L The Importance of Emergency Contraception.ppt

7/17/2019 L The Importance of Emergency Contraception.ppt

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The Importance ofEmergency Contraception:-

By - Dr. Ashwini Bhalerao Gandhi ,

- Consltant Gynecologist

!.D. "ind#a $ational "ospital % &edical'esearch

Centre ,&ahim, &m(ai.

- Chairperson of Adolescent "ealth

Committee of The )ederation of *(st. %

Gynec +ocieties of India /-01.

- E2 Associate !rofessor, T.$. &edical



Historical aspects of Post coitalcontraception

1. A foetus-preventing tampon of Ajowan seeds androck salt ground in oil.

(Sacred Vedas of the Hindus

!. "rease# m$atet her%# sweet ale - cook them. &o %eswallowed for four mornings.

(&he 'erlin edical Pap)rus* +irca 1# , '.+.

,. +oloc)nth pulp# %r)on)# iron scoria# sulphur#

scammon) ca%%age seed* "rind these upthoroughl) and mi/ with tar - 0nsert one afterintercourse.

(Al-a2i# 3!4 A.5.



0n 0ndia -

678 of conceptions occurring annuall)are unplanned*

!98 are unwanted*

:.6 million a%ortions induced ever) )ear

A ratio of 1-11 illegal a%ortions for eachlegal a%ortion.

(;ational <amil) Health Surve)# 1339

+ontraceptive prevalence rate onl) 418.



easons -

1. =ack of awareness regarding <.P. methods

!. =ack of willingness to use the methods

,. =acunae in service deliver) s)stem

4. >verall weakness in the social# economical

and health status of women.



0ndications for ?mergenc)+ontraception

5efn - @sed after unprotected intercourse toprevent pregnanc).

hen B 1. ;ot using an) contraceptive

!. Se/ual assault# rape# coercion

,. ecent use of suspectedteratogens -

c)toto/ic drugs# live vaccines. 4. Se/ against will# failure to plan ahead

9. +ontraceptive accidents



+ontraceptive accidents

<ailed coitus interruptus

?jaculation on e/ternal genitalia

iscalculation of rh)thm method

+ondom rupture# dislodgment or misuse

5iaphragm C +ap inserted incorrectl)#dislodged# found to %e torn or removed tooearl).

+omplete or partial e/pulsion of 0@5. id-c)cle 0@5 removal due to side eDects

issed com%ined pills

issed progestin - onl) pill.



&)pes of ?+

1. ?strogens - 9mg of 5?S was Erst tried on a

rape victim (13:.

5?S - !9 to 9mgCda) for 4-9 da)s

?? - ! - 9mgCda) for ,-9 da)s

+? - , - 9mgCda) for !-9 da)s

Side eDects - ;ausea# vomiting# headache#

di22iness#

%reast tenderness# irregular %leeding.



&)pes of ?+ - contd

!. Fu2pe method - +anadian Ph)sician tried single dose of1ugm of estrogen and 1 mg of dl-norgestrel (136.

! ta%s of ?? 9 ugm G =;" !9 ugm stat# to %e

repeated after 1! hours. 4 ta%s of ?? , ugm G ;" , ugm stat#to %e

repeated after 1! hrs.

(P+ 4# &etrag)non# <ertilan



&)pes of ?+ - contd

,. *nly !rogestins - 4e5onorgestrel .67 mg1 or$orgestrel 8.7 gm1 stat and repeat after 8 hrs.

=;" - ?cee ! ("erman emedies

Pill 6! (+ipla =td

;orlevo (in-edicare

This method is most commonly sed all o5er the world

today.

echanisms of Action -

1. 0nhi%it C 5ela) ovulation

!. ?Dect on tu%al transport

,. Hamper development of fertili2ed ovum

4. Prevent implantation in endometrium %) making it out ofphase %) hormonal im%alance

9. 5oes not interrupt an esta%lished pregnanc)



&)pes of ?+ - contd

4. Anti Progestogen ifepristone - :mg single

dose of @ - 47: - A - +ompetes withprogesterone for receptor %inding# alters ovarianfollicular maturation# eDect on ovulation Cfertilisation C tu%al transport C implantation.

9. 5ana2ol - ! or , doses of 4 mg each at 1! hrinterval. A - Anti-implantation agent.

:. +entchroman - Anti-implantation agent

6. +opper 0@5 - 0nserted within 9 da)s

A - prevent fertili2ation# implantation#%lastoto/ic C em%r)oto/ic.

0n case of method failure - &P recommended.



anagement of a euest for ?+

1. Histor) - =P# 5uration of c)cle# timings of allunprotected acts in relation to the current c)cle*medical histor)* <P.

!. ?/amination - 'P# PS-PV not mandator) (isk of

pregnanc) ! to ,8 in midc)cle# under 1.8 at othertimes.

,. +ontraindications for ?GP - +urrent focal migraine#current hepato-cellular jaundice# past HCo throm%otic

disease. +.0. <or 0@5 - ;ulliparit)# P05

4. Antiemetic 1 hr %efore the dose

9. 'arrier method C a%stinence till ne/t period.



+ounselling

Supportive non-judgemental wa)

Assess necessit) ?/plain proper use

5iscuss side-eDects# eDectiveness

;eed for ongoing contraception <irst contact point for eproductive Health

)ollow - p

ithin ,-4 weeks of /

5ela) in menses of more than 1 week

=ower a%dominal pain

Heav) %leeding

;e/t period scant)

9h t t t ' l



9hen to start 'eglarContraception

'arrier methods - 0mmediatel)

0@5- 0mmediatel)

>+S - <irst da) of ne/t period

0njecta%les - within 6 da)s of ne/t period

Sterilisation - After ne/t period

?Dectiveness

?+ not used - 78 lead to pregnanc)Progetin onl) - 18 lead to pregnanc)

?GP used - !8 lead to pregnanc)

ost eDective when taken earl)



<reuentl) Asked Iuestions

?+PS are not a%ortion pills# not ana%ortifacient agent.

5ose should %e repeated if vomiting occurswithin 1 hour.

+an %e used at an) time during menstrualc)cle.

;ot a regular method of <P

5o not prevent S&5S.



<reuentl) Asked Iuestions - +ontd

5ou%le ?+P doses when onanticonvulsants anti%iotics

ill not cause menses to start

immediatel) - ma) start ! to , da)s earl)or late.

ill not provide protection for the rest of

the c)cle. ill not harm a pregnanc)



4egal, Ethical % 'eglatoryAspects of EC

"rossl) underutili2ed method especiall) indeveloping countries.

;o legal risk in prescri%ing

0nfact legal risks incurred if the client nottold a%out ?+.

ill it promote irresponsi%le# promiscuous

life-st)le speciall) in adolescents B +an %e provided even in countries where

a%ortion is illegal.



4egal, Ethical % 'eglatory

Aspects of EC - contd Should %e availa%le over-the-counter

(;o counselling# no follow-upB

5esira%le to hold a dialogue %etweenmedical communit)# drug regulator)%odies# )outh women activist groups.



The World’s BestContraceptive Secret !!



&hanks to all contri%utors.

J 5r Adarsh 'hargava.

J 5r Ashwini 'halerao.J 5r Alka Kriplani.

J 5r. Kalpana Apte.

J 5r ala Arora.J 5r.eenakshi 'harath.

J 5r. andakini Parihar.

J 5r.;o2er Sheriar.J 5r.Parikshit &ank.

J 5r. o2a >l)ai.

J 5r.Sasikala Kola.J



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L The Importance of Emergency Contraception.ppt