How to rule out pregnancy before initiating a contraception

Sexual and reproductive health

1. Ruling Out Pregnancy

2. Scenario 1 A 29yr P2+0 woman came to IRC clinic for IUD insertion. Her menstruation has not been commenced since delivery and her baby is 3-month-old. She is breastfeeding her baby, but she also feed some supplement because of inadequate breastmilk. She is not using any FP method since delivery and have sex contact 2 weeks ago. Will you provide IUD insertion to the client? How will you manage this case?

3. Scenario 2 A 35yr old, P3+0 woman from hard-to-reach areas come to IRC clinic for Implant insertion. She is the mother of 10-month boy and has no period since delivery. She took one Depo inj : from AMW 45 days after the delivery but no longer use any FP method since then. How will you exclude pregnancy? Will you provide implant insertion service?

4. Scenario 3 A 42yr old, P3+1 woman visit IRC clinic for FP method switch due to her irregular menstrual pattern and weight gain. she said she has inserted Jadelle over 4 year ago but can’t remember the exact date. She want to remove Jadelle and use IUD method now. She has sex with her husband just occasionally, but her last sex contact is 18 days ago. Will you provide IUD to the client?

5. Scenario 3 A 21-year-old, P1+0 woman visit IRC clinic for implant insertion. She has history of regular bleeding, but it is between her two periods. Her last menstrual period is 17 days ago, and she believe her next period will come after 12 days from now. She has sex contact with her husband 7 days ago and use withdrawal method only. How will you exclude pregnancy? How would you like to manage this case?

6. Scenario 4 A 17-year-old newly married girl came to IRC clinic for LARC method insertion. She has a history of regular menstrual pattern, but her period is late for 3 days now. She has regular sex contact and her husband use condom sometime. Will you provide LARC to this young girl?

7. Important points to remember! Start with Pregnancy Checklist When the Checklist can be used appropriately, no reason to prefer a test Pregnancy tests are not likely to work before the first day of missed monthly bleeding The only FP method which pose a health risk if started during pregnancy is the IUD All hormonal methods except LNG-IUD can be provided without delay Delaying the start of the method is the worst choice

8. Pregnancy Checklist Providers can be reasonably certain that a client is not currently pregnant if one or more of the checklist are met. Ask the client criteria question 1 – 7. If the client answers “Yes” to at least one of the questions, reasonably sure she is not pregnant If the client answers “No” to all questions, rule out pregnancy by other means.

9. No Criteria Questions Yes 1. Did your last monthly bleeding start within the past 7 days?* 2. Have you abstained from sex since your last menstruation, delivery, abortion, or miscarriage? 3. Have you been using a reliable contraceptive method correctly and consistently since your last menstruation, delivery, abortion or miscarriage? 4. Have you have a baby in the last 4 weeks? 5. Did you have a baby < 6 month ago, are you fully or nearly-fully breastfeeding and had no monthly bleeding since then? (LAM) 6. Have you had a miscarriage or abortion in the past 7 days?* 7. Have not sex for at least 21 days and have a negative high-sensitivity urine pregnancy test** *If for Copper-bearing IUD, the 7-day window is expanded to 12 days.

10. Thank You