Many circumstances call for consideration of emergency contraception use Regular contraception should be started after EC
Slide 66-

Why the US SPR is important Evidence-based guidance Quality family planning care Help individuals use methods correctly and consistently Decrease medical barriers to contraceptive use
Slide 67-

http://www.cdc.gov/reproductivehealth/unintendedpregnancy/USSPR.htm National Center for Chronic Disease Prevention and Health Promotion Division of Reproductive Health