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DRCOG OSCE for Circuit B Answers
Published in Una F. Coales, DRCOG: Practice MCQs and OSCEs: How to Pass First Time three Complete MCQ Practice Exams (180 MCQs) Three Complete OSCE Practice Papers (60 Questions) Detailed Answers and Tips, 2020
The risk of pregnancy using the lactational amenorrhoea method is 1-2%. The mother should be advised of alternative forms of postpartum contraception if she wishes the risk to be nil. The progestogen-only pill is safely administered from 6 weeks postpartum in women who breast-feed. The combined oral contraceptive (coc) pill is contraindicated in breast-feeding women as the oestrogen component inhibits the production of breast milk. An alternative form of contraception is the Levonorgestrel-releasing intrauterine system (LNG-IUS), which may be inserted at 6 weeks postpartum in breast-feeding women. The delay in insertion is to avoid the high expulsion rates associated with post-placental insertion. Female sterilization may also be offered but is not recommended at the time of Caesarean section due to higher failure rates associated with oedematous, vascular Fallopian tubes and a higher incidence of regret.
Natural family planning methods: fertility awareness
Published in Suzanne Everett, Handbook of Contraception and Sexual Health, 2020
The lactational amenorrhoea method is the use of breast feeding to inhibit ovulation and act as a contraceptive. If a woman has a baby of less than six months old and is amenorrhoeic and fully breast feeding, then there is only about a 2% chance of pregnancy occurring. However, if a woman is not fully breast feeding or not amenorrhoeic, then the risk of pregnancy will be greater. Many women will choose to rely upon another method of contraception such as barrier methods or the progestogen-only pill as well as LAM.
Adolescent contraception
Published in Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo, Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
Hanna Goldberg, Jasmine Multani, Sari Kives
The rhythm method, Billings method, and calculations of basal body temperature can all be used by the highly motivated adolescent to identify the body's physiologic changes and thus the most fertile period of the cycle. They can then avoid sexual activity during these times. Due to the high degree of motivation required, this method is not applicable to most adolescents, and failure rates of these methods over time are quite high (6%–38%).16 However, in low-resource areas, the rhythm method can be quite helpful. Lactational amenorrhea is not a reliable method, especially if the infant is over 6 months of age or if breastfeeding is not exclusive and the woman has resumed menses.16 Coitus interruptus or withdrawal is a technique that is also unreliable and relies on the male partner's ability and willingness to withdraw before ejaculation; these concepts are not realistic for many adolescent males. Furthermore, there is no protection against STI with any of these methods.16
Hormonal and natural contraceptives: a review on efficacy and risks of different methods for an informed choice
Published in Gynecological Endocrinology, 2023
Andrea R. Genazzani, Tiziana Fidecicchi, Domenico Arduini, Andrea Giannini, Tommaso Simoncini
Another natural method of contraception is the Lactational Amenorrhea Method (LAM). The definition of postpartum amenorrhea is a difficult issue. Recently, a Cochrane review suggested redefining lactational amenorrhea as no vaginal bleeding for at least 10 days after the end of postpartum bleeding [13]. Breastfeeding causes a delay in the return of ovulation and menstruation due to the effects of prolactin on the pulsatile release of gonadotropin-releasing hormone [14]. In breastfeeding women, the first menstrual period tends to be anovulatory [15]: with exclusive breastfeeding, ovulation returns in only 1-5% of women in the first 6 months after delivery [16]. However, this percentage increases if breastfeeding is not regular or stops before six months postpartum [16]. Anovulation in LAM is achieved when three criteria are fully met: (1) exclusive breastfeeding (no supplemental foods or liquids; at least 5 regular breastfeedings/day, including four during the day and one at night); (2) amenorrhea; (3) <6 months postpartum [17]. The efficacy of LAM is >98% in the first 6 months postpartum [16]. However, this method can only be temporary and should be replaced with another method after six months or earlier if the criteria are not fully met, and it can have a high failure rate due to the variability of ovulation return, so it will not be considered further in this review.
Rural-Urban Differences in Unintended Pregnancies, Contraceptive Nonuse, and Terminated Pregnancies in Latin America and the Caribbean
Published in Women's Reproductive Health, 2022
Second, contraceptive use measures whether a woman is currently using a contraceptive method or not. In the survey, the possible answers to this question were: “using modern method,” “using traditional method,” “nonuser intends to,” and “nonuser does not intend to,” which I coded into a dichotomous outcome variable. Responses of “using modern method, using traditional method” were considered ‘using contraceptive method’ and coded in the analysis as one (1). Modern contraceptive methods included: the pill, IUD, injection, diaphragm, Norplant™ or implant, condom, female condom, foam and jelly, female sterilization, male sterilization, other contraceptive methods, and country-specific contraceptive methods. Traditional or folk contraceptive methods included: lactational amenorrhea, periodic abstinence (rhythm), and withdrawal. Responses of “nonuser intends to, nonuser does not intend to” were considered ‘not using contraceptive method’ and coded in the analysis as zero (0).
Intrauterine device penetrating the anterior urinary bladder wall discovered during caesarean section: a case report
Published in Journal of Obstetrics and Gynaecology, 2020
Goda Jievaltienė, Dominyka Surgontaitė, Rosita Aniulienė, Donatas Venskutonis
This report describes a case when during a caesarean section (C-section) an IUD was found stuck in the anterior wall of a 41-year-old woman’s urinary bladder. The patient, gravida 2, 40 weeks pregnant arrived at the hospital with irregular uterine contractions and lower abdominal pain. During the general examination, class III obesity was diagnosed. As the labour progressed, it was decided to perform an urgent C-section due to dystocia caused by the pelvis and foetus disproportion. During the operation, a copper IUD was found penetrating the anterior wall of the urinary bladder (Figure 1). No additional scarring was visible on the uterine wall. After successful IUD removal, the urinary bladder wound was closed with separated two layer sutures. A girl, weighing 4435 g, was born. The patient and the newborn were stable, no complications occurred. The woman’s urinary bladder was catheterised for a week using Foley’s self-retaining catheter. Lactational amenorrhoea and its contraceptive effect were explained, further use of desogestrel was recommended. The patient stated that she would only use barrier contraceptive methods.