EBCOG P1 – Postnatal Care & SRH – day 5 – EMQ

A. Combined oral contraceptive pill (COC)
B. Combined oral contraceptive transdermal patch (Evra)
C. Combined oral contraceptive vaginal ring (NuvaRing)
D. Copper intrauterine device (Cu-IUD)
E. Progestogen-only injection (Depo-Provera)
F. Hysteroscopic sterilisation
G. Laparoscopic sterilisation
H. Levonelle
I. Mirena (LNG-IUS)
J. Natural family planning (Persona; Clearblue)
K. Progestogen-only pill
L. Progestogen-only implant (Nexplanon)
M. Ulipristal acetate
N. Vasectomy

1.21 years old, unprotected sexual intercourse 4 days earlier. Currently she is day 18 of her 28-day menstrual cycle. Wishes the most effective method to avoid pregnancy. This is her third episode of requesting emergency contraception.

A Take both missed pills, take the remaining pills as usual, condoms should be used for the next seven days or sexual intercourse avoided in case further pills are missed. No indication for emergency contraception.

B Take the most recent missed pill, take the remaining pills as usual, condoms should be used for the next seven days or sexual intercourse avoided in case further pills are missed. No indication for emergency contraception.

C Administer the next injection, offer emergency contraception, additional contraception or abstinence should be advised for the next seven days and a pregnancy test should be carried out in 21 days.

D Take both missed pills, take the remaining pills as usual, condoms should be used for the next seven days or sexual intercourse avoided in case further pills are missed. Emergency contraception should also be advised.

E The next injection should not be administered, emergency contraception should be offered and a pregnancy test should be carried out in 21 days.

F Administer the next injection, emergency contraception not required, additional contraception or abstinence for the next seven days.

Match the most appropriate advice to each scenario:

2. A 28-year-old woman misses two consecutive 30 mcg combined pills in the second week of taking her packet (days 9 and 10). She has been taking all her pills on days 1–7. She had sexual intercourse with her boyfriend on day 8.

3.A 32-year-old woman had her last DMPA (Depo-Provera) injection 14 weeks and two days ago. She had sexual intercourse with her partner two days ago.

A Condoms

B Copper intrauterine device (IUD)

C Danazol

D Medroxyprogesterone acetate

E Co-cyprindiol (Dianette)

F Levonorgestrel 1.5 mg

G Ethinylestradiol/drospirenone(Yasmin)

H Ethinylestradiol/levonorgestrel (Microgynon)

I Mifepristone

J Levonorgestrel IUS

K Norethisterone

L Progestogen only pill

M Sterilisation

N Gestrinone

O GnRH analogues

Instructions: For each scenario described below, select the single most appropriate method of contraception from the list of options above. Each option may be used once, more than once, or not at all.

4. A 42-year-old woman presents to the labour ward at 34 weeks of gestation in pre-term labour. She progress very quickly and proceeds to have an emergency caesarean section for fetal distress. She was discharged home after 1 week as her baby was admitted to the special care baby unit. Two weeks later, she attends the general practitioner centre seeking contraception. She wants to continue to breastfeed her baby.

5.A 20-year-old woman presents to the emergency gynaecology services at a hospital at midnight for advice. She gives a history of condom rupture while having sexual intercourse 3 hours ago. She is worried that she will get pregnant and her parents will abandon her. She wishes to have pill.

6.A 28-year-old happily married woman presents to the family planning clinic for advice. She gives a history of unprotected intercourse 3 days ago and does not want to get pregnant. She is also looking for long-term contraception. She has two children who are primary school age.

7.A 20-year-old young Asian woman is about to start a new relationship. She had previously used progestogen only pills for contraception but became pregnant after the delayed intake of two consecutive pills.  The pregnancy had to be terminated as it was unwanted. She is still keen to take pills. She has suffered from acne for the last 6 months and is worried that her boyfriend will leave her because of this problem.

A Leave in for a further 12 months and then remove or check two FSH (follicular stimulating hormone) levels, six weeks apart, and if both over 30 IU/L, remove.
B Take a full sexual history and commence a 30 mcg or 35 mcg combined oral contraceptive pill. If not resolving, consider endometrial biopsy.
C Take a full sexual history and investigate for sexually transmitted infections if appropriate.
D Take a full sexual history and a cervical smear.
E Stop the contraceptive and advise trying a long-acting reversible contraceptive such as the implant.
F Take a full sexual history, do a pelvic examination and cervical smear. If normal, consider adding mefenamic acid alongside.
G Remove the device now.
H Leave in for a further 24 months and then remove or check two FSH levels six weeks apart and if both over 30 IU/L, remove after 12 months.

Match the most appropriate management to each scenario:

8. A 43-year-old woman started a combined oral contraceptive pill three months ago. She has started having irregular bleeding. She is known to have PCOS (polycystic ovarian syndrome). She is a non-smoker and is up to date with her smears.

9.A 24-year-old woman presents with irregular bleeding six months after starting the combined oral contraceptive pill. She has no medical problems. She has recently started a new relationship. She is up to date with her smears.