05-29-2008, 11:46 AM
CC
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contraception - jazzblue
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05-29-2008, 12:29 PM
sunshine09 and mpowerag r right
Correct answer is D Explanation: Patients with sickle-cell disease are at a very high risk for complications during pregnancy. The possible complications include acute crisis, endometrial infection, pyelonephritis, and thromboembolic events. Up to 46% of sickle-cell patients have complications during pregnancy. Such patients therefore need a safe and very effective method to prevent undesirable pregnancies. In this patient, depot medroxyprogesterone appears to be the contraceptive of choice. Since medroxyprogesterone acetate is given every three months, this patient will most likely be compliant with the treatment. Furthermore, there are some studies which suggest that the use of medroxyprogesterone acetate in patients with sickle-cell disease decreases the risk of acute crisis. (Choice A) The use of combined oral contraceptive pills (OCPs) in sickle-cell disease is controversial. Although no studies have shown that the use of OCPs in patients with sickle-cell disease is associated with an increased risk of thromboembolic complications, many physicians still do not use this form of contraception for such patients. Aside from this patient's disease, her history of a stroke and noncompliance are more reasons to not recommend the use of OCPs. A history of stroke is a contraindication to use OCPs, and noncompliance to a daily contraceptive regimen such as OCPs will decrease the efficacy of this regimen. (Choice B) Progesterone-only pills are associated with an increased incidence of breakthrough bleeding. Such an adverse event may lead to a significant blood loss which may aggravate the anemia of this patient. Furthermore, patients who use this mode of contraception have to be compliant since regular intake of these pills is required for the drug to be efficacious. (Choice C) Intrauterine devices (IUDs) are also safe in patients with sickle-cell disease. There is no increase in the incidence of uterine infection with the use of an IUD; however, IUDs are sometimes associated with increased uterine bleeding which could worsen the anemia of these patients. For this reason, most physicians avoid using IUDs in patients with sickle-cell disease. (Choice E) Patients with sickle-cell disease should have a reliable method for contraception because the complication rate of an undesirable pregnancy is very high. Barrier contraception is associated with a high failure rate. Furthermore, this patient has a previous history of noncompliance with barrier contraception; therefore, this method is not preferred. Educational Objective: Pregnancies in patients with sickle-cell disease are associated with a very high risk of complications; therefore, patients with sickle-cell disease need a safe and reliable method for contraception to prevent undesired pregnancies. The use of oral contraceptive pills in patients with sickle-cell disease is controversial despite the fact that no studies show any associated increased side effects with OCP use. Depot medroxyprogesterone appears to be safe and effective in preventing pregnancies in patients with sickle-cell disease. |
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