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sue



Points : 42144
Join date : 2013-12-26

PostSubject: AMC Clinical discussion   Thu Dec 26, 2013 1:14 pm



Miss Howe is a 22 years old woman with two children and would like to be sterilized. Obtain informed consent for tubal sterilization.

More history:2 children

Partner, father of second child

No work, partner is also unemployed

She doesn’t like the pill




Management
Explore relationship: stable?

Talk about other contraception:

# Male sterilization: easier

# IUD (Mirena): carry risk of infection esp. this case; more chance of having more than one partner and unstable relationship

# Implantation: last about 3 years (Implanon)

Explain pros and cons of sterilization

# If fail, increase risk of ectopic pregnancy

# reverse rate is very poor: 25-70% and still increase ectopic pregnancy after reverse

# reverse procedure is not cover by medicare

# long waiting list

# dose not protect from STD.

Explain about laparoscopy and surgery of tubal ligation

Give another contraception before she leaves as she has to be on contraception while she is in the waiting list




(Hello Mrs. Howe, I’m Dr……., I understand that you come to see me today because you want to do permanent sterilization. I would like to ask you a few questions and the condition related to you, is that alright?




You are 22? Do you have children? How many? Are you sure that you don’t want to have any more children in the future?

Do you have a partner? Does he know about your decision? Does he agree?

Why do you want to be sterilized?




Do you know about other contraception methods such as oral contraceptive pills, coils, condoms, diaphragm and cups? There is also an implantation for contraception that is very effective and can be used for about 3 years each time. Have you heard about that? Are you interested in considering that?




What do you know about female sterilization?

Female sterilization is a procedure by which the fallopian tubes that are the tubes between the womb and ovaries are cut, sealed or blocked (draw diaphragm). This stops eggs moving down to meet sperms.




The operation can be done in several ways, the most common method is by laparoscopy or a key hold surgery. This is usually done under general anesthesia, where you will be put to sleep. A doctor will make 2 tiny cuts, one just below your navel and the other just above the bikini line in the lower part of your tummy, they will then insert a laparoscope, it is a thin telescope-like instrument with lens to look at your reproductive organs.




Another common way is by mini-surgery, usually you will be put to sleep as well. A doctor will make a small cut in your tummy, just below the bikini line to reach the tubes.




You need to stay in the hospital, usually a couple of days, depending on types of anesthesia and operation. After operation, if you have general anesthesia, you might feel unwell for few days and may have some bleeding and pain, which is slight.




You must consider sterilization as permanent method of contraception. However, there is an operation to reverse it but it is complicated and may not work, Medicare doesn’t cover for that either.




The failure rate of female sterilization is 0.1-0.3%. Pregnancy rate after reversal is around 50% with high risk of ectopic pregnancy, which is very dangerous.




The advantage is that it does not interfere with sex, your womb and ovaries will remain in place. Ovaries will still release an egg every month and your sex drive and enjoyment will not be affected. Actually, they may improve as fear of pregnancy is no more an issue. Occasionally, some women might find their period becomes heavier, but it is usually because of their age and stopping contraceptive pills. You can start sex as soon as you feel comfortable.




You must continue contraception until time of operation as now you are put on a waiting list. If you use IUCD, it should be left until the next period. You should contact your doctor if you think that you are pregnant or if you miss a period and especially if it is accompanied with tummy pain.)

Pamphlet to consider. Make appointment any time when you have made up your mind.

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