Latest Edition
Postpartum IUD Placement at 4 Weeks: Timing, Risk, and Counseling
A 23-year-old G1P1 (she/her) is coming in for her first postpartum visit after a normal spontaneous vaginal delivery. She was supposed to come for a 2-week check-in, but missed the appointment. She is now 4 weeks postpartum. She reports the baby is doing well. She is feeling fine, currently breastfeeding and tells you she stopped spotting “a while ago.” She had vaginal sex with her partner 2 days ago for the first time since delivery and they used a condom. Toward the end of her pregnancy, she indicated she wanted to get a copper IUD and now asks you if you can place it today. Her partner went back to work and childcare for an extra visit is difficult.
Person-Centered Pregnancy Options Counseling for Ambivalent Patients
A 21-year-old patient (she/her) presents to your health center after a positive home urine pregnancy test last week. Based on a sure last menstrual period (LMP), the patient currently has an estimated gestational duration of 6 weeks. When you ask how she's feeling about being pregnant, she pauses and says, "Honestly? I don't know. I think I could see myself going either way. I just don't know what the right thing to do is."
She has a 3-year-old at home, a job she's not sure allows for more time off, and a partner she describes as "supportive but not pushing me either way." She denies urgent safety concerns and has no significant medical history.
Rh Testing in Early Abortion Care: A Clinical Scenario
A 29-year-old G2P1 (she/they) presents for medication abortion at 8 weeks of gestation, consistent with a 6-week ultrasound demonstrating a single intrauterine pregnancy. She reports, “I think I got a shot after I had my son. Do I need a shot before I take the pills?"
She reports her previous pregnancy was uncomplicated. She is not certain of her prior Rh status. She is not certain about a desire for future pregnancies.
Correcting Crisis Pregnancy Center Disinformation: Abortion, Breast Cancer Risk, and Ultrasound Reliability
A 22-year-old G1P0 patient comes in after a positive home urine pregnancy test two weeks ago. While waiting for their visit with you, they went to a local crisis pregnancy center (CPC) for a free ultrasound. The CPC estimated they were 7 weeks. During the visit, they were told that abortion significantly increases the risk of breast cancer. They are feeling ambivalent about continuing this pregnancy or having an abortion and not sure what to believe.
Vasovagal Reactions During IUD Insertions: How to Recognize, Interrupt, and Prevent
A 24-year-old (she/they) presents to your health center requesting an IUD. They filled out her intake form online and noted they are "nervous about procedures." As you are sounding their uterus, they say they feel "kind of weird." You ask for more detail, and they report they are a little sweaty and like they need to go to the bathroom. The medical assistant notes that their face has “gone pale.”
Residual Products of Conception After Medication Abortion: Diagnosing and Managing RPOC
A 26-year-old (she/her) presents to your health center four weeks after a medication abortion at eight weeks of gestation. She reports bleeding was initially heavy with blood clots, and is now lighter, but she continues to have intermittent light bleeding and mild cramping. She reports she believes she is not pregnant anymore, as pregnancy symptoms have resolved, but is not sure if things are "done."
A transvaginal ultrasound shows a heterogeneous collection and thickened endometrial stripe, without a persistent gestational sac or evidence of an ongoing pregnancy.
Counseling Patients on Fertility Awareness-Based Methods (FABM): A Clinical Scenario
What providers need to know about supporting patients who want to use fertility awareness-based methods
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