Tubal sterilization SD by copy direct

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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

Structured Discussion Sections

Questions
  1. What points in her history do you want to know?
  2. How are you going to counsel her?
  3. Tell me about pros & cons of each & failure rate of each
  4. After counselling she is insisting for sterilization. What are you going to do?
  5. After meeting with Counsellor and Consultant, she is still insisting.
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: Degree of Epilepsy & Its Control, Other Medical Conditions, Medication History, Drug Allergy & BMI
  • Surgical History: Any Expecting Difficulties During The Procedure
  • Social History: Relationship Difficulties, Not Informing Partner, Safeguarding Issues
  • Mental History: Capacity to Consent, Emotional Stress/Postpartum State
Is Partner Consent Needed For The Procedure?
  • By Law No Need For Partner’s Permission.
  • Recommended That They Should be Counseled Together.
  • Some Doctors Prefer Both Married Partners Agree After Proper Information & Counselling.
How Will You Counsel Her Regarding The Procedure?

✔ Female Sterilization: Permanent procedure. Blocks/seals fallopian tubes to prevent fertilization.

✔ Benefits (Pros):

  • >99% Effective
  • Does Not Affect Sex Drive or Hormones
  • No Need to Remember Daily Contraception

✔ Risks (Cons):

  • Not Immediately Effective – Use Contraception Until Confirmed
  • Surgical Risks: Infection, Internal Bleeding, Organ Damage
  • Failure Rate ~1:200 → Ectopic Risk
  • High Regret Rate in <30 yrs or Childless
  • Reversal Difficult & Not Routinely Offered on NHS
  • No STI Protection – May Need Condoms

✔ The Procedure:

  • Minor Day Case Surgery (NHS Available but Waiting Lists Exist)
  • Performed Under GA or LA
  • Contraception Until Day of Surgery + Pregnancy Test
  • Can be Done Any Time in Menstrual Cycle
Surgical Methods for Female Sterilization
  • Laparoscopy: Preferred. Quick Recovery. Failure Rate 2–5:1000
  • Mini-Laparotomy: Preferred for Obese, Prior Surgery or PID

Surgeon May Use:

  • Clips: Plastic/Titanium. Failure Rate 3:1000
  • Rings: Fallopian Loop Through Silicone Ring, Clamped Shut
  • Salpingectomy: Full Removal of Tubes → Reduces Ovarian Cancer Risk
What to Expect After Surgery
  • Wound Care, Bleeding
  • Anesthetic Effects & Driving
  • When to Resume Sex
  • Red Flag Signs
  • Return to Work
Alternatives (LARC)

1. IUCD (Copper Coil)

  • Prevents Sperm Survival & Fertilization
  • Failure Rate: 6:1000
  • Duration: 5–10 Years
  • Periods May be Heavier
  • Fertility Returns Immediately

2. IUS (Mirena)

  • Hormonal (Levonorgestrel)
  • Failure Rate: 2:1000
  • Lasts 5 Years
  • Periods Become Lighter or Stop
  • Fertility Returns on Removal

3. Injectable (Depo-Provera)

  • IM every 12 weeks
  • Failure Rate: 2:1000
  • Delays Fertility Return (~1 year)
  • May Cause Amenorrhea or Irregular Bleeding
  • Safe for Epileptic Patients on Enzyme Inducers

4. Implant

  • Most Effective: Failure Rate 5:10000
  • Not suitable for enzyme-inducer drugs (e.g., Carbamazepine)

5. Male Sterilization (Vasectomy)

  • Failure Rate: 1 in 2000
  • Less Risk, Usually Under Local
  • Not Applicable in This Case
Additional Precautions
  • IUCD/IUS Should Be Inserted in Hospital Setting with Seizure Precautions
  • IUCD is Safe in Women with Prior Ectopic
  • Condoms for STI Protection but High Failure Rate (~2 in 100)

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