Immunizations in pregnancy US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Immunizations in pregnancy. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Immunizations in pregnancy US Medical PG Question 1: A 21-year-old woman, gravida 1, para 0, at 39 weeks' gestation comes to the physician for a prenatal visit. She has some mild edema and tiredness but generally feels well. She recently had a nephew visiting for 1 week who became ill and was diagnosed with the chickenpox. She has no history of chickenpox and is not vaccinated against the varicella zoster virus. Current medications include folic acid supplements and a prenatal vitamin. Her temperature is 37°C (98.6°F), pulse is 82/min, respirations are 15/min, and blood pressure is 116/64 mm Hg. Pelvic examination shows a uterus consistent in size with 39 weeks' gestation. IgG antibody titers for varicella zoster virus are negative. Which of the following is the most appropriate next step in management?
- A. Reassurance
- B. Serial ultrasounds
- C. Varicella vaccine
- D. Varicella zoster immune globulin (Correct Answer)
- E. Ganciclovir therapy
Immunizations in pregnancy Explanation: ***Varicella zoster immune globulin***
- The patient has been exposed to **chickenpox** (via her nephew), has no history of the disease, and is **not vaccinated**, indicating she is susceptible. Her negative **IgG antibody titers** confirm her lack of immunity.
- Due to her **39 weeks' gestation**, there is a risk of severe maternal varicella and congenital varicella syndrome, making **varicella zoster immune globulin (VZIG)** an appropriate post-exposure prophylaxis to mitigate the severity of infection.
*Reassurance*
- Reassurance alone is insufficient given the patient's **non-immune status** and recent **exposure to varicella**, which places her and the fetus at risk.
- Varicella infection during pregnancy can lead to serious complications, including **congenital varicella syndrome** or **neonatal varicella**.
*Serial ultrasounds*
- While ultrasounds may be used to monitor for fetal complications if **maternal infection** occurs, they are not a prophylactic measure to prevent or reduce the severity of the infection itself.
- The immediate priority is to prevent or attenuate the infection after exposure in a **non-immune pregnant woman**.
*Varicella vaccine*
- The **live attenuated varicella vaccine** is **contraindicated** during pregnancy due to the theoretical risk of fetal infection.
- Vaccination should ideally occur **before pregnancy** or postpartum.
*Ganciclovir therapy*
- **Ganciclovir** is an antiviral medication primarily used for **cytomegalovirus (CMV)** infections and is generally not the first-line treatment for varicella, especially in a prophylactic setting.
- For varicella, **acyclovir** or **valacyclovir** might be considered for treatment of active infection, but VZIG is the recommended post-exposure prophylaxis in non-immune pregnant women.
Immunizations in pregnancy US Medical PG Question 2: A 23-year-old woman presents to her physician requesting the chickenpox vaccine. She is also complaining of nausea, malaise, and moderate weight gain. She developed these symptoms gradually over the past 2 weeks. She reports no respiratory or cardiovascular disorders. Her last menstruation was about 6 weeks ago. She has one sexual partner and uses a natural planning method for contraception. Her vital signs include: blood pressure 110/70 mm Hg, heart rate 92/min, respiratory rate 14/min, and temperature 37.2℃ (99℉). The physical examination shows non-painful breast engorgement and nipple hyperpigmentation. There is no neck enlargement and no palpable nodules in the thyroid gland. The urine beta-hCG is positive. What is the proper recommendation regarding chickenpox vaccination in this patient?
- A. Confirm pregnancy with serum beta-hCG and if positive delay administration of the vaccine until the third trimester.
- B. Perform varicella viral load and schedule the vaccine based on these results.
- C. Confirm pregnancy with serum beta-hCG and if positive, postpone administration of the vaccine until after completion of the pregnancy. (Correct Answer)
- D. Schedule the vaccination.
- E. Confirm pregnancy with serum beta-hCG and if positive, schedule the patient for pregnancy termination.
Immunizations in pregnancy Explanation: ***Confirm pregnancy with serum beta-hCG and if positive, postpone administration of the vaccine until after completion of the pregnancy.***
- The patient's symptoms (nausea, malaise, weight gain, breast engorgement, nipple hyperpigmentation, missed menses) and a **positive urine beta-hCG** are highly indicative of **pregnancy**.
- The **chickenpox vaccine (varicella vaccine)** is a **live attenuated vaccine**, which is **contraindicated in pregnancy** due to the theoretical risk of fetal infection and congenital varicella syndrome. Vaccination should be deferred until after delivery.
*Confirm pregnancy with serum beta-hCG and if positive delay administration of the vaccine until the third trimester.*
- While confirming pregnancy with **serum beta-hCG** is appropriate, delaying vaccination only until the **third trimester** is still inappropriate for a live attenuated vaccine.
- Live attenuated vaccines are generally **contraindicated throughout pregnancy** due to potential fetal risks.
*Perform varicella viral load and schedule the vaccine based on these results.*
- A **varicella viral load** test is used to detect active viral infections, not to determine immunity or the need for vaccination in an uninfected individual.
- The primary concern here is the patient's likely pregnancy, not current varicella infection status.
*Schedule the vaccination.*
- Given the strong suspicion of **pregnancy** and a **positive urine beta-hCG**, immediately scheduling a live attenuated vaccine like the chickenpox vaccine would be **medically inappropriate and potentially harmful** to the fetus.
- Vaccination must be deferred until pregnancy status is confirmed and, if positive, until after delivery.
*Confirm pregnancy with serum beta-hCG and if positive, schedule the patient for pregnancy termination.*
- A potential need for a chickenpox vaccine, even if the patient is pregnant, is not an indication for **pregnancy termination**.
- This option is ethically and medically unsound, as exposure to the varicella vaccine in pregnancy does not warrant termination.
Immunizations in pregnancy US Medical PG Question 3: A 40-year-old pregnant woman, G4 P3, visits your office at week 30 of gestation. She is very excited about her pregnancy and wants to be the healthiest she can be in preparation for labor and for her baby. What vaccination should she receive at this visit?
- A. Measles, mumps, and rubella (MMR)
- B. Varicella vaccine
- C. Herpes zoster vaccine
- D. Live attenuated influenza vaccine
- E. Tetanus, diphtheria, and acellular pertussis (Tdap) (Correct Answer)
Immunizations in pregnancy Explanation: ***Tetanus, diphtheria, and acellular pertussis (Tdap)***
- The Tdap vaccine is recommended during each pregnancy, preferably between **27 and 36 weeks of gestation**, to maximize maternal antibody response and passive antibody transfer to the fetus.
- This provides critical protection against **pertussis (whooping cough)** for the newborn, who is too young to be vaccinated.
*Measles, mumps, and rubella (MMR)*
- The **MMR vaccine is a live vaccine** and is **contraindicated during pregnancy** due to the theoretical risk of congenital rubella syndrome, although no cases have been reported.
- It should be administered **postpartum** if the mother is not immune to rubella.
*Varicella vaccine*
- The **varicella vaccine is a live vaccine** and is **contraindicated during pregnancy** due to the theoretical risk of congenital varicella syndrome.
- Like MMR, it should be offered in the **postpartum period** if the woman is not immune.
*Herpes zoster vaccine*
- The herpes zoster vaccine is typically recommended for **older adults** (50 years and older) for shingles prevention.
- It is **not routinely recommended during pregnancy**, and its safety and efficacy in this population have not been sufficiently established.
*Live attenuated influenza vaccine*
- The **live attenuated influenza vaccine (LAIV)** is **contraindicated during pregnancy** due to its live virus content.
- Pregnant women should receive the **inactivated influenza vaccine (IIV)**, which is safe and recommended during any trimester.
Immunizations in pregnancy US Medical PG Question 4: A 27-year-old G2P1 woman is diagnosed with an HIV infection after undergoing routine prenatal blood work testing. Her estimated gestational age by first-trimester ultrasound is 12 weeks. Her CD4 count is 150 cells/mm^3 and her viral load is 126,000 copies/mL. She denies experiencing any symptoms of HIV infection. Which of the following is appropriate management of this patient's pregnancy?
- A. HAART (Correct Answer)
- B. Breastfeeding
- C. Vaginal delivery
- D. HAART after delivery
- E. Avoidance of antibiotic prophylaxis
Immunizations in pregnancy Explanation: ***HAART***
- **Highly active antiretroviral therapy (HAART)** is recommended immediately for pregnant women with HIV, regardless of CD4 count or viral load, to reduce maternofetal transmission.
- Starting HAART early in pregnancy significantly lowers the **viral load**, protecting the fetus from HIV infection.
*Breastfeeding*
- **Breastfeeding** is contraindicated in HIV-positive mothers in developed countries because it carries a risk of HIV transmission to the infant.
- Formula feeding is recommended to prevent **postnatal HIV transmission**.
*Vaginal delivery*
- A **vaginal delivery** may be considered if the viral load is undetectable or very low (<1,000 copies/mL) at the time of delivery.
- Given this patient's **high viral load** (126,000 copies/mL), a scheduled cesarean section would be indicated to minimize the risk of perinatal transmission.
*HAART after delivery*
- Delaying **HAART until after delivery** would increase the risk of maternofetal HIV transmission during pregnancy and delivery.
- Prompt initiation of HAART is crucial for both maternal health and **fetal protection**.
*Avoidance of antibiotic prophylaxis*
- **Antibiotic prophylaxis** is commonly used in combination with antiretroviral agents to prevent opportunistic infections, especially when the **CD4 count is low** (<200 cells/mm³).
- Given a CD4 count of 150 cells/mm³, prophylaxis against opportunistic infections like **Pneumocystis jirovecii pneumonia** might be indicated, making avoidance inappropriate.
Immunizations in pregnancy US Medical PG Question 5: A 34-year-old woman, gravida 2, para 0, at 28 weeks' gestation comes to the physician for a prenatal visit. She has not had regular prenatal care. Her most recent ultrasound at 20 weeks of gestation confirmed accurate fetal dates and appropriate fetal development. She takes levothyroxine for hypothyroidism. She used to work as a nurse before she emigrated from Brazil 13 years ago. She lost her immunization records during the move and cannot recall all of her vaccinations. She appears well. Vital signs are within normal limits. Physical examination shows a fundal height of 26 cm and no abnormalities. An ELISA test for HIV is negative. Serology testing shows hepatitis B surface antibody positive, hepatitis B core antibody and surface antigen negative, and hepatitis A antibody negative. Hepatitis C antibody is positive with detectable RNA. Given her incomplete vaccination history and current serologic results, which of the following vaccinations is most appropriate to recommend at this time?
- A. Undergo liver biopsy
- B. Schedule a cesarean delivery
- C. Start combination therapy with interferon α and ribavirin
- D. Counsel about transmission risks and plan postpartum treatment
- E. Hepatitis A vaccination (Correct Answer)
Immunizations in pregnancy Explanation: ***Hepatitis A vaccination***
- The patient has no prior immunity to **Hepatitis A**, as indicated by the **negative Hepatitis A antibody** serology.
- Vaccination against **Hepatitis A** is crucial in this patient, especially given her increased risk of exposure due to being a former healthcare worker and a positive hepatitis C infection.
*Undergo liver biopsy*
- A **liver biopsy** is an invasive procedure and is generally not recommended during pregnancy, especially when other diagnostic or management strategies are available.
- While it can assess the degree of liver damage, it is usually reserved for specific indications and is not the most appropriate immediate step for vaccine recommendation.
*Schedule a cesarean delivery*
- **Hepatitis C viral transmission** to the fetus is primarily vertical during birth, but a **cesarean delivery** has not been shown to significantly reduce this risk compared to vaginal delivery.
- The decision regarding delivery method is typically made based on obstetric indications rather than solely for Hepatitis C prevention.
*Start combination therapy with interferon α and ribavirin*
- **Interferon α** and **ribavirin** are contraindicated during pregnancy due to their **teratogenic effects** and severe side effects.
- Antiviral treatment for Hepatitis C is generally deferred until **postpartum**.
*Counsel about transmission risks and plan postpartum treatment*
- While counseling about **transmission risks** and planning **postpartum treatment** for Hepatitis C is essential, it addresses the existing Hepatitis C infection rather than prescribing a vaccination, which is the direct question.
- It is an important part of comprehensive care for this patient but not the most appropriate *vaccination* recommendation.
Immunizations in pregnancy US Medical PG Question 6: A 34-year-old gravida 5, para 4 presents to the physician for prenatal care at 32 weeks of pregnancy. She comes from a rural region of Ethiopia and did not have appropriate prenatal care during previous pregnancies. She has no complaints of swelling, contractions, loss of fluid, or bleeding from the vagina. During her current pregnancy, she has received proper care and has completed the required laboratory and instrumental tests, which did not show any pathology. Her blood pressure is 130/70 mm Hg, heart rate is 77/min, respiratory rate is 15/min, and temperature is 36.6°C (97.8°F). Her examination is consistent with a normal 32-weeks’ gestation. The patient tells the physician that she is going to deliver her child at home, without any medical aid. The physician inquires about her tetanus vaccination status. The patient reports that she had tetanus 1 year after her first delivery at the age of 16, and it was managed appropriately. She had no tetanus vaccinations since then. Which of the following statements is true?
- A. The patient should receive at least 2 doses of tetanus toxoid within the 4-week interval to ensure that she and her baby will both have immunity against tetanus. (Correct Answer)
- B. The antibodies from tetanus immune globulin vaccine, if given to a pregnant woman, would not cross the placental barrier.
- C. Even if the patient receives appropriate tetanus vaccination, it will be necessary to administer toxoid to the newborn.
- D. The patient is protected against tetanus due to her past medical history, so only the child is at risk of developing tetanus after an out-of-hospital delivery.
- E. The patient does not need vaccination because she has developed natural immunity against tetanus and will pass it to her baby.
Immunizations in pregnancy Explanation: ***The patient should receive at least 2 doses of tetanus toxoid within the 4-week interval to ensure that she and her baby will both have immunity against tetanus.***
- For unvaccinated or incompletely vaccinated pregnant women, the **CDC recommends a series of at least two doses of tetanus toxoid-containing vaccine (Tdap or Td)**. These doses should be given at least 4 weeks apart to provide sufficient maternal protection and ensure the transfer of **passive immunity** to the newborn.
- This regimen ensures that both the mother and the baby receive protection against tetanus, particularly crucial in settings of **home delivery without medical aid** where the risk of exposure is higher.
*The antibodies from tetanus immune globulin vaccine, if given to a pregnant woman, would not cross the placental barrier.*
- **Tetanus immune globulin (TIG)** provides immediate, but short-lived, passive immunity and its antibodies **do cross the placental barrier**.
- However, TIG is not routinely used for prenatal vaccination; **tetanus toxoid (Tdap/Td)** is administered to stimulate active antibody production in the mother and subsequent passive transfer to the fetus.
*Even if the patient receives appropriate tetanus vaccination, it will be necessary to administer toxoid to the newborn.*
- If the mother receives **appropriate tetanus vaccination (Tdap/Td) during pregnancy**, sufficient **maternal antibodies are transferred to the newborn** via the placenta, protecting the infant during the first few months of life.
- Therefore, the newborn typically does not require immediate tetanus toxoid administration at birth if the mother was adequately vaccinated during pregnancy; their primary series of vaccinations begins later.
*The patient is protected against tetanus due to her past medical history, so only the child is at risk of developing tetanus after an out-of-hospital delivery.*
- While prior tetanus infection can provide some immunity, it is **not always long-lasting or fully protective**, and it does not guarantee protection for future pregnancies or the newborn.
- Therefore, the mother should still be vaccinated to ensure both her and the baby's protection, especially when delivering in a high-risk environment.
*The patient does not need vaccination because she has developed natural immunity against tetanus and will pass it to her baby.*
- **Natural immunity to tetanus following infection is often insufficient and may not be long-lasting**, unlike immunity conferred by vaccination.
- Therefore, vaccination is still recommended to ensure adequate immunity for the mother and to facilitate the transfer of protective antibodies to the baby.
Immunizations in pregnancy US Medical PG Question 7: A 24-year-old newly immigrated mother arrives to the clinic to discuss breastfeeding options for her newborn child. Her medical history is unclear as she has recently arrived from Sub-Saharan Africa. You tell her that unfortunately she will not be able to breastfeed until further testing is performed. Which of the following infections is an absolute contraindication to breastfeeding?
- A. Human Immunodeficiency Virus (HIV) (Correct Answer)
- B. Latent tuberculosis
- C. Hepatitis B
- D. Hepatitis C
- E. All of the options
Immunizations in pregnancy Explanation: ***Human Immunodeficiency Virus (HIV)***
- In developed countries where safe alternatives are available, **HIV-positive mothers** are advised against breastfeeding due to the risk of **vertical transmission** through breast milk.
- This is considered an **absolute contraindication** in settings where formula feeding is accessible and safe.
*Latent tuberculosis*
- **Latent tuberculosis** is not a contraindication to breastfeeding; mothers can breastfeed while receiving treatment.
- Active, untreated tuberculosis, however, generally requires temporary separation of mother and child until the mother is no longer infectious, but pumping and feeding expressed milk is often still an option.
*Hepatitis B*
- **Hepatitis B** infection in the mother is not a contraindication to breastfeeding, especially if the infant receives **hepatitis B vaccine** and **Hepatitis B Immune Globulin (HBIG)** at birth.
- Breastfeeding is considered safe and does not increase the risk of transmission to the infant.
*Hepatitis C*
- **Hepatitis C** is generally **not a contraindication** to breastfeeding, as studies have shown a very low risk of transmission through breast milk.
- Breastfeeding is supported unless the mother has **cracked or bleeding nipples**, which could potentially allow viral transmission.
*All of the options*
- This option is incorrect because **only HIV** is considered an absolute contraindication to breastfeeding in settings where safe alternatives are available.
- Latent TB, Hepatitis B, and Hepatitis C alone do not preclude breastfeeding.
Immunizations in pregnancy US Medical PG Question 8: A 29-year-old woman presents to a medical office complaining of fatigue, nausea, and vomiting for 1 week. Recently, the smell of certain foods makes her nauseous. Her symptoms are more pronounced in the mornings. The emesis is clear-to-yellow without blood. She has had no recent travel out of the country. The medical history is significant for peptic ulcer, for which she takes pantoprazole. The blood pressure is 100/60 mm Hg, the pulse is 70/min, and the respiratory rate is 12/min. The physical examination reveals pale mucosa and conjunctiva, and bilateral breast tenderness. The LMP was 9 weeks ago. What is the most appropriate next step in the management of this patient?
- A. Beta-HCG levels and a transvaginal ultrasound (Correct Answer)
- B. Beta-HCG levels and a transabdominal ultrasound
- C. Beta-HCG levels and a pelvic CT
- D. Abdominal x-ray
- E. Abdominal CT with contrast
Immunizations in pregnancy Explanation: ***Beta-HCG levels and a transvaginal ultrasound***
- The patient's symptoms (fatigue, nausea, vomiting, morning sickness, breast tenderness, and **amenorrhea** for 9 weeks) strongly suggest **early pregnancy**.
- **Urine or serum beta-HCG** confirms pregnancy, and a **transvaginal ultrasound** is crucial for confirming an **intrauterine pregnancy**, estimating gestational age, and ruling out complications like ectopic pregnancy, especially at this early stage when transabdominal ultrasound might not provide clear images.
*Beta-HCG levels and a transabdominal ultrasound*
- While beta-HCG levels are appropriate, a **transabdominal ultrasound** may not be sufficient to visualize an early intrauterine pregnancy at 9 weeks due to limited resolution compared to transvaginal ultrasound.
- A definitive confirmation of **intrauterine pregnancy** is critical to rule out an **ectopic pregnancy**, which is better achieved with transvaginal imaging in early gestation.
*Beta-HCG levels and a pelvic CT*
- **CT scans** expose the patient to significant **ionizing radiation**, which is **contraindicated in pregnancy** unless absolutely necessary for life-threatening conditions.
- While it could identify some pelvic pathologies, it is **not the primary imaging modality** for confirming or evaluating early pregnancy due to radiation risks and inferior soft tissue resolution for early gestational sacs compared to ultrasound.
*Abdominal x-ray*
- An **abdominal X-ray** involves **ionizing radiation** and offers very limited diagnostic value for early pregnancy, as it cannot visualize the gestational sac, fetus, or fetal heart activity.
- It is **contraindicated** in suspected pregnancy due to the risk of fetal harm.
*Abdominal CT with contrast*
- **Abdominal CT with contrast** involves both **ionizing radiation** and **contrast agents**, both of which pose significant risks to a developing fetus.
- It is an **inappropriate initial step** for suspected pregnancy and offers no specific diagnostic benefits for confirming or characterizing early gestation.
Immunizations in pregnancy US Medical PG Question 9: A 23-year-old primigravid woman comes to the physician at 36 weeks' gestation for her first prenatal visit. She confirmed the pregnancy with a home urine pregnancy kit a few months ago but has not yet followed up with a physician. She takes no medications. Vital signs are within normal limits. Pelvic examination shows a uterus consistent in size with a 36-week gestation. Laboratory studies show:
Hemoglobin 10.6 g/dL
Serum
Glucose 88 mg/dL
Hepatitis B surface antigen negative
Hepatitis C antibody negative
HIV antibody positive
HIV load 11,000 copies/mL (N < 1000 copies/mL)
Ultrasonography shows an intrauterine fetus consistent in size with a 36-week gestation. Which of the following is the most appropriate next step in management of this patient?
- A. Intrapartum zidovudine and vaginal delivery when labor occurs
- B. Intrapartum zidovudine and cesarean delivery at 38 weeks' gestation
- C. Start cART and prepare for vaginal delivery at 38 weeks' gestation
- D. Conduct cesarean delivery immediately
- E. Start cART and schedule cesarean delivery at 38 weeks' gestation (Correct Answer)
Immunizations in pregnancy Explanation: ***Start cART and schedule cesarean delivery at 38 weeks' gestation***
- This patient presents at 36 weeks with a **newly diagnosed HIV infection** and a **viral load of 11,000 copies/mL**, which is considered high. Starting **combination antiretroviral therapy (cART)** immediately is crucial to reduce the viral load and the risk of **mother-to-child transmission (MTCT)**.
- For patients with **HIV viral loads > 1,000 copies/mL** near term, a **scheduled cesarean delivery at 38 weeks** is recommended to minimize fetal exposure to maternal blood and secretions during labor, further reducing the risk of MTCT.
*Intrapartum zidovudine and vaginal delivery when labor occurs*
- This approach is appropriate for HIV-positive mothers with a **low viral load (< 1,000 copies/mL)** at or near delivery, as a scheduled cesarean section would not significantly further reduce the risk of transmission.
- Given the patient's **high viral load (11,000 copies/mL)**, **only intrapartum zidovudine** would be insufficient to adequately reduce the risk of MTCT during a vaginal delivery.
*Intrapartum zidovudine and cesarean delivery at 38 weeks' gestation*
- While a **scheduled cesarean delivery at 38 weeks** is indicated for a high viral load, simply administering **intrapartum zidovudine without prior cART** misses the opportunity to significantly reduce viral load before delivery.
- Starting **cART immediately** offers the best chance to lower viral load and optimize outcomes for both mother and child, which is superior to only intrapartum prophylaxis.
*Start cART and prepare for vaginal delivery at 38 weeks' gestation*
- Starting **cART is essential**, but preparing for a vaginal delivery with a **viral load of 11,000 copies/mL** at 36 weeks is inappropriate.
- A **high viral load** necessitates a ** scheduled cesarean delivery** to minimize the risk of MTCT, regardless of cART initiation at this late stage.
*Conduct cesarean delivery immediately*
- While immediate action is needed, an **emergency cesarean delivery** is not indicated at 36 weeks unless there are other obstetric complications or rapid deterioration.
- The primary goal is to **reduce viral load through cART** and then perform a **scheduled cesarean at 38 weeks**, balancing safety for both mother and fetus with the greatest reduction in HIV transmission risk.
Immunizations in pregnancy US Medical PG Question 10: A 34-year-old woman presents at 6 weeks of delivery. She wants contraception for the next 3 years. What will be the best contraceptive method in this case?
- A. Nothing besides lactation amenorrhea
- B. IUCD with progesterone
- C. Injectable progesterone
- D. Copper T (Correct Answer)
Immunizations in pregnancy Explanation: ***Copper T***
- A **Copper T intrauterine device (IUD)** is an excellent choice for long-term contraception (up to 10 years), making it suitable for her 3-year requirement.
- It's **non-hormonal**, making it safe for breastfeeding mothers and avoiding potential hormonal side effects.
*Nothing besides lactation amenorrhea*
- **Lactational amenorrhea method (LAM)** is effective for only the first six months postpartum, provided the mother is exclusively breastfeeding and her periods have not returned.
- It is not a reliable method for contraception beyond six months postpartum or for the requested 3-year duration.
*IUCD with progesterone*
- An **intrauterine device (IUD) with progesterone** (e.g., Mirena) can be a good long-term option, but it releases hormones which can potentially affect breastfeeding, especially if initiated very early postpartum.
- While generally safe for breastfeeding, a non-hormonal option like the copper T is often preferred if there are concerns about hormonal exposure or side effects.
*Injectable progesterone*
- **Injectable progesterone** (e.g., Depo-Provera) is an effective contraceptive, but it needs to be administered every 3 months.
- While safe for breastfeeding, it's not considered as convenient for a 3-year duration as a single-insertion IUD, and some women experience side effects like irregular bleeding or weight gain.
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