EBCOG Part 1-Postnatal Care & Sexual Reproductive Health-Day 5(SBA)

1. A 35-year-old nulliparous patient is HIV positive and takes efavirenz and nevirapine. She is using a 30-mcg oestrogen combined oral contraceptive preparation as well as barrier contraception. She finished a pill packet 10 days ago, forgot to restart again and had unprotected sexual intercourse 2 days ago. She also missed two pills in her first week of the previous pill packet. A chlamydia urine polymerase chain reaction test is positive. She attends asking for emergency contraception.

What is the most appropriate method of emergency contraception in this situation?

2.  Which one of the following is appropriate when counselling a woman who is requesting emergency contraception following unprotected sexual intercourse (UPSI)?

3.  Ms XY presents to the GUM clinic seeking emergency contraception. She recalls her last unprotected sexual intercourse was 4 days ago. She has erratic cycles other- wise, and exact time of ovulation cannot be confidently determined. She consents to STI screening. Which of the following treatment options are best suited to her?

4. Which two drugs are the only selective progesterone receptor modulators (SPRMs) licensed for use in the United Kingdom?

5. As a post coital contraception, the primary mechanism of action of Ulipristal acetate is delaying of ovulation. What is the conception rate when Ulipristal acetate is taken within 120 hours of unprotected sexual intercourse?

6.  On a Saturday morning, an 18-year-old girl who is on an enzyme-inducing drug comes to the accident and emergency department requesting advice as she had unprotected sexual intercourse on the 18th day of her cycle. She does not wish to become pregnant. She did not accept your advice for an intrauterine device (IUD) fitting. What alternatives can you offer her?

7.  A 17-year-old girl comes to the accident and emergency department. She had unpro- tected intercourse four days previously. She was not very keen on an intrauterine device (IUD). What other alternatives do you wish to offer?

8.  Which method of emergency contraception works primarily by inhibiting fertilisation?

9.  According to the UK Medical Eligibility Criteria for Contraceptive Use (UKMEC), what is the medical contraindication to the use of levonorgestrel for emergency contraception?

10. A 47-year-old woman who has been using condoms for contraception with her partner attends for contraceptive advice. Her last menstrual period was 8 months ago and she has no overt menopausal symptoms. Assuming she has no further periods, for how long should she continue to use contraception?

11. A 35-year-old now para 1 attends for perineal review after an episiotomy wound infection 1 week postdelivery. All has healed well. She has had difficulties with a variety of contraceptive methods she has tried over a number of years and is keen to rely on lactational amenorrhoea. She asks about its efficacy. If a mother is amenorrhoeic, is less than 6 months postnatal and is exclusively breast feeding, how effective is lactational amenorrhoea as a method of contraception?

12. A 22-year-old woman presents to her GP for advice regarding the most appropriate postnatal contraception. She had an uncomplicated vaginal delivery 6 weeks back at 40 weeks gestation. She is intermittently breastfeeding and bottle feeding her baby. She and her partner are keen to space out child bearing by 2–3 years and requesting for the most reliable form of contraception. She admits to having difficulty in remembering to take contraceptive medication. Select the SINGLE most appropriate contraceptive option:

13. A 22-year-old woman presents to her GP for advice regarding the most appropriate postnatal contraception. She had an uncomplicated vaginal delivery at 40 weeks gestation 3 weeks prior. She is bottle feeding her baby. She and her partner are keen to space out child bearing by 1–2 years and wishing a reliable form of contraception. She has a history of irregular menstrual cycles and polycystic ovarian syndrome. Select the SINGLE most appropriate contraceptive option:

14. Ms XY has an ERPC/SMM 1 week ago for a missed miscarriage following an unplanned pregnancy at 10/40 weeks. The histology results suggest a molar preg- nancy. Ms XY is keen on contraception to avoid a further unplanned pregnancy. Her beta hCG levels are 960 mIU/l today. Which of the following contraceptives are best suited to her?

Options:

a. Barrier contraception

b. Combined oral contraception

c. Copper IUCD

d. Minipill

e. Mirena IUS

15. Lord Fraser, in his ruling of the Gillick case in the House of Lords, produced guidelines regarding contraceptive advice given by doctors. Doctors can proceed to advise and give contraception provided they are satisfied with all of the following five criteria. Which one does not apply?

16. An 18-year-old nulliparous patient attends the gynaecology clinic for heavy painful menstrual bleeding. She is in a sexual relationship with a new partner and both have tested negative for STIs, though she has had a previously treated chlamydia infection. She does not want any children in the near future. She takes lamotrigine for epilepsy control and has not Suffered any seizures for 3years. General and pelvic examinations are normal and her BMI Is 30? What is the best appropriate method of contraception in her situation?

17. Which one of the following is appropriate when counselling a woman who is requesting postnatal contraception?