OD, Pre-Test: Advanced LARC Topics for Providers: Difficult Insertions

1. Advanced LARC Topics for Providers: Difficult Insertions

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* 1. Your primary professional category (choose the one best response):

Health Professional Educator

Nurse Midwife

Nurse Practitioner

Pharmacist

Physician

Physician Assistant

Registered Nurse

Resident

Student

Other (please specify)

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* 2. Do you interact with patients?

Yes

CASE STUDY (for all questions): A 22-year-old gravida 0 who has been in a serious relationship for the past 7 months comes to your clinic. She is currently using oral contraceptive pills (OCPs). Before she started using OCPs, she had irregular periods. She is considering switching to intrauterine contraception (IUC), and she has come to the clinic with her boyfriend to learn more about the method. She has an otherwise negative medical history.

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* 3. What would be your first step when considering LARC for this patient?

Ask the patient about sexually transmitted infections (STIs) and test if appropriate

Counsel the patient about the increased costs for this method of contraception

Counsel the patient about another form of birth control, as nulliparity is a contraindication for LARC

Rule out termination of a pregnancy within the past month; this is a contraindication to IUC insertion

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* 4. What information would you provide about the advantages and disadvantages of the available LARC options?

LNG 52 IUS is not ideal for nulliparous women and associated with long-term heavy bleeding

Copper T 380A IUD is non-hormonal and approved for use as emergency contraception

LNG 13.5 IUS was developed for older women because they need less progestational effect to control cycles

Bleeding irregularities are not associated with the implant

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* 5. After comprehensive counseling, the patient is convinced that IUC is appropriate for her, and she wishes to have it placed at this visit. How would you address this patient’s concerns about insertion pain?

Agree that she should not consider IUC and discuss other options, such as barrier methods and oral contraceptives, that do not require painful insertion

Inform her that local anesthesia and cervical dilation may help reduce IUC insertion pain

Reassure her that IUC insertion is not painful

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* 6. The IUC is inserted with some cramping and spotting at the time of the procedure. You discuss a non-prescription treatment plan to address cramping. What would you advise regarding suggested follow-up after IUC insertion?

Return in 3-6 weeks to review symptoms and confirm that the IUC is in place

Return for annual exam in 1 year

As long as there is no severe cramping or heavy bleeding, no other follow-up is required

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* 7. The patient calls 5 days later with unexpected, persistent, heavy bleeding and severe cramping slightly relieved by nonsteroidal anti-inflammatory drugs (NSAIDs). Which statement best describes your evaluation at this point?

Bleeding and cramping are expected in early cycles after IUC insertion; no further follow-up is needed unless she has fever

If the IUC has perforated the uterus, she will not be able to consider this type of contraception in the future

She must be seen promptly to determine placement of the IUC and to rule out expulsion and/or perforation

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* 8. As a result of participating in this activity, I hope to be better able to:

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