An oral combined contraceptive user with elevated D-dimer post COVID-19: a case report

Background This case discusses the challenges created by COVID-19 (coronavirus disease 2019) in the area of hormonal contraception, highlighting the contraception knowledge gap for women in their post COVID-19 period, especially if they had high D-dimer levels. Case presentation This case involves a thirty-eight-year-old woman taking combined oral contraception (desogestrel/ethinyl oestradiol tablets) with a history of varicose veins. She recovered from a COVID-19 infection in November 2020. She presented to the emergency room with right lower-limb pain below the knee and progressive swelling for five days in February 2021. Physical examination of the lower limb showed mild swelling and tenderness of the right leg compared to the left leg. D-Dimer was elevated (1.06 mcg/mL FEU). COVID-19 screening was negative. A Doppler scan to exclude DVT was performed considering the clinical picture and high D-dimer level. There was no evidence of DVT in the right limb. She was reassured and discharged with instructions on when to visit the emergency room. The D-dimer had decreased to 0.53 mcg/mL FEU in March 2021. She booked an appointment with family medicine clinics because she was concerned about the continuation of combined oral contraception (desogestrel/ethinyl oestradiol tablets) with high D-dimer and risk of thrombosis. The follow-up D-dimer level in May 2021 was normal (0.4 mcg/mL FEU). The patient preferred to continue taking oral contraception. Conclusion An evidence-based consensus is needed to guide clinicians in providing contraception counselling for such patients.

Oestrus synchronisation with progestagen injectables in West African Dwarf does.

The efficacy of progestagen injection for synchronising oestrus in West African Dwarf (WAD) does was evaluated. The progestagen injections used were 50mg Progesterone; 100mg Progesterone; 25mg Medroxyprogesterone acetate, MPA, 50mg MPA; 25mg Progesterone plus 0.04mg Ethinyl oestradiol combination and 50mg progesterone plus 10i.u oxytocin. The highest oestrous response of 84.6% was obtained with 100mg of Progesterone injection while the MPA groups did not show: oestrus for upward of 50days post injection. A degree of synchrony >50% was obtained only in those treatments containing above 50mg progesterone. Conception rate (Fertility) at first oestrus was above 75% in'all the responding groups except the 50mg progesterone where only 20% of the 71.4% does in oestrus and mated conceived. A single intramuscular injection of 100mg progesterone to postpartum does between 21 and 28days post-kidding led to significant (p<0.05) reduction of 47 and 27 days in the kidding interval of does under the scavenging and confined management systems respectively. These results indicated that there is good prospect in the use of progestagens injectables for oestrus synchronisation and possibly to shorten the kidding interval of WAD does especially under the predominant smallholder management situation. However further studies are required to establish the mechunism of the effects observed and to determine the appropriate dosage of administration of the progestagens.