STUDENT PROBLEM-BASED LEARNING SESSION

Contraception, Sterilization, Abortion

Contraception Case | Abortion Case

Clinical Case #1: Contraception

A 17 year old G0 presents to clinic desiring information about contraceptive methods. She reports that she is sexually active with her boyfriend, using condoms occasionally, when she “needs them.” She has never used any other methods. She has had 2 lifetime partners. She became sexually active at age 15 and had sex with her first partner 3-4 times but didn't use contraception. She has been sexually active with her current partner for the last year. She came today because she last had unprotected intercourse 3 days ago and is worried she might get pregnant. She has decided it's time for a more reliable method of contraception. She has never had a Pap smear. She has history of well controlled seizure disorder and had appendicitis at age 11. She is taking Valproic Acid. She smokes one-half pack of cigarettes per day, drinks alcohol socially, and uses occasional marijuana. Her blood pressure is 100/60 and pulse is 68.

Discussion questions:

  1. What history is required for recommending appropriate contraception?
  2. What physical exam and studies are required for prescribing hormonal contraceptives?
  3. What contraceptives should the patient be counseled about and what are the advantages and disadvantages of each method?
  4. When/how to start the contraceptive method?

 

References:

  1. Obstetrics and Gynecology by Beckmann 5 th Edition, 2006; Chapter 25 Contraception. Pages 241-257.
  2. Essentials of Obstetrics and Gynecology by Hacker and Moore 4 th Edition, 2004; Chapter 27 Family Planning: Contraception, Sterilization, and Abortion. Pages 341-351.

A Pocket Guide to Managing Contraception, 2005-2007, Hatcher, Zieman, Creinin, et al.

An understanding of the medical and personal issues involved in decisions regarding contraceptive methods is necessary to adequately advise patients requesting contraception. In the process of deciding whether to have a sterilization procedure, men and women often seek the advice of their physicians. Providing accurate information will allow patients to make an informed decision regarding this elective surgery.

The APGO Educational Objectives related to this topic are the following:

  1. Describe the physiologic basis of contraception (OCPs, emergency contraception, patches, rings, IUD, sterilization, etc.) *
  2. Describe the effectiveness of each form of contraception *
  3. Counsel the patient regarding the benefits and risks for each form of contraception *
  4. Cite the financial considerations of the various forms of contraception
  5. Describe the methods of male and female surgical sterilization *
  6. List the risks and benefits of procedures, including: *
    1. Potential surgical complications
    2. Failure rates
    3. Reversibility (lack of)

*Designated as Priority One in the APGO Medical Student Educational Objectives, 8 th Edition

 

Clinical Case #2: Abortion

The patient is a 14-year-old G 1 P 0 who presents to a private clinic requesting termination of pregnancy. Her last menstrual period began 9 weeks prior to arrival. She has been experiencing intermittent nausea and vomiting. She is sexually active with her 21-year-old partner and reports she is having consensual sex with him. She has been using condoms for contraception. She has no history of sexually transmitted infections. She has mild asthma for which she uses an inhaler as needed. She drinks “socially” – 3-5 drinks a day on the weekends. She does not use drugs or tobacco and lives with her mother and 17-year old brother. Her physical exam is unremarkable, uterine size is approximately 8 weeks. Ultrasound confirms intrauterine pregnancy at 8 weeks with fetal heart motion present.

Discussion questions:

  1. What is options counseling and how would you counsel this patient about her options?
  2. Is this patient a victim of sexual abuse? Should this case be reported to authorities?
  3. Can the patient consent for termination herself or must she have parental consent since she is a minor?
  4. What types of abortion is this patient eligible for, given her gestational age of 8 weeks?
  5. How is a surgical abortion performed?
  6. How is a medication abortion performed?
  7. What are the potential complications of abortion?
  8. How should this patient be counseled about contraception?
  9. How should this patient be counseled and managed regarding STD prevention?

References:

  1. Obstetrics and Gynecology by Beckmann 5 th Edition, 2006; Chapter 2 Ethics in Obstetrics and Gynecology. Pages 28-29 & Chapter 14 Abortion . Pages 158-159.
  2. Essentials of Obstetrics and Gynecology by Hacker and Moore 4 th Edition, 2004; Chapter 27 Family Planning: Contraception, Sterilization, and Abortion. Pages 350-351.

Induced abortion is a reproductive option considered by some patients. Regardless of one's personal views, the practitioner should be aware of the techniques, management and complications of induced abortions.

The APGO Educational Objectives related to this topic are the following:

  1. Explain surgical and non-surgical methods of pregnancy termination*
  2. Identify potential complications of induced abortion*
  3. Provide non-directive counseling to patients surrounding pregnancy options*

*Designated as Priority One in the APGO Medical Student Educational Objectives, 8 th Edition

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