A nurse is reinforcing teaching with a client about various contraceptive methods. Which of the following statements should the nurse include in the teaching?

(a) "You will need to receive a medroxyprogesterone acetate injection once per month."
Medroxyprogesterone acetate injections (Depo-Provera) are administered every three months (every 12 weeks), not monthly. This statement is incorrect and could lead to confusion about the correct usage of this contraceptive method.

(b) "Combined estrogen-progestin contraceptive pills cause longer periods."
Combined estrogen-progestin contraceptive pills typically result in shorter, lighter, and more regular periods, rather than longer ones. This statement is incorrect and misrepresents the effects of combined oral contraceptives on menstrual cycles.

(c) "Oral contraceptives decrease the risk for endometrial cancer."
This statement is correct. Oral contraceptives, particularly those containing both estrogen and progestin, are known to decrease the risk of endometrial cancer. This is an important benefit of using oral contraceptives and is a factual statement that should be included in the teaching.

(d) "You will need to have your diaphragm replaced every 4 years."
A diaphragm typically needs to be replaced every 2 years, not every 4 years. Additionally, a diaphragm should be refitted if there are significant changes in weight, childbirth, or abdominal/pelvic surgery. This statement is incorrect regarding the replacement timeline.

(A) Retained placental fragments:
Retained placental fragments can lead to postpartum hemorrhage (PPH) due to incomplete expulsion of the placenta or membranes, which can cause ongoing bleeding. Failure of the uterus to contract effectively after childbirth to compress blood vessels at the placental site can result in excessive bleeding. This is a significant risk factor for PPH and requires prompt intervention to prevent complications.

(B) Urinary tract infection:
While urinary tract infections (UTIs) can occur in the postpartum period, they are not typically considered significant risk factors for postpartum hemorrhage. UTIs are more commonly associated with symptoms such as dysuria, frequency, and urgency.

(C) Oligohydramnios:
Oligohydramnios, a condition characterized by decreased amniotic fluid volume, is not a direct risk factor for postpartum hemorrhage. Oligohydramnios may be associated with other pregnancy complications but is not directly related to the risk of postpartum hemorrhage.

(D) Breech presentation:
While breech presentation (when the baby's buttocks or feet are positioned to deliver first) may increase the risk of complications during labor and delivery, it is not specifically linked to postpartum hemorrhage. Breech presentation may necessitate interventions such as cesarean section delivery to reduce the risk of birth-related complications, but it is not a direct risk factor for postpartum hemorrhage.