Download EMERGENCY CONTRACEPTION (EC)

EMERGENCY
CONTRACEPTION (EC)
DR. SUNESH KUMAR
DEPT. OF OBST-GYNAE
AIIMS
Emergency Contraception (EC)
(Post coital contraceptive / Morning after pill)
What is EC?
“Administration of a contraceptive after
unprotected coitus & before implantation of
pregnancy”
History of
Emergency Contraceptive (EC)
Ancient Methods
1. Vaginal douches
2. Inducing menses by taking oral drugs
Drugs
1.
2.
3.
4.
5.
Diethyl stillbesterol (DES)
Yuzpe’s regimen
Levonorgestrel (LNG)
Intra-uterine contraceptive device
Mifepristone (RU-486)
Emergency Contraception (EC)
“Seventy five percent of pregnancies are unwanted”
“Women decide to continue since they just conceived
and had no choice”
“If they know about a method which could protect
them after unprotected coitus, they would have used
it”
Why there is a need for EC
1. More often than not they get exposed when
they were not expecting it to happen.
2. Woman thinks she cannot conceive.
3. Unfortunate events - sexual assault / rape.
4. Failure of contraceptive : condom breakage
Mechanism of Action of EC
1. Prevent implantation of blastocyst
2. Tubal hurry
3. Changes in endometrium
4. Changes in cervical mucous
Emergency Contraception Window Period
“Emergency contraceptives (EC) are
effective if taken within 120 hours”
Yuzpe’s Regimen
 Tab Ovral -G : 2 stat, 2 after 12 hours
(Ethinyl estradiol : 50 µgm
+
Levonorgestrel : 500 µgm)
 Tab Ovral-L/Mala-D/Mala-N
4 stat, 4 after 12 hours
(To be taken within 72 hrs after coitus)
Success rate : 85%
Why Yuzpe’s Regimen
is not Popular
1. High incidence of nausea and vomiting
2. Breast tenderness
3. Relatively unsafe in women with CVA/CAD/Ca
Breast/Jaundice
Newer - Levonorgestrel (LNG)
Levonorgestrel 750 µgm 1 stat, 1 after 12 hrs
OR
Levonorgestrel 1500 µgm stat
Advantages1.
2.
3.
4.
Lesser nausea and vomiting
Relatively safe
Can be given upto 12 hrs
Success rate : 95-98%
Preparation of Levonorgestrel
(LNG)
1. Pill 72®
2. Ecee tablet®
3. Norlevo®
: Cipla
: German Remedies
: Shreya’s
Cost : Rs. 35-75/2 tabs
OTHER METHODS OF EC
1. Intrauterine Contraceptive Device
Advantage
: Can continue to use
Disadvantage : Risk of PID
2. Mifepristone (RU-486)
‘Still under trial’
“Not acceptable to some due to its use for
inducing abortion”
EC : Client Counseling and
Useful Information
Useful information to be provided to a client :
1. Emergency contraceptive is effective if taken within 120
hours after unprotected intercourse
2. Sooner the ECPs are taken after unprotected intercourse
more effective they are
3. Repeated unprotected intercourse in the same cycle can
not be protected by single use of ECPs
4. ECPs can prevent only 85% of pregnancies after
unprotected intercourse.
EC : Client Counseling and
Useful Information
5. Next period may be delayed upto 7 days after using
ECPs. In case she fails to get period within 7 days
after expected period she should contact her doctor.
6. Use of ECPs do not protect against STDs. She
should be advised tests for STD and treatment
accordingly
7. She should be advised against further act of
intercourse in current cycle after using EC.
Client Screening & Assessment for
EC use
History
1. Date of last menstrual period (LMP)
2. Average length of menstrual cycle
3. Timing of last act of intercourse and previous acts in
the current cycle
4. Time in hours since last act of unprotected intercourse
5. Current or recent use of contraception
6. History of medical disorders, sexually transmitted
disease or major illness
Client Screening and Assessment
for EC use
Physical Examination :
Not necessary except when pregnancy is suspected.
Laboratory tests :
1. Urine pregnancy test if pregnancy is suspected.
2. Tests for sexually transmitted diseases.
Side Effects of EC
1.
2.
3.
4.
Nausea
Vomiting
Delay in menses : upto 7 days
Failure : 2-5%
When should she return after
using EC
1. If periods are delayed > 7 days
2. Wants to use regular contraceptive
3. Any unexplained symptom/sign
Regular Contraceptive Use
After EC Use
“More than 75% women prefer to switch to
a regular method after using EC once”
Contraindications for EC use
Pregnancy seems to be the only contraindication for
the use of Emergency Contraceptive Pill (ECPs).
Levonorgestrel only regimen is devoid of any risks
and can be safely used in situations where use of
Combination Pills is a concern due to presence of
Estrogen dependent conditions.
Use of Copper intrauterine devices, although as
effective as ECPs may be avoided in following situations
due to risk of PID.
Misconceptions with Use of EC
1.
2.
3.
4.
Will promote promscuity
Will decrease use of regular contraception
Is a kind of abortion
Is a method of family planning
Record Keeping
Example of Record Keeping for EC use
1. Name (optional)
2. Age
3. Marital Status
4. Date of LMP
5. Length of duration of menstrual cycle
6. No. of unprotected acts in current cycle
7. Time since last act of unprotected coitus (in hour)
8. Past use of ECPs
9. Past use of Regular Contraceptive
10. Method prescribed