1 enjezab 6152021 2 enjezab 6152021 Emergency contraception

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Emergency contraception postcoital contraception morning-after pill typically refers to the administration of drugs to prevent pregnancy in women who have had recent unprotected intercourse including: -sexual assault - those who have had a failure of another method of contraception 3 enjezab 6/15/2021

CANDIDATES FOR EMERGENCY CONTRACEPTION consensual or rape within the previous 120 hours Suspected contraceptive failure within the previous 120 hours -Breakage , slippage, or leakage of a male condomd - breakage, or incorrect use of a diaphragm -cervical cap 4 enjezab 6/15/2021

CANDIDATES FOR EMERGENCY CONTRACEPTION -female condom failure of a spermicide tablet or film to melt before intercourse -failure to withdraw before ejaculation -expulsion of an intrauterine device - Missed oral contraceptive pills -late injection of injectable contraceptive (>2 weeks late for a progestin-only formulation ->3 days late for a combined estrogen plus progestin formulation 5 enjezab 6/15/2021

Probability of pregnancy after unprotected intercourse by timing of coitus 3 days before ovulation 15 percent 1 or 2 days before ovulation 30 percent day of ovulation 12 percent 1 or 2 days after ovulation 6 enjezab near zero 6/15/2021

Postcoital contraceptive methods Combined Pills Progestin-only Pills Copper-T IUD Dedicated Product: Plan B® Trussell J, Raymond EG. 2007. 7 enjezab 6/15/2021

Mechanisms of Action Inhibit ovulation Trap sperm in thickened cervical mucus Inhibit tubal transport of egg or sperm Interfere with fertilization, early cell division, or transport of embryo Prevent implantation by disrupting the uterine lining 8 enjezab 6/15/2021

Postcoital contraceptive methods Estrogen plus progesterone 100 µg ethinyl estradiol plus 0. 5 mg levonorgestrel, each given twice, 12 hours apart 75 to 80 percent of pregnancies prevented 9 enjezab 6/15/2021

The Value of a Dedicated Product Ovral Alesse Preven 10 enjezab 6/15/2021

EC in the U. K. Schering 1998 11 enjezab 6/15/2021

In 1998, the United States Food and Drug Administration (FDA) approved marketing (by prescription) of the Preven Emergency Contraceptive Kit, which includes four combination tablets, each containing 50 mcg of ethinyl estradiol and 0. 25 mg of levonorgestrel, and a pregnancy test to rule out pregnancy before taking the tablets. 12 enjezab 6/15/2021

Preven TM Gynétics 1998 -2004 13 enjezab 6/15/2021

Combined ECP Effectiveness: Single Use 100 women have unprotected sex in the 2 nd or 3 rd week of their cycle 8 will become pregnant without emergency contraception 2 will become pregnant using combined ECPs (75% reduction) 14 enjezab 6/15/2021 Source: Trussell, Rodríguez and Ellertson 1998

side effects Nausea vomiting Dizziness Fatigue Headache breast tenderness lower abdominal pain 15 enjezab 6/15/2021

*Levonorgestrel 0. 75 mg given twice, 12 hours apart Equivalent to or better than estrogen-progestin *a single dose of levonorgestrel 1. 5 mg recommend the levonorgestrel regimen because it has higher efficacy and lower frequency of side effects than the combined hormonal regimen it is an effective alternative for women with a history of thrombosis or who are otherwise unable to take estrogen preparations. 16 enjezab 6/15/2021

The Value of a Dedicated Product Ovrette Plan B® 17 enjezab 6/15/2021

Progestin-only ECP Effectiveness: Single Use 100 women have unprotected sex in the 2 nd or 3 rd week of their cycle 8 will become pregnant without emergency contraception 1 will become pregnant using progestin ECPs (88% reduction) 18 enjezab 6/15/2021 Source: WHO 1998

Copper intrauterine device Inserted within 120 hours after intercourse Over 99 percent. 19 enjezab 6/15/2021

IUD Effectiveness - Single Use 1000 women have unprotected sex in the 2 nd or 3 rd week of their cycle 80 will become pregnant without emergency contraception 1 will become pregnant after IUD insertion (99% reduction) 20 enjezab 6/15/2021 Source: Trussell and Ellertson 1995

Mifepristone Single dose 600 mg 100 percent Mifepristone, although effective in preliminary studies, is not FDA approved for this indication. 21 enjezab 6/15/2021

Additional contraception and doses advised that a risk of pregnancy still exists barrier or hormonal methods the day after the last emergency contraception pill (hormonal methods require a back-up method for the first seven days of use) depot medroxy-progesterone acetate, the levonorgestrel-releasing IUD, or the implant until they are sure that pregnancy has not occurred 22 enjezab 6/15/2021

• The duration of effectiveness of emergency contraception has not been determined. • There is no contraindication to giving a second dose of emergency contraception if a second episode of unprotected intercourse occurs anytime after the first dose was administered 23 enjezab 6/15/2021

Follow-up A routine follow-up office visit is not required. menstrual bleeding after emergency contraception typically occurs within one week of the expected time. Exceptions are with the intrauterine device and mifepristone. 24 enjezab 6/15/2021

any form of emergency contraception, a pregnancy test should be performed to exclude the possibility of an intrauterine or ectopic pregnancy if bleeding has not occurred within three to four weeks or if there is abdominal pain or irregular bleeding. *There is no increase in the risk of ectopic pregnancy. *Oral contraceptives taken daily are not teratogenic, although specific data regarding emergency contraception are not available. 25 enjezab 6/15/2021

contraindications Although the World Health Organization's Medical Eligibility Criteria for Oral Contraceptive Use applies contraindications to daily use of oral hormonal contraceptives in some women based on their medical history; these contraindications do not apply to women seeking emergency contraception 26 enjezab 6/15/2021

contraindications In particular: * previous ectopic pregnancy *cardiovascular disease * migraine * liver disease * breastfeeding are not considered contraindications to emergency contraception use. 27 enjezab 6/15/2021

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