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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Which Test Should Be Ordered To Confirm Pregnancy?

Hi There I am GP in Australia. I have been questioned by medical board about prescribing depo- provera injection for a 20 day pregnant woman. the story is that patient said her LMP was last week and she has not had any sexual contact since then. she received depo injection the next day. 2-3 weeks later after 3 more consultations with chief compliant of nausea and bloating with me and another senior doctor finally I ordered a HCG test which came back positive. My question is should I order a urine or blood HCG test if a woman with regular cycles come to receive intramascular contraption when she claims her LMP was a week ago and she has had no sexual contact ? I appreciate your answers.
Wed, 14 May 2014
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OBGYN 's  Response
Hi,
Thanks for consulting us.
I would like to revise some facts about Depo provera birth control with you.
Birth control with Depo-Provera begins immediately after the first shot if given within the first five days of a woman's menstrual period.
It may take about one week to effect if given after the first five days of the cycle.
So,to ensure that our patient is not pregnant at the time of the first injection, the first injection should be given ONLY during the first 5 days of cycle, ONLY within the first 5-days postpartum if not breast-feeding and if exclusively breast-feeding, ONLY at the end of sixth postpartum week.
A deviation from these precautions usually result in failures.
We all know that LMP is no longer considered the most reliable marker to date a pregnancy, rather we rely more on dating ultrasound because LMP can be wrong in 40% of pregnant ladies. In other words we seek for lab evidence now.
It is considered a good practice to do a pregnancy test ( preferably serum beta hCG) before initiating a new contraception to minimize the chances of undiagnosed/ unsuspected pregnancies. This can save us from situations like yours. As patients are lay persons & they cannot be blamed for any mishap. Doctors usually have to take the responsibility, if anything goes wrong.
Last but not the least, no ill effects on the developing baby have been shown to occur if Depo Provera is given accidentally to a pregnant lady or in the very rare case where a woman becomes pregnant despite the injection.
Hope this is somehow helpful for you.
Best regards.



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Which Test Should Be Ordered To Confirm Pregnancy?

Hi, Thanks for consulting us. I would like to revise some facts about Depo provera birth control with you. Birth control with Depo-Provera begins immediately after the first shot if given within the first five days of a woman s menstrual period. It may take about one week to effect if given after the first five days of the cycle. So,to ensure that our patient is not pregnant at the time of the first injection, the first injection should be given ONLY during the first 5 days of cycle, ONLY within the first 5-days postpartum if not breast-feeding and if exclusively breast-feeding, ONLY at the end of sixth postpartum week. A deviation from these precautions usually result in failures. We all know that LMP is no longer considered the most reliable marker to date a pregnancy, rather we rely more on dating ultrasound because LMP can be wrong in 40% of pregnant ladies. In other words we seek for lab evidence now. It is considered a good practice to do a pregnancy test ( preferably serum beta hCG) before initiating a new contraception to minimize the chances of undiagnosed/ unsuspected pregnancies. This can save us from situations like yours. As patients are lay persons & they cannot be blamed for any mishap. Doctors usually have to take the responsibility, if anything goes wrong. Last but not the least, no ill effects on the developing baby have been shown to occur if Depo Provera is given accidentally to a pregnant lady or in the very rare case where a woman becomes pregnant despite the injection. Hope this is somehow helpful for you. Best regards.