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Chapter 36: Prenatal and Obstetric Care

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    AMA Citation
    Prenatal and Obstetric Care. In: David JA. David J.A.(Ed.),Ed. Jacob A. David.eds. CURRENT Practice Guidelines in Primary Care 2020. McGraw-Hill; Accessed July 12, 2020. https://accessmedicine.mhmedical.com/content.aspx?bookid=2866&sectionid=246306119
    APA Citation
    Prenatal and obstetric care. David JA. David J.A.(Ed.),Ed. Jacob A. David. (2020). CURRENT Practice Guidelines in Primary Care 2020. McGraw-Hill. https://accessmedicine.mhmedical.com/content.aspx?bookid=2866&sectionid=246306119
    MLA Citation
    "Prenatal and Obstetric Care." CURRENT Practice Guidelines in Primary Care 2020 David JA. David J.A.(Ed.),Ed. Jacob A. David. McGraw-Hill, 2020, https://accessmedicine.mhmedical.com/content.aspx?bookid=2866&sectionid=246306119.

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ABORTION

Population

  • Women with incomplete abortion.

Recommendations

WHO 2018

  • Offer surgical or medical management vs. watchful waiting.

  • If patient <13-wk gestation elects medical management, give misoprostol 600 μg orally or 400 μg sublingually. Do not use vaginal misoprostol.

  • If patient ≥13-wk gestation elects medical management, give repeated doses of misoprostol 400 μg every 3 h sublingually, vaginally, or buccally.

Population

  • Women with intrauterine fetal demise between 14- and 28-wk gestation.

Recommendation

WHO 2018

  • Offer surgical or medical management vs. watchful waiting.

  • If patient elects medical management, give 200-mg mifepristone orally; 1–2 d later, give 400-μg misoprostol sublingually or vaginally, and repeat every 4–6 h. If mifepristone is not available or not preferred by the patient, give misoprostol 400 μg every 4–6 h as the initial treatment.

Population

  • Women who elect to induce an abortion.

Recommendations

WHO 2018

  • Options include vacuum aspiration (manual or electric), dilation, and evacuation or medical management.

  • For medical abortion, give mifepristone 200 mg once as initial dose. At least 24 h later, give misoprostol vaginally, sublingually, or buccally. If <12-wk gestation, use 800 μg. If ≥12-wk gestation give 400 μg. If mifepristone is not available, use misoprostol as initial dose.

Source

  • Medical Management of Abortion. Geneva: World Health Organization; 2018. License: CC BY-NC-SA 3.0 IGO.

CONTRACEPTION

View Table|Favorite Table|Download (.pdf)

PERCENTAGE OF WOMEN EXPERIENCING AN UNINTENDED PREGNANCY WITHIN THE FIRST YEAR OF TYPICAL USE AND THE FIRST YEAR OF PERFECT USE AND THE PERCENTAGE CONTINUING USE AT THE END OF THE FIRST YEAR: UNITED STATES

% of Women Experiencing an Unintended Pregnancy Within the First Year of Use

Method

Typical Usea

Perfect Useb

Women Continuing Use at 1 Yc

Male sterilization

0.15

0.10

100

Female sterilization

0.5

0.5

100

Implanon

0.05

0.05

84

Intrauterine contraceptives

 

 

 

ParaGard (copper T)

0.8

0.6

78

Mirena (LNG-IUS)

0.2

0.2

80

Depo-Provera

3

0.3

56

NuvaRing

8

0.3

68

Evra patch

8

0.3

68

Combined pill and Progestin-only pill

8

0.3

68

Diaphragm

12

6

57

Condom

 

 

 

Female (fc)

21

5

49

Male

15

2

53

Sponge

 

 

 

Parous women

24

20

 

Nulliparous women

16

9

 

Withdrawal

22

4

46

Fertility awareness-based methods

24

 

47

Standard Days methode

 

5

 

Two-Day methode

 

4

 

Ovulation methode

 

3

 

Symptothermal methode

 

0.4

 

Spermicidesf

28

18

42

No methodg

85

85

 

Emergency Contraceptive Pills: Treatment with COCs initiated within 120 h after unprotected intercourse reduces the risk ...

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