Which of the following is the best contraceptive method for a woman who has a history of thrombophlebitis, di… - AIIMS Rishikesh NO - 2019

AIIMS Rishikesh NO - 2019

Obstetrics & Gynaecology

Hard

Appeared in: AIIMS Rishikesh NO - 2019

Explanation

Tubal ligation is a permanent surgical method of contraception, as shown in the image.
It is non-hormonal, so it does not increase the risk of blood clots, making it safe for a woman with a history of thrombophlebitis.
The procedure does not involve placing any device in the vagina or uterus, so it does not interfere with or worsen an active vaginal infection.
It is considered one of the most effective forms of contraception and is a safe option for women with complex medical histories like the one described.

Option B: Oral contraceptive pills, especially those containing estrogen, are absolutely contraindicated in women with a history of thrombophlebitis or deep vein thrombosis (DVT).
Option C: A diaphragm is a barrier method that is inserted into the vagina. Its use is contraindicated during an active vaginal infection as it can trap bacteria, potentially worsening the infection and increasing the risk for pelvic inflammatory disease (PID) or toxic shock syndrome (TSS).
Option D: An Intrauterine Device (IUD) should not be inserted in a woman with an active, untreated vaginal or pelvic infection. The insertion process could spread the infection into the uterus, causing PID.

Clinical Relevance

Nursing practice connection: Use the key finding related to Selection of appropriate contraceptive methods based on a patient's medical history and contraindications to guide bedside assessment, documentation, and the next nursing action.
A nurse's primary role in contraceptive counseling is to perform a thorough health history assessment to identify any absolute or relative contraindications for each method.
Patient education is critical. The nurse must explain the risks and benefits of each suitable option, ensuring the patient can make an informed decision that aligns with their health status and reproductive goals.
What if the patient's vaginal infection was treated and resolved? An IUD could then become a viable long-term option, but oral contraceptives would still be contraindicated due to the history of thrombophlebitis.

How to Approach the Question

First, identify the key elements of the patient's medical history provided in the question: thrombophlebitis, diabetes, and vaginal infection.
Next, evaluate each contraceptive option against this medical history.
Consider Oral Contraceptive Pills: Recall that hormonal methods with estrogen are contraindicated in patients with a history of blood clots (thrombophlebitis). This eliminates this option.
Consider the Diaphragm and IUD: Recall that methods involving insertion of a device into the vagina or uterus are contraindicated in the presence of an active infection. This eliminates both of these options.
Finally, evaluate Tubal Ligation: This is a surgical, permanent method that has no hormonal component and does not involve placing a foreign body in the infected area. It does not carry the risks associated with the other options in this specific clinical scenario.
Conclude that tubal ligation is the safest and therefore the 'best' choice among the given options.

Concept Tested & Keywords

Concept Tested: Selection of appropriate contraceptive methods based on a patient's medical history and contraindications.
Stem keywords: contraceptive method, thrombophlebitis, diabetes, vaginal infection
Lead-in keywords: best
Clinical cues: History of thrombophlebitis is a major contraindication for hormonal contraceptives.
Clinical cues: Active vaginal infection is a contraindication for intrauterine devices and diaphragms.

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E6 Medicine Harrison 22e Part 2 pp. 1057-1059, 1056-1058

E6 Nursing Fundamentals Potter Perry 12e Part 4 p. 2