TEALE FENNING

Jullien Brady · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 39

Contraception this week.

The parents of a 16-year old girl with severe learning difficulties who lives in a dedicated care home are worried that she may be sexually active. They wish to discuss what contraceptive methods are available.

What are the specific risk factors in this case? (3 marks)

What history would you require? (4 marks)

What examination and investigations may be required? (3 marks)

In light of the patients problems what contraceptives might be used? (10 marks)

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Jullien Brady B.Sc. MB.BS. MRCOG.
Teale Fenning Administrator

Xerxes I · Posted: Tue Jul 29, 2008 12:08 pm Post subject:

The parents of a 16-year old girl with severe learning difficulties who lives in a dedicated care home are worried that she may be sexually active. They wish to discuss what contraceptive methods are available.

What are the specific risk factors in this case? (3 marks)
an unplanned Pregnancy in this case will have serious consequences in terms of the child's welbeing and also the matenal and fetal risks associated with teenage pregnancies, i.e. preterm labour, IUGR, higher risk of PET. Therefore a reliable method should be used. Her guardian should make the decision considering the severity of her learning difficulty.
On the other hand, the possibility of sexual abuse shuld be thoroughly explored and advice sough from legal advisors in view of her age and incompetence.

What history would you require? (4 marks)
It should be clarified what the nature of her sexual activity is and appropriate advice given to carers and the guardian regarding the risk of sexually transmitted infections in particulat chlamydia, gonorrhea, hepatitis B and HIV. Is the sexual partner significantly older?
Previous personal and family history of venous thromboembolism, migraine headache and heart conditions should b sought.
Congenital heart disease is in particular common in Down's syndrome.
Menstrual history should also be taken including the daate of the last period and the regularity of these.

What examination and investigations may be required? (3 marks)
Examination should include measurement of height and weight nd calculation of BMI. Blood pressure should be taken. Cardiac auscultation should be carried out to rule out significant murmurs and referred i present. Internal examination is not necesary unless there is concern about PID to get swabs or if IUCD is being considered.

If significant history of VTE, thrombophilia screen may be indicated. A pregnancy test should be performed to rule out ongoing pregnancy. Urine can be sent for Chlamydia if PS not performed for ...

In light of the patients problems what contraceptives might be used? (10 marks)

will answer after gym!

Abik · Posted: Thu Aug 14, 2008 5:42 pm Post subject:

Blimey S - how long do you spend at the gym!!!!

I would have put risk of infection in the first part.
three marks for risk factors
1 pregnancy
2 infection
3 abuse
(4 consent)

Xerxes I · Posted: Thu Aug 14, 2008 7:30 pm Post subject:

This is what I'm dreading, amongst other things, to mentions things in the wrong section. But it's a bit stupid, not to get the point even though you show that you've thought about them. But I guess that's the way it is.

Looking forwards to next Friday Abi.

S

Nick Raine-Fenning · Posted: Thu Aug 14, 2008 8:27 pm Post subject:

Take more time planning then!

This has become even more important now. Make sure you really think about what goes where before committing pen to paper.

Plan, plan, plan ... or bubble, bubble, bubble Wink

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