TAILIEUCHUNG - Special considerations

How can a provider be reasonably sure that a woman is not pregnant, or just about to be pregnant in a conception cycle? WHOSPR advises that the provider can be reasonably certain that the woman is not pregnant if she has no symptoms or signs of pregnancy and one or more of the following criteria apply: 1. She has not had intercourse since last normal menses 2. She has been correctly and consistently using a reliable [sic] method of contraception 3. She is within the first 7 days after (onset of) normal menses 4. She is within 4 weeks postpartum for. | Special considerations How can a provider be reasonably sure that a woman is not pregnant or just about to be pregnant in a conception cycle WHOSPR advises that the provider can be reasonably certain that the woman is not pregnant if she has no symptoms or signs of pregnancy and one or more of the following criteria apply 1. She has not had intercourse since last normal menses 2. She has been correctly and consistently using a reliable sic method of contraception 3. She is within the first 7 days after onset of normal menses 4. She is within 4 weeks postpartum for non-lactating women 5. She is within the first 7 days post abortion or miscarriage 6. She is fully or nearly fully breastfeeding as in LAM - Figure 19 p. 143 amenorrhoeic and less than 6 months postpartum. Note Good clinical judgement is vital with respect to assessing the accuracy of the given history including the absence of symptoms of pregnancy the believability of reported abstinence especially regarding point 2 in the list reliability of reported correct condom use is notoriously difficult to assess. In the UK as appropriate these criteria can be backed by a urine pregnancy test with a sensitivity of at least 25 lU l best on a concentrated early morning sample. Such tests are unnecessary and wasteful if there could not possibly yet be an implanted blastocyst present - including for example at the time of most requests for EC . in pill-takers when pills have just been missed . 144 Some applications of the above Quick start This means immediate starting of usually a pill method at first visit late in the menstrual cycle or straight after EC. This may often be an entirely appropriate though unlicensed use p. 150 but only when the above criteria have been applied so that the provider is reasonably sure of a woman neither being nor just about to be pregnant. Secondary amenorrhoea wants to re- start contraception This is where the greatest difficulty arises - for example postpartum not breastfeeding .

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