QuestionSBA
QuestionChoice
An ultrasound would not be able to reliably detect pregnancy in its early stages. Before sterilisation, patients are advised to be on effective contraceptive for a month to minimise the risk of pregnancy at the time of the procedure, which can lead to ectopics occurring. This patient has not been taking effective contraception and has had sex recently; thus, her procedure should be cancelled.
53076
e
Ultrasound to assess for pregnancy and, if negative, proceed
QuestionChoice
Before sterilisation, patients are advised to be on effective contraceptive for a month to minimise the risk of pregnancy at the time of the procedure, which can lead to ectopics occurring. This patient has not been taking effective contraception and has had sex recently; thus, her procedure should be cancelled. Pregnancy tests may be negative in the very early stages of a pregnancy and as such a negative pregnancy test on the day of the procedure is not reliable enough to enable the operation to proceed. This should be explained to the patient and suitable contraception offered; in this case, due to issues with taking oral contraception or barrier methods previously, a LARC may be the best option but this is a conversation to be had with the patient. Levonelle is an emergency contraceptive medication, which is provided within 3 d of unprotected intercourse to prevent pregnancy; there is nothing in the question to suggest the patient wants emergency contraception, and even if she did this would not be an option available to her since her unprotected intercourse was 2 weeks ago. If Levonelle were an option, you would still not proceed with the procedure due to the subsequent risk of pregnancy still being relatively too high and you would postpone until the patient has been taking contraception for a month.
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53075
d
Give levonorgestrel (Levonelle) and proceed
QuestionChoice
Before sterilisation patients are advised to be on effective contraceptive for a month to minimise the risk of pregnancy at the time of the procedure, which can lead to ectopics occurring. Pregnancy tests may be negative in the very early stages of a pregnancy and as such a negative pregnancy test on the day of the procedure is not reliable enough to enable the operation to proceed. This patient has not been taking effective contraception and has had sex recently; thus, her procedure should be cancelled.
53074
c
Perform a pregnancy test and, if negative, proceed
QuestionChoice
Before sterilisation, patients are advised to be on effective contraceptive for a month to minimise the risk of pregnancy at the time of the procedure, which can lead to ectopics occurring. This patient has not been taking effective contraception and has had sex recently; thus, her procedure should be cancelled. Pregnancy tests may be negative in the very early stages of a pregnancy and as such a negative pregnancy test on the day of the procedure is not reliable enough to enable the operation to proceed. This should be explained to the patient and suitable contraception offered; in this case, due to issues with taking oral contraception or barrier methods previously, a long-acting reversible contraception (LARC) may be the best option but this is a conversation to be had with the patient.
53072
a
Postpone sterilisation
QuestionChoice
Before sterilisation, patients are advised to be on effective contraceptive for a month to minimise the risk of pregnancy at the time of the procedure, which can lead to ectopics occurring. This patient has not been taking effective contraception and has had sex recently; thus, her procedure should be cancelled. Pregnancy tests may be negative in the very early stages of a pregnancy and as such a negative pregnancy test on the day of the procedure is not reliable enough to enable the operation to proceed. This should be explained to the patient and suitable contraception offered; in this case, due to issues with taking oral contraception or barrier methods previously, a LARC may be the best option but this is a conversation to be had with the patient.
53073
b
Proceed with sterilisation
QuestionComment
Not really clear from the stem whether she has been taking the pill or not
58266
User
subscriber
Monoclonal Metabolism
Concept
Chapter
# Management of missed combined oral contraception pills


​If patients are sick (vomit) within 3 hours of taking a combined pill, or within 2 hours of taking a progestogen-only pill, it probably will not have been absorbed by their body. Patients should take another pill straight away.
As long as they're not sick again, they will still be protected against pregnancy.
Patient should be advised to take their next pill as usual.


The pill free week is the 7 days between taking packets of pills. There is occasionally a breakthrough bleed, a small bleed similar to a period, however the absence of a breakthrough bleed does not indicate pregnancy.


Missed pill rules:


- If pills are missed in week 1: use emergency contraception if she had UPSI in pill free interval for 1 week


- If pills are missed in week 2: no need for emergency contraception


- If pills are missed in week 3: Take the last pill that was missed, finish the current pack and start the next pack immediately after.


# References


[Click here to see information on NICE about missed pills](https://cks.nice.org.uk/topics/contraception-combined-hormonal-methods/management/combined-oral-contraceptive/#missed-coc-pills-except-qlaira-zoely)
8
3456
Missed combined oral contraceptive pills
Topic
27
Genitourinary medicine
10675
Prior to female sterilisation, ensure effective contraception is used for at least one month to reduce the risk of unintended pregnancy, a contraindication for sterilsation.
Presentation
172
Contraception request/advice
UkmlaTopic
18
Obstetrics and gynaecology
A 34-year-old woman attends the surgical admission unit as she is scheduled to undergo female sterilisation today. She reports she has been using the combined oral contraceptive pill sporadically and does not use barrier contraception regularly. She has had sex in the past 2 weeks and her last menstrual period was 2 weeks ago. She has irregular cycles lasting between 25 and 32 d.

What is the next best step in her management?
a