Tubal sterilization SD
Candidate’s Instructions
This is a Structured Discussion Task assessing the Following Clinical Skills:
- Information Gathering
- Communication with Colleagues
- Applied Clinical Knowledge
- Patient Safety
You are an ST5 in the Contraception Clinic. You are Going to See Mrs. Sansa Lannister, 28 Years Old Housewife. She is Asking for Tubal Sterilization as a Method of Contraception.
Your Consultant (The Examiner) Wants to Discuss With You The Management Plan for Mrs. Lannister Before You See Her.
You Have 10 Minutes During Which You are Expected to:
- What are the Additional Information You Need to Know?
- How You Will Discuss her about Her Options?
- Is Partner Consent Needed for The Procedure?
- Is History of Ectopic Pregnancy a Contraindication for IUCD?
- What about Condom? Failure Rate of Condom?
Patient Referral Letter
Watford Clinic, Bond Street
Name: Mrs. Sansa Lannister
DOB: 1/4/1995
Hospital Number: 1234567789
To:
The Gynecology Clinic
University Hospital
Dear Doctor,
Good day,
I Appreciate If You Could Arrange an Appointment For Mrs. Lannister, a 28 Years Old Woman Who Wants to Discuss Her Options for Contraception.
Mrs. Lannister Is In a New Relationship. She is P1+1 With History of Previous CS & Has 1 Boy From a Previous Partner & History of Previous Ectopic Pregnancy. She is Asking for Tubal Sterilization but She is Not Willing to Inform her Partner About The Procedure. She Is Known Epileptic On Carbamazepine.
Yours Sincerely
Dr. H. Salah
Questions & Answers
What Are The Additional Information You Need To Know About Her?
- The Reason Behind Her Request of Sterilization
- If She Knows about LARC as an Alternative
- If She has Been Offered PIL
- Previous Contraception History (Needs Protection Now)
- Previous Obstetric History
- Number & Mode of Deliveries
- Number & Sex of Living Children
- Gynecological History
- Periods Regularity, Amount & LMP
- History of STIs
- Medical History
- Details about the Degree of Epilepsy & Its Control
- Other Medical Condition that Contraindicate Pregnancy
- Medication History, Drug Allergy & BMI
- Surgical History
- For Expecting Difficulties During The Procedure
- Social History
- To assess The Possibility of Relationship Difficulties
- Why She is Not Willing to Inform The Partner?
- Safe Guarding Issues for Her & Child
- Mental History
- To Assess her Capacity to Consent For The Procedure
- To assess if Unsure or Under Stress
Is Partner Consent Needed For The Procedure?
- By Law No Need For Partner’s Permission.
- It is Recommended They Are Counseled Together.
- Some Doctors Prefer Mutual Agreement in Married Couples.
How Will You Counsel Her Regarding The Procedure?
- Definition: Operation to block/seal fallopian tubes to prevent fertilization
- Benefits:
- >99% effective
- No hormonal effect or interruption to sex life
- Risks:
- Failure rate 1:200
- Complications: bleeding, infection, organ damage
- Not reversible or covered by NHS
- High regret in <30s with no children
- Important:
- Use contraception before/after
- Pregnancy test on day of procedure
Surgical Methods for Female Sterilization
- Laparoscopy: Fast recovery (Failure Rate 2-5:1000)
- Mini-Laparotomy: Recommended in certain cases
- Tubal Occlusion:
- Clips, rings, cut and tie, or salpingectomy
- Salpingectomy may reduce ovarian cancer risk
What to Expect after Surgery
- Wound care, pain, bleeding
- Anesthesia side effects
- Return to sex, work, and exercise
- Red flag signs & contact numbers
Alternatives (LARC)
- IUCD: Copper coil, failure rate 6:1000
- IUS: Mirena, hormonal, failure rate 2:1000
- Depo Injection: Every 3 months, suitable for epilepsy
- Implants: Most effective, avoid in enzyme-inducer users
- Vasectomy: Not suitable in this case
Additional Precautions
- IUCD/IUS better under hospital setting for epilepsy
- No contraindication of IUCD with ectopic hx
- Condoms protect STIs but high failure (2:100)
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