Lecture 7 Contraception

Question 1

Ailsa, a 15 year old girl, attends the Sexual Health Clinic after school on Monday at 4pm. She had unprotected sex on Friday night around 11pm with casual male partner. She doesn’t think he used condoms and is now asking for emergency contraception.

What emergency contraception methods are available?

Answer 1

1. Copper IUD- 0-120h after unprotected sexual intercourse or 120h after earliest expected ovulation (99% risk reduction)
2. Ullipristal (Ellaone/UPA)- 0-120h after UPSI- 60-80& risk reduction
3. Levonorgestrel (Levonelle)- 0-72h afer UPSI- 69% risk reduction (not effective after LH surge)

Question 2

What information do you need from Ailsa to discuss emergency contraception?

Answer 2

• LMP, regular cycle
• Usual method of contraception
• Circumstances: UPSI/ Condom failure/ other method problem? Tyle of sex
• Hours from first episode of UPSI since LMP/hormonal method failure
• Pregnancy test in 3-4 weeks if no normal period; Future contraception
• STI risk (test after 10-14d for Chlamydia/ Gonorrhoea/ Trichomoniasis)
• <16 assessment, Social History
• Medical history, including medications and allergies and weight/BMI

Question 3

What needs to be assessed for an under 160year-old

Answer 3

• Fraser competency- Gillick Competence
• Child protection risk
• Brook/BASHH child sexual exploitation

Question 4

Ailsa re-attends the clinic 5 weeks later with a positive pregnancy test she did at home. What are her options?

Answer 4

• Continue the pregnancy - GP/ midwife will need informed to start antenatal care
• Adoption – again need to start antenatal care
• Termination of pregnancy
• Consider social work involvement if further support is necessary

Question 5

What are the two types of abortion available in the UK?

Answer 5

• Surgical- up to 12 weeks within Grampian (this is a possible option between 12 and 24 weeks by referring to another provider)
• Medical- – up to 20 weeks within Grampian (legally up to 24 weeks but no service in Scotland for this)

Question 6

When can surgical termination of pregnancy be carried out

Answer 6

5-12 weeks

Question 7

When can a medical termination be carried out

Answer 7

Up to 20 weeks

Question 8

When can a home abortion be carried out

Answer 8

Under 10 weeks gestation