Women’s Health Exam 2 Review UPDATED ACTUAL
Questions and CORRECT Answers
Preconception Period - 3-4 months prior to conception (egg and sperm maturation)
Goal: optimize maternal/paternal health to improve pregnancy outcomes
Key clinician questions: "if this woman became pregnant today, would I expect
a health pregnancy?"
PATH model Primary and follow-up questions
Assess: Knowledge of fertility and conception
Support systems
Lifestyle & behavioral risks
Note: 40% of women unaware of ovulation cycle
Lifestyle & Behavioral Factors Nutrition: Mediterranean diet (vegetables, fruits, whole grains, plan proteins,
healthy fats)
Folate (B9): DNA replication, reduces NTDs, miscarriage, preterm birth;
sources: leafy greens, citrus, liver, avocado
Exercise: 150 min/week moderate-vigorous; avoid extremes (low weight,
excessive exercise)
Stress management: mindfulness, social support
Environmental exposures: avoid toxins, promote fresh foods, outdoor activity
Substance use: avoid tobacco, alcohol, marijuana, opioids
Preventative health Immunizations: ensure up-to-date, especially on live vaccines that cannot be
given during pregnancy
Dental Care: periodontal disease increases preterm birth & low birth weight
Genetic & Infection risk Carrier screening: CF, SMA, Tay-sachs, Canavan, Fragile X,
hemoglobinopathies, familial dysautonomia
STIs & Zika: Screen & prevent, untreated STIs increase infertility and risk of
preterm birth
Health conditions impacting Fertility Obesity >30 BMI: increased infertility, miscarriage; manage with
diet/exercise/surgery/other interventions
HTN & DM: Increased risk for preeclampsia, preterm birth, neonatal
complications
PCOS: leading cause of infertility
Thyroid disease: untreated can increase risk of miscarriage, preeclampsia
Seizure disorders: review anti-epileptic meds
Thrombophilia & HIV: increased pregnancy complications
Mental health: screen & manage; consider psychotropic med effects
Perinatal History Interpregnancy interval: optimal 18-60 months
Past complications: preterm birth, miscarriage, c/s, GDM, PreE, VTE increases
future risk
NTD history: 4 mg folic acid if previous pregnancy affected
Male partner health: lifestyle, chronic conditions, medications, fertility
, 70% of US women: Sexually active but do not want pregnancy
Consistency of contraception MATTERS nonuse: 54% result unintended pregnancy
Inconsistent: 41% unintended pregnancy
Consistent: 5% unintended pregnancy
Efficacy vs Effectiveness Efficacy: perfect use
Effectiveness: real-world use
Tiered contraceptive Effectiveness 1. LARC (IUD, nexplanon), sterilization
2. OCPs, injection, patch, ring
3. Condoms, fertility awareness diaphragm, sponge
4. Withdrawal, spermicide
LARC - IUD- Hormonal LNG): thickens mucus, impairs implantation, may suppress
ovulation
- IUD- copper (Paragard): sterile inflammatory response, toxic to sperm, lasts
10-12 years, EC < or equal to 5 days
- Progestin Implant (Nexplanon): thickens cervical mucus, inhibits ovulation
variability, duration 3 years
Permanent Contraception Female: Tubal occlusion = 99% effective; post-reversal pregnancy 46-73%
Male: Vasectomy = 99.8% effective
Hormonal Methods Combined (estrogen + progestin): OCPs, patch, vaginal ring
Progestin-only: POP, injection, implant, LNG-IUD
OCPs
MOA: suppress ovulation, thicken cervical mucus, alter endometrium
Failure: perfect 0.3%, typical - 7%
Contraindications: age > or equal to 35, smoking >15/day, VTE, CVD, breast
cancer, uncontrolled DM/HTN, migraines with aura
Emergency Contraception Works up to 5 days post-UPI
MOA: prevent ovulation/fertilization, hostile endometrium
Options: Plan B (levonorgestrel), Ella (ulipristal), Copper IUD (99% effective)
Barrier & Physiologic Methods of Contraception Barrier: Condoms, diaphragm, cervical cap, sponge, spermicide (hormone-
free, STI protection)
Physiologic: abstinence, withdrawal, LAM (<6 months exclusive BF), FABM
Unintended pregnancy Scope: 6.6 million/year in U.S., 45% unintended (highest in 18-24 y/o, unmarried,
minorities, lower education)
Outcomes: 40% abortion, <1% adoption
Risks: later entry to prenatal care, anxiety/depression, DV risk, low birth weight,
developmental delays
Causes: individual knowledge deficit about conception/contraception,
interpersonal (partner/family), societal (access, cost, forced sex)
Professional Guidance: compassionate, non-judgmental, support patient
autonomy
Management of unintended pregnancy Prevention: education, contraception options/education
Diagnosis: urine HCG (-14 days post fertilization), serum HCG (-8-10 days)
Counseling: nondirective, confidential, explore options (abortion, adoption,
parenting)
Questions and CORRECT Answers
Preconception Period - 3-4 months prior to conception (egg and sperm maturation)
Goal: optimize maternal/paternal health to improve pregnancy outcomes
Key clinician questions: "if this woman became pregnant today, would I expect
a health pregnancy?"
PATH model Primary and follow-up questions
Assess: Knowledge of fertility and conception
Support systems
Lifestyle & behavioral risks
Note: 40% of women unaware of ovulation cycle
Lifestyle & Behavioral Factors Nutrition: Mediterranean diet (vegetables, fruits, whole grains, plan proteins,
healthy fats)
Folate (B9): DNA replication, reduces NTDs, miscarriage, preterm birth;
sources: leafy greens, citrus, liver, avocado
Exercise: 150 min/week moderate-vigorous; avoid extremes (low weight,
excessive exercise)
Stress management: mindfulness, social support
Environmental exposures: avoid toxins, promote fresh foods, outdoor activity
Substance use: avoid tobacco, alcohol, marijuana, opioids
Preventative health Immunizations: ensure up-to-date, especially on live vaccines that cannot be
given during pregnancy
Dental Care: periodontal disease increases preterm birth & low birth weight
Genetic & Infection risk Carrier screening: CF, SMA, Tay-sachs, Canavan, Fragile X,
hemoglobinopathies, familial dysautonomia
STIs & Zika: Screen & prevent, untreated STIs increase infertility and risk of
preterm birth
Health conditions impacting Fertility Obesity >30 BMI: increased infertility, miscarriage; manage with
diet/exercise/surgery/other interventions
HTN & DM: Increased risk for preeclampsia, preterm birth, neonatal
complications
PCOS: leading cause of infertility
Thyroid disease: untreated can increase risk of miscarriage, preeclampsia
Seizure disorders: review anti-epileptic meds
Thrombophilia & HIV: increased pregnancy complications
Mental health: screen & manage; consider psychotropic med effects
Perinatal History Interpregnancy interval: optimal 18-60 months
Past complications: preterm birth, miscarriage, c/s, GDM, PreE, VTE increases
future risk
NTD history: 4 mg folic acid if previous pregnancy affected
Male partner health: lifestyle, chronic conditions, medications, fertility
, 70% of US women: Sexually active but do not want pregnancy
Consistency of contraception MATTERS nonuse: 54% result unintended pregnancy
Inconsistent: 41% unintended pregnancy
Consistent: 5% unintended pregnancy
Efficacy vs Effectiveness Efficacy: perfect use
Effectiveness: real-world use
Tiered contraceptive Effectiveness 1. LARC (IUD, nexplanon), sterilization
2. OCPs, injection, patch, ring
3. Condoms, fertility awareness diaphragm, sponge
4. Withdrawal, spermicide
LARC - IUD- Hormonal LNG): thickens mucus, impairs implantation, may suppress
ovulation
- IUD- copper (Paragard): sterile inflammatory response, toxic to sperm, lasts
10-12 years, EC < or equal to 5 days
- Progestin Implant (Nexplanon): thickens cervical mucus, inhibits ovulation
variability, duration 3 years
Permanent Contraception Female: Tubal occlusion = 99% effective; post-reversal pregnancy 46-73%
Male: Vasectomy = 99.8% effective
Hormonal Methods Combined (estrogen + progestin): OCPs, patch, vaginal ring
Progestin-only: POP, injection, implant, LNG-IUD
OCPs
MOA: suppress ovulation, thicken cervical mucus, alter endometrium
Failure: perfect 0.3%, typical - 7%
Contraindications: age > or equal to 35, smoking >15/day, VTE, CVD, breast
cancer, uncontrolled DM/HTN, migraines with aura
Emergency Contraception Works up to 5 days post-UPI
MOA: prevent ovulation/fertilization, hostile endometrium
Options: Plan B (levonorgestrel), Ella (ulipristal), Copper IUD (99% effective)
Barrier & Physiologic Methods of Contraception Barrier: Condoms, diaphragm, cervical cap, sponge, spermicide (hormone-
free, STI protection)
Physiologic: abstinence, withdrawal, LAM (<6 months exclusive BF), FABM
Unintended pregnancy Scope: 6.6 million/year in U.S., 45% unintended (highest in 18-24 y/o, unmarried,
minorities, lower education)
Outcomes: 40% abortion, <1% adoption
Risks: later entry to prenatal care, anxiety/depression, DV risk, low birth weight,
developmental delays
Causes: individual knowledge deficit about conception/contraception,
interpersonal (partner/family), societal (access, cost, forced sex)
Professional Guidance: compassionate, non-judgmental, support patient
autonomy
Management of unintended pregnancy Prevention: education, contraception options/education
Diagnosis: urine HCG (-14 days post fertilization), serum HCG (-8-10 days)
Counseling: nondirective, confidential, explore options (abortion, adoption,
parenting)
