***A persistent occiput posterior position is associated with a higher risk of cesarean delivery and assisted vaginal delivery, and a lower chance of spontaneous vaginal delivery compared with an occiput anterior fetal position.
***Mirena IUD (Levonorgestrel-releasing Intrauterine system) is the best option for a patient who has heavy menstrual bleeding, associated anemia, and morbid obesity (BMI >50). Medroxyprogesterone can contribute to weight gain and thus should not be the first choice for this person. The Norelgestromin/Ethinyl estradiol transdermal system is not recommended in patients with a weight over 90kg and is not good for this patient. A diaphragm won’t decrease menstrual blood loss.
Drospirenone and Spironolactone
“Drospirenone is a novel synthetic progestin approved in combination with Ethinyl estradiol as an oral contraceptive (OC).[1] Marketed as Yasmin® and Yaz®, drospirenone is one of the most popular oral contraceptives in the United States.[2] Drospirenone is a fourth generation OC and it possesses antimineralocorticoid effects not present in previous generations of OCs. Its antimineralocorticoid potency is approximately eight times greater than spironolactone,[3] thus a 3 mg tablet of drospirenone has a similar effect to 20–25 mg of spironolactone.[4] This activity enhances sodium, chloride, and water excretion, while reducing the excretion of potassium, ammonium, and phosphate.[5] The similarity in chemical structure between drospirenone and spironolactone and the known association between spironolactone and hyperkalemia both strengthen the plausibility that clinically significant hyperkalemia might result from drospirenone use.” Medscape
“Drospirenone is the only progestin currently used in US combined oral contraceptives (COCs) that is not derived from 19-nortestosterone. Drospirenone is derived from 17α-spirolactone, making it unique among progestins (Figure 4). Spironolactone and drospirenone both exhibit antiandrogenic and antimineralocorticoid activity, but only drospirenone has progestogenic activity.” Medscape
Topics to review
Contraception
Misoprostol (Cytotec), Oxytocin (Pitocin), Methylergonovine, and Carboprost are used for uterine atony and postpartum hemorrhage.
Carboprost should not be used in patients with asthma.
Methylergonovine shouldn’t be used in patients with Hypertension.
| Patients with a history of Migraines with aura should NEVER be put on OCPs. It’s an unacceptable health risk. | |