4th. August July 2022.
|
40 |
Role-play. VBAC. |
|
41 |
EMQ. Cytomegalovirus and Pregnancy |
|
42 |
EMQ. WOMAN trial |
|
43 |
EMQ. Relugolix |
Candidate’s
instructions.
You are a 5th.
year SpR in the antenatal clinic. The midwives have asked you to see Maria
Shufflebottom who has recently moved to the area. She is 36 weeks advanced in
her second pregnancy. Her first baby was delivered by elective Caesarean section
for breech presentation and she wishes an elective C section.
The midwives report
that the history and findings are normal apart from the Cs. Your instructions
are to deal with the patient as you would in your antenatal clinic.
41. Cytomegalovirus infection and pregnancy.
Abbreviations.
AI: avidity index.
CMV: cytomegalovirus.
CNS: central nervous system.
FGR: fetal growth restriction.
HIG: hyperimmunoglobulin.
IUFD: intrauterine
fetal death.
Scenario
1.
What does the term
“cytomegalovirus” mean?
Option list.
|
A |
it is an unusually
large virus |
|
B |
it is the largest
known virus |
|
C |
the viral
cytoplasm is increased in volume |
|
D |
infected cells
are enlarged and have enlarged nuclei |
|
E |
none of the
above |
Scenario
2.
Which of the following
terms is used in relation to CMV infected cells?
Option list.
|
A |
almond-eyed |
|
B |
apple of my eye |
|
C |
cross-eyed |
|
D |
doe-eyed |
|
E |
owl-eyed |
Scenario
3.
Which family of
viruses does CMV belong to?
Option list.
|
A |
Adenoviridae |
|
B |
Arachnoviridae |
|
C |
Enteroviridae |
|
D |
Herpesviridae |
|
E |
Poxviridae |
Scenario
4.
What kind of virus
is CMV?
Option list.
|
A |
bacteriophage |
|
B |
DNA virus |
|
C |
RNA virus |
|
D |
none of the above |
Scenario
5.
What is the structure
of the herpes virus?
Option list.
|
A |
double-stranded
DNA core, surrounded by three layers: capsid, tegument and envelope |
|
B |
single-stranded
DNA core, surrounded by two layers: capsid and envelope |
|
C |
double-stranded
RNA core, surrounded by three layers: capsid, tegument and envelope |
|
D |
single-stranded
RNA core, surrounded by two layers: capsid and envelope |
|
E |
none of the
above |
Scenario
6.
How many herpes
viruses have been described?
Option list.
|
A |
>1,000 |
|
B |
> 500 |
|
C |
> 250 |
|
D |
> 100 |
|
E |
none of the above. |
Scenario
7.
How many herpes viruses
are of relevance to human infection?
Option list.
|
A |
8 |
|
B |
10 |
|
C |
12 |
|
D |
14 |
|
E |
20 |
Scenario
8.
Write the list of
herpes viruses which affect humans and the conditions they cause?
Option list. There is none. You have to write your own list.
Scenario 9.
Where does CMV rank
in the list of the most common causes of congenital viral infection?
Option list.
|
A |
1 |
|
B |
2 |
|
C |
3 |
|
D |
4 |
|
E |
5 |
Scenario
10.
Which of the following
statements is the most accurate in relation to CMV?
Option list.
|
A |
CMV can lie
dormant after 1ry. infection, usually in bone marrow |
|
B |
CMV can lie
dormant after 1ry. infection, usually in dorsal root ganglia |
|
C |
CMV can lie dormant
after 1ry. infection, usually in the lungs |
|
D |
CMV can lie
dormant after 1ry. infection, usually in the salivary glands |
|
E |
CMV does not
lie dormant after 1ry. infection |
Scenario
11.
Which, if any, of
the following statements is true of CMV & pregnancy in the UK?
Option list.
|
A |
approximately
10-20% of women are immune before their 1st. pregnancy |
|
B |
approximately 20-30%
of women are immune before their 1st. pregnancy |
|
C |
approximately 30-50%
of women are immune before their 1st. pregnancy |
|
D |
approximately 40-60%
of women are immune before their 1st. pregnancy |
|
E |
none of the above |
Scenario 12.
Which of the following
statements is true in relation to vertical transmission?
Option list.
|
A |
it is mainly
transplacental |
|
B |
it is mainly
due to feto-maternal haemorrhage |
|
C |
it mainly
occurs during labour and delivery |
|
D |
it mainly occurs
during lactation |
|
E |
none of the
above |
Scenario
13.
What is the approximate
incidence of 1ry. CMV infection in pregnancy?
Option list.
|
A |
< 1% |
|
B |
< 5% |
|
C |
< 7.5% |
|
D |
< 10% |
|
E |
≥ 10% |
Scenario
14.
What is the biggest
source of CMV infection for women of reproductive age?
Option list.
|
A |
contaminated
food or water |
|
B |
blood transfusion |
|
C |
infected sexual
partner |
|
D |
infected small
children |
|
E |
undercooked
meat, particularly pork |
Scenario
15.
What proportion of
1ry. maternal CMV infection in pregnancy is asymptomatic?
Option list.
|
A |
up to 10% |
|
B |
11 – 29% |
|
C |
30 – 49% |
|
D |
50 – 79% |
|
E |
80 – 89% |
|
F |
≥ 90% |
Scenario
16.
What is the approximate
prevalence of CMV infection in UK neonates?
Option list.
|
A |
0.10- 0.25% |
|
B |
0.10- 0.50% |
|
C |
0.20- 0.50% |
|
D |
0.20- 1.00% |
|
E |
0.20- 2.25% |
Scenario
17.
Where does CMV rank
in the non-genetic causes of SNHL in children?
Option list.
|
A |
1 |
|
B |
2 |
|
C |
3 |
|
D |
4 |
|
E |
none of the
above |
Scenario 18.
When does vertical
transmission carry the greatest risk of inflicting neurological damage on the
fetus?
Option list.
|
A |
with 1ry
infection during the 1st. trimester |
|
B |
with 2ry
infection during the 1st. trimester |
|
C |
with 1ry infection
during the 2nd. trimester |
|
D |
with 2ry
infection during the 2nd. trimester |
|
E |
with 1ry
infection during the 3rd. trimester |
|
F |
with 2ry
infection during the 3rd. trimester |
|
G |
with 1ry
infection during labour / delivery |
|
H |
with 2ry infection
during labour / delivery |
|
I |
none of the
above |
Scenario 19.
What is the risk
of vertical transmission after CMV infection in the immediate preconception
period?
Option list.
|
A |
< 1% |
|
B |
1-5% |
|
C |
6-10% |
|
D |
11-15% |
|
E |
16-20% |
|
F |
21-30% |
Scenario 20.
A fetus is
infected with CMV at the time of highest risk for neurological damage. What is
the approximate upper limit for the risk that the child will have neurological
damage?
Option list.
|
A |
up to 1% |
|
B |
up to 5% |
|
C |
up to 7.5% |
|
D |
up to 10% |
|
E |
up to 12.5% |
|
F |
up to 15% |
|
G |
up to 20% |
|
H |
none of the
above |
Scenario
21.
Approximately what
% of cerebral palsy is thought attributable to fetal CMV?
Option list.
|
A |
1% |
|
B |
5% |
|
C |
7.5% |
|
D |
10% |
|
E |
12.5% |
|
F |
15% |
|
G |
20% |
|
H |
25% |
Scenario
22.
Approximately what
% of SNHL is thought attributable to fetal CMV infection?
Option list.
|
A |
1% |
|
B |
5% |
|
C |
7.5% |
|
D |
10% |
|
E |
12.5% |
|
F |
15% |
|
G |
20% |
|
H |
25% |
Scenario
23.
Which, if any, of
the following statements is true of CMV?
Option list.
|
A |
1ry. infection
is followed by life-long latent infection |
|
B |
1ry. infection
is followed by life-long latent infection in a minority of cases |
|
C |
life-long
latent infection is characteristic of CMV but not other herpes viruses |
|
D |
life-long latent
infection only occurs after 2ry. infection |
|
E |
none of the
above. |
Scenario
24.
How is 1ry.
maternal CMV infection best diagnosed?
Option list.
|
A |
by the regional
laboratory |
|
B |
IgM to IgG conversion |
|
C |
presence of IgM
with low avidity IgG |
|
D |
religious
conversion |
|
E |
sero-conversion
from IgG -ve to IgG +ve |
Scenario
25.
Which, if any, of the
following is true in relation to ‘avidity’ in CMV infection?
Option list.
|
A |
avidity
declines directly with the interval from 1ry infection to the test |
|
B |
avidity is an indirect
measure of viral load |
|
C |
avidity measures
the determination of the obstetrician to make a diagnosis |
|
D |
avidity measures
the enthusiasm of the laboratory for maximising the cost of testing |
|
E |
avidity
measures the strength of binding of CMV antibody to the virus |
Scenario
26.
Which, if any, of
the following is true in relation to the CMV ‘avidity index’?
Option list.
|
A |
the AI is the
ratio of free: albumin-bound CMV IgG in maternal serum |
|
B |
the AI is the
IgG antibody titre in maternal serum |
|
C |
the AI is the percentage
of IgG that is bound to the antigen |
|
D |
the AI is the
amount of IgG bound to the antigen expressed as micrograms / gram |
|
E |
none of the above |
Scenario
27.
Which, if any, of
the following is true in relation to the CMV ‘avidity index’?
Option list.
|
A |
an AI < 30
is indicative of old infection |
|
B |
an AI < 30
is indicative of recent 1ry infection |
|
C |
an AI < 30 suggests
a faulty assay |
|
D |
the AI assay
used in the NHS is standard across all laboratories |
|
E |
none of the
above |
Scenario
28.
Which, if any, of the following statements is true in
relation to identifying women at greatest risk of having a baby with severe congenital
infection?
Option list.
|
A |
a low AI < 18
weeks indicates high risk |
|
B |
a high AI <
18 weeks indicates high risk |
|
C |
a high IgM
titre indicates low risk |
|
D |
a high IgG
titre indicates high risk |
|
E |
none of the
above |
Scenario
29.
What is UK policy
in relation to routine screening for CMV in pregnancy?
Option list.
|
A |
routine
screening was introduced in 2018 |
|
B |
routine
screening is not advocated because of cost |
|
C |
routine
screening is not advocated because of the lack of an accurate test |
|
D |
routine
screening is not advocated because of cross-reaction with EBV |
|
E |
none of the
above |
Scenario
30.
What is UK policy
in relation to routine screening of the neonate for CMV?
Option list.
|
A |
routine
screening was introduced in 2015 |
|
B |
routine screening
is not advocated because of cost |
|
C |
routine screening
is not advocated because of the lack of an accurate test |
|
D |
routine
screening is not advocated because of cross-reaction with EBV |
|
E |
none of the
above |
Scenario
31.
Pick the true statements
from the list below.
Option list.
|
A |
avidity testing is not done on CMV IgM antibodies |
|
B |
CMV IgG is a maverick and does not play by
the usual rules |
|
C |
CMV IgM is a maverick and does not play by
the usual rules |
|
D |
CMV IgG persists for many years |
|
E |
CMV IgM persists for 1 year or more |
|
F |
none of the above |
Scenario 32.
A woman has been
shown to have had CMV infection in pregnancy. It is decided to check for
evidence of fetal infection. What does SIP56 say is the mainstay of diagnosing
fetal CMV infection.?
Option list.
|
A |
amniocentesis
and PCR for evidence of CMV |
|
B |
amniocentesis
and electron microscopy for evidence of CMV |
|
C |
amniocentesis
and light microscopy for evidence of CMV |
|
D |
amniocentesis
and viral culture |
|
E |
MRI |
|
F |
ultrasound –
abdominal |
|
G |
ultrasound - transvaginal |
Scenario 33.
A woman has been shown
to have had CMV infection in pregnancy. Which, if any of the following
statements best describe the role of MRI scanning in assessing the fetus? This
is not a true EMQ as more than one statement may be true.
Option list.
|
A |
it should be
offered in conjunction with ultrasound |
|
B |
it should be
offered if ultrasound examination suggests fetal infection |
|
C |
it should be
offered if ultrasound examination does not suggest fetal infection |
|
D |
it should be
offered if there is sufficient funding to pay for it |
|
E |
the role of MRI
scanning is not yet clear |
|
F |
none of the
above |
Scenario
34.
A pregnant woman
is HIV+ve? Which of the following statements is true?
Option list.
|
A |
the risk of
vertical transmission in pregnancy is ↑ |
|
B |
the risk of
vertical transmission in pregnancy is ↓ |
|
C |
the risk of
vertical transmission in pregnancy is the same as in HIV-ve women |
Scenario
35.
A pregnant woman
is HIV+ve? Which of the following statements is true?
Option list.
|
A |
her neonate is
at ↑ risk of acquiring CMV perinatally |
|
B |
her neonate is
at ↓ risk of acquiring CMV perinatally |
|
C |
her neonate is
at normal risk of acquiring CMV perinatally |
|
D |
none of the
above |
Scenario 36.
A pregnant woman
is HIV+ve? Her neonate is +ve for both CMV and HIV. Which of the following
statements is true?
Option list.
|
A |
the child has a
↓
risk of HIV progression and ↓ risk of CNS damage from CMV |
|
B |
the child has a
↓
risk of HIV progression and ↑ risk of CNS damage from CMV |
|
C |
the child has a
↓
risk of HIV progression and normal risk of CNS damage from CMV |
|
D |
the child has an
↑
risk of HIV progression and ↓ risk CNS damage from CMV |
|
E |
the child has an
↑
risk of HIV progression and ↑ risk CNS damage from CMV |
|
F |
the child has
an ↑ risk of HIV progression and normal risk of CNS
damage from CMV |
|
G |
the child has a
normal risk of HIV progression and ↓ risk of CNS damage from CMV |
|
H |
the child has a
normal risk of HIV progression ↑ risk of CNS damage from CMV |
|
I |
the child has a
normal risk of both HIV progression and CNS damage from CMV |
Scenario 37.
Which of the following
treatments in pregnancy is of proven efficacy and safety in reducing the risk
of vertical transmission to the fetus?
Option list.
|
A |
acyclovir |
|
B |
CMV vaccine |
|
C |
ganciclovir |
|
D |
HIG |
|
E |
valaciclovir |
|
F |
none of the above |
TOG CPD
Comprehensive review and update of
cytomegalovirus infection in pregnancy
Regarding cytomegalovirus (CMV),
1. it is a double-stranded RNA herpes virus. True False
2. it is the commonest congenital viral infection in
the developed world. True False
3. prevalence is most common in social class V. True False
Regarding CMV morbidity,
4. it is the leading genetic cause of
sensorineural deafness. True False
5. maternal infection occurring in the third
trimester carries the highest risk to the
fetus. True False
6. previous infection confers complete future
immunity to the mother. True False
Regarding feto-maternal transmission of CMV,
7. there is good evidence to suggest that
gestational age has no apparent influence on
risk of transmission. True False
8. breastfeeding is a route of transmission. True False
9. for healthy mature babies, an infection with
the CMV through breastmilk does not pose
significant danger. True False
10. transmission can be reduced by appropriate
hand washing after nappy changes and
exposure to bodily fluids, avoiding kissing
young children on mouth and cheeks and by
avoiding sharing food, drinks or utensils with
young children. True False
11. primary infection, reactivation and reinfection
with different CMV strains during pregnancy
has been shown to lead to congenital CMV. True False
Regarding maternal CMV in pregnancy,
12. diagnosis of maternal CMV based on
symptoms is reliable with over 70% of women
presenting with classic symptoms. True False
13. viral reactivation is more common in HIV
positive pregnant women. True False
Regarding diagnosis of CMV infection in pregnancy,
14. seroconversion of CMV specific
immunoglobulin G (IgG) in paired acute and
convalescent sera is diagnostic of a new
acute infection. True False
15. When prepregnancy status is unknown,
detection of immunoglobulin M (IgM)-
specific antibody is diagnostic of
primary infection. True False
16. IgM serology is imprecise for determining
primary infection as it has been shown to
remain positive for up to a year following
acute infection. True False
17. The presence of IgG and IgM CMV antibodies
with low CMV antibody avidity is diagnostic
of primary infection. True False
Concerning congenital CMV infection,
18. 85% are asymptomatic at birth. True False
19. 30% of affected infants will develop
neurological sequelae. True False
20. 15% of infants born to mothers with recurrent
CMV infection are overtly symptomatic. True False
Comprehensive review and update of cytomegalovirus infection
in pregnancy.
These derive from the TOG article by Navti et al. The
article is from 2016 and is open-access.
TOG. Volume 18, Issue 4 October 2016 Pages
301–7.
Some of the questions are badly written – I would expect exam
questions to be better.
Regarding cytomegalovirus (CMV),
1. it
is a double-stranded RNA herpes virus. True False
2. it
is the commonest congenital viral infection in the developed world. True False.
3. prevalence
is most common in social class V. True False
Regarding CMV
morbidity,
4.
it is the leading genetic cause of sensorineural deafness. True False
5. maternal
infection occurring in the 3rd. trimester carries the highest risk
to the fetus. True False
6. previous
infection confers complete future immunity to the mother. True False
Regarding
feto-maternal transmission of CMV,
7. there
is good evidence to suggest that gestational age has no apparent influence on
risk of transmission. True False
8. breastfeeding
is a route of transmission. True False
9. for
healthy mature babies, an infection with the CMV through breastmilk does not
pose significant danger. True False
10. transmission
can be reduced by appropriate hand washing after nappy changes and exposure to
bodily fluids, avoiding kissing young children on mouth and cheeks and by
avoiding sharing food, drinks or utensils with young children. True False
11. primary
infection, reactivation and reinfection with different CMV strains during
pregnancy has been shown to lead to congenital CMV. True Fal
Regarding maternal
CMV in pregnancy,
12. diagnosis
of maternal CMV based on symptoms is reliable with over 70% of women presenting
with classic symptoms. True False
13. viral
reactivation is more common in HIV positive pregnant women. True False
Regarding diagnosis
of CMV infection in pregnancy,
14. seroconversion
of CMV specific immunoglobulin G (IgG) in paired acute and convalescent sera is
diagnostic of a new acute infection. True False
15. When
prepregnancy status is unknown, detection of immunoglobulin M (IgM)- specific
antibody is diagnostic of primary infection. True False
16. IgM
serology is imprecise for determining primary infection as it has been shown to
remain positive for up to a year following acute infection. True
17. The
presence of IgG and IgM CMV antibodies with low CMV antibody avidity is
diagnostic of primary infection. True False
Concerning
congenital CMV infection,
18. 85%
are asymptomatic at birth. True False
19. 30%
of affected infants will develop neurological sequelae. True False
20. 15%
of infants born to mothers with recurrent CMV infection are overtly symptomatic.
True False
42. WOMAN Trial.
Question 1.
What does the
acronym “WOMAN” mean? There is no option list.
Question 2.
Which condition
and drug were the subjects of the trial?.
Question 3.
What were the main
outcomes of the trial?
Question 4.
Which, if any, of
the following were in the WHO’s response to the outcomes?
Option list.
|
D |
the drug to be stored
at room temperature |
|
A |
the drug to be
used for all pregnant women |
|
B |
the drug to be
used prophylactically |
|
C |
the drug to be
used orally |
|
F |
the drug to be
used within 6 hours |
|
E |
drug manufacturers
to be asked to reduce the cost to facilitate use in developing countries |
Question 5.
Which, if any, of
the following are true about the WOMAN-2 trial?
Option list.
|
D |
the trial does
not exist |
|
A |
the drug to be
used for all pregnant women |
|
B |
the drug to be
used prophylactically |
|
C |
the drug to be
used intravenously |
|
F |
the drug to be
used within 6 hours |
|
E |
hysterectomy will
be included in the outcomes |
43. Relugolix.
Abbreviations.
DEXA: dual-energy
x-ray absorptiometry for bone density.
RON: relugolix + oestradiol
+ norethisterone
Question 1.
Which, if
any, of the following are correct about relugolix?
Option list.
|
A |
it is a FSH
agonist |
|
B |
it is a FSH
antagonist |
|
C |
it is a GnRH
agonist |
|
D |
it is a GnRH antagonist |
|
E |
is an oestrogen
receptor modulator |
|
F |
is a
progestogen receptor modulator |
Question 2.
Which, if
any, of the following are true about the preparation recommended by NICE
for the use of relugolix in gynaecology?
Option list.
|
A |
it contains
relugolix as the only active component |
|
B |
it contains relugolix and ibuprofen |
|
C |
it contains
relugolix with ethinylestradiol and desogestrel |
|
D |
it contains relugolix
with oestradiol and norethisterone |
|
E |
it is administered
intramuscularly |
|
F |
it is
administered orally |
|
G |
it is
administered nasally as a spray |
|
H |
it is
administered subcutaneously |
|
I |
it is
administered daily |
|
J |
it is
administered monthly |
|
K |
it is
administered three-monthly |
|
L |
it is in the
form of a rod which can be removed easily |
|
M |
the proprietary
preparation in called ‘Ryegg’ |
|
N |
the proprietary
preparation in called ‘Ryego’ |
|
O |
the proprietary
preparation in called ‘Wryegg’ |
|
P |
the proprietary
preparation in called ‘Wryego’ |
Question 3.
Which, if any, of
the following were described by NICE as proven benefits from the use
of RON?
Option list.
|
A |
↓ menstrual bleeding compared
with GnRH agonists |
|
B |
↓ menstrual bleeding compared
with placebo |
|
C |
↓ size
of fibroids compared with GnRH
agonists |
|
D |
↓ size of fibroids
compared with placebo |
|
E |
↓ rate of expulsion of
submucous fibroids compared with GnRH agonists |
|
F |
↓ rate of expulsion of
submucous fibroids compared with placebo |
Question 4.
Which, if any, of
the following are described by NICE as likely benefits from the use of
relugolix preparation available in the UK?
Option list.
|
A |
is effective
long-term |
|
B |
is safe long-term |
|
C |
is well-tolerated |
|
D |
has no adverse
effect on fertility |
|
E |
↓ the risk of breast
cancer |
|
F |
↓ the
risk of cervical cancer |
|
G |
↓ the risk of endometrial cancer |
Question 5.
For which of the
following is the UK relugolix preparation licensed?
Option list.
|
A |
breast cancer |
|
B |
cervical cancer |
|
C |
endometrial
cancer |
|
D |
ovarian cancer |
|
E |
prostate cancer |
|
F |
endometriosis |
|
G |
fibroids |
|
H |
premenstrual
syndrome |
|
I |
puerperal
psychosis |
preparation
available in the UK?
Option list.
|
A |
asthma |
|
B |
breast cancer |
|
C |
breastfeeding |
|
D |
osteoporosis |
|
E |
protein C deficiency |
|
F |
von Willebrand’s disease |
Question 7.
Which, if any, of
the following are listed as side-effects by the manufacturer?
Option list.
|
A |
acne |
|
B |
alopecia |
|
C |
angina |
|
D |
anxiety |
|
E |
asthma |
|
F |
breast
cysts |
|
G |
breast
pain |
|
H |
depression |
|
I |
dyspepsia |
|
J |
expulsion
of fibroid |
|
K |
hot
flushes |
|
L |
hyperhidrosis |
|
M |
night
sweats |
|
N |
red
degeneration of fibroid |
|
O |
reduced
libido |
|
P |
uterine
bleeding |
Question 8.
Which, if any, of
the following are correct in relation to contraception with RON?
Option list.
|
A |
barrier methods
are recommended |
|
B |
depot and
implant progestogens are recommended |
|
C |
IUDs are
recommended |
|
D |
combined oral
contraception is contraindicated |
|
E |
RON provides
adequate contraception, but additional contraception should be used for 3/12 |
|
F |
RON may delay
recognition of an unplanned pregnancy |
Question 9.
Which, if any, of
the following are advised prior to prescribing RON?
Option list.
|
A |
clotting screen |
|
B |
DEXA scan |
|
C |
endometrial
histology |
|
D |
full blood
count |
|
E |
liver function
tests |
|
F |
pregnancy test |
|
G |
thyroid
function tests |
Question 10.
Which, if any, of
the following are true in relation to the potential for the preparation
available in the UK to react adversely with other drugs?
Option list.
|
A |
use with P-glycoprotein inhibitors is not recommended |
|
B |
use with CYP3A4
inducers in not recommended |
|
C |
use with
penicillin in not recommended |
|
D |
use with
aspitin is not recommended |
|
E |
use with St John’s
wort is not recommended |
Question 11.
What advice should
be given after missed pills?
Option list.
|
A |
non-hormonal
contraception for 7 days after 1 missed pill |
|
B |
non-hormonal
contraception for 10 days after 1 missed
pill |
|
C |
non-hormonal
contraception for 14 days after 1 missed
pill |
|
D |
non-hormonal
contraception for 7 days after 2 consecutive missed pills |
|
E |
non-hormonal
contraception for 10 days after 2 consecutive
missed pills |
|
F |
non-hormonal
contraception for 14 days after 2 consecutive
missed pills |
|
G |
non-hormonal
contraception for 7 days after ≥ 3 consecutive missed pills |
|
H |
non-hormonal
contraception for 10 days after ≥
3 consecutive missed pills |
|
I |
non-hormonal
contraception for 14 days after ≥
3 consecutive missed pills |
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