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POP after vomiting — DFSRH MCQ

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HardProgestogen-only contraceptionPOP after vomitingDFSRH

An etonogestrel implant was inserted yesterday, 48 hours after UPSI, but neither the clinician nor patient could palpate it before discharge. Pregnancy was not otherwise excluded and no emergency contraception was given. What is the best next step?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Use alternative contraception, assess EC and pregnancy follow-up, and image the implant

The best answer is “Use alternative contraception, assess EC and pregnancy follow-up, and image the implant”. An implant should be palpable after insertion; if it is not, effective insertion and location cannot be assumed. The patient needs alternative contraception while imaging locates the radiopaque device, with specialist management if deeply placed or migrated. Because insertion followed recent UPSI and pregnancy was not excluded, emergency contraception must be assessed promptly and a pregnancy test timed at least 3 weeks after the exposure. Blind reinsertion risks two devices.

Reference: CoSRH/FSRH, Progestogen-only Implant: https://www.cosrh.org/Common/Uploaded%20files/documents/fsrh-guideline-progestogen-only-implants.pdf | CoSRH/FSRH, Emergency Contraception (amended July 2023): https://www.cosrh.org/Common/Uploaded%20files/documents/fsrh-guideline-emergency-contraception03dec2020-amendedjuly2023-11jul.pdf