EMERGENCY CONTRACEPTION _EC_ - Unimondo

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					   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.   Diethyl stillbesterol (DES)
 2.   Yuzpe’s regimen
 3.   Levonorgestrel (LNG)
 4.   Intra-uterine contraceptive device
 5.   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

Advantages-
1.   Lesser nausea and vomiting
2.   Relatively safe
3.   Can be given upto 12 hrs
4.   Success rate : 95-98%
 Preparation of Levonorgestrel
            (LNG)
1. Pill 72®       : Cipla
2. Ecee tablet®   : German Remedies
3. Norlevo®       : 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.   Nausea
2.   Vomiting
3.   Delay in menses : upto 7 days
4.   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.   Will promote promscuity
2.   Will decrease use of regular contraception
3.   Is a kind of abortion
4.   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

				
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posted:3/21/2013
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