1. Rhogam

-Given to all Rh neg women at 28 weeks, and and again immediately after delivery if baby is Rh positive (draw the baby's blood). 

-Give earlier than 28 weeks if there is blood-blood mixing (i.e. miscarriage)

2. Vaginal bleeding through a closed cervix happens in 20-40% of pregnancies, leads to spontaenous Ab half the time. 

-Worry about an ectopic. 

-Do u/s to look for viable fetus, check cervix-- if its open, abortion is inevitable, B-hcg to trend to follow progress. 

-For the next pregnancy, they can get a cerclage if incompetent cervix is the problem (no contractions before loss)

3. EC effectiveness (in descending order)

-Copper iud

-Ella (ulipristal)

-Plan b (1.5 mg levonorgestrel)

-Yuzpe method - 100 ug estrogen, 0.5 mg levonorgestrel, then another dose of the same 12 hours later. If you give the estrogen all at once, it can cause bad nausea and then the method fails. 

4. Contraindications for estrogen: 

-Smoking 10-15 cigarettes per day or more

-Personal hx of breast cancer within last 5 years is an absolute CI. Family history of breast cancer is not.

-Within 6 weeks of delivery, increased risk of DVT 2/2 increased estrogen. Wait 3 weeks in low risk women, 4 weeks if the woman is breast-feeding, 6 weeks in high risk women. 

-Hypertension (>160/100) 

-Migraine with true aura (seeing things, Neuro sx) 

Highly useful chart for determining relative and absolute CI to various methods of birth control by comborbidity
5. Soft contraindications for contraception: 
-Patch isn't effective in obese women, as the transdermal absorption is ineffective at some point
-Depo-provera shot can cause weight gain, so 

6. Pregnancy termination: 

-Chronic systemic corticosteroid use is a CI to mifepristone as the latter has some effect on adrenal cortex receptor and can interfere with steroid effects. 

-For d&c, you need to be N mm dilated for a pregnancy that is N weeks. 

7. Screening tests in sexually active teen female

-Hiv, gc/chlamydia, syphillis in high prevalence locations or high risk populations (men who have sex with men, ppl who have sex for drugs or $)

-Depression

-Intimate partner violence 

-Ask them if they wear a seat belt-- Wearing a seat belt is the single most predictive factor of risky behavior
8. Screening tests in sexually active teen male: 

-Males have the same tests as above, except they don't get gc/chlamydia because they are usually symptomatic and because the long-term consequences are not as severe for them. 

9. Easy pap generalization: 

-21 to 30 q3

-30 to 65 q5/hpv
10. Drinking something bitter (ex dandelion root tea) 30 minutes before a meal may improve digestion