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EMERGENCY CONTRACEPTION

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EMERGENCY CONTRACEPTION B la Veszpr mi MD., PhD. University of P cs Faculty of Medicine Department of Obstetrics and Gynecology – PowerPoint PPT presentation

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Title: EMERGENCY CONTRACEPTION


1
EMERGENCY CONTRACEPTION
  • Béla Veszprémi MD., PhD.
  • University of Pécs
  • Faculty of Medicine
  • Department of Obstetrics and Gynecology

2
Emergency contraception refers to a particular
type of contraception that is used as an
emergency procedure to prevent pregnancy
following unprotected, possible fertile,
intercourse (Van Look)
  • (Br. Med.Bull. 1993.)

3
METHODS OF EMERGENCY CONTRACEPTION
  • High-dose estrogen
  • Ethinyl estradiol with levonorgestrel (Yuzpe
    regimen)
  • Levonorgestrel alone
  • IUD
  • Mifepristone (Antiprogesterone)
  • GnRh antagonists

4
MECHANISM OF ACTION
  • Maturation of follicle
  • Inhibit or delay ovulation
  • Inhibit sperm transport
  • fertilisation
  • development and
  • transport of zygote
  • (Croxatto et al. Contraception 2001)
  • Inhibition of implantation
  • influencing
  • endometrial receptivity
  • blastocyst signalisation
  • corpus luteum function

5
Features of EC pills
  • Low toxicity
  • Overdosage is rare
  • Non teratogenic
  • Medical screening is not required
  • Self administration
  • Uniform dosage
  • Drug interaction is not significant
  • (Grimes et al. Obstet.-Gynecol. 2001.)

6
Efficacy of postcoital contraceptive methods
  • Yuzpe regimen 75
  • Progesterone only 85
  • Mifepristone 85
  • IUD 90
  • (Curr.Opin.Obstet.Gynecol. 2000.)

7
Composition of EC pills
  • (Richter Gedeon Rt.)
  • Fertilan (Noral,Neogynon)
  • 50 µg ethinyl estradiol
  • 250 µg levonorgestrel
  • Rigesoft
  • 750 µg levonorgestrel

8
Treatment with EC pills
  • 1st dose within 48-72 hours after unprotected
    intercourse
  • 2nd dose repeat after 12 hours
  • If vomitus occurs within two hours after pill
    intake, repeated dosage is required
  • Multiple application in the same cycle is
    contraindicated
  • Not teratogenic

9
Efficacy of EC and time of treatment
Percentage of expected pregnancies prevented
100
95
83
79
66
61
47
50
0
0 - 12
13 - 24
25 - 36
61 - 72
49 - 60
37 - 48
Delay between intercourse and time of treatment
with EC
10
Percentage of expected pregnancies prevented in
relation to the delay between intercourse and
time of treatment with EC
Time of treatment Levonorgestrel Yuzpe
Within 24 hours 95 77
24-48 hours 85 36
48-72 hours 58 31
WHO 1998.
11
EC outpatient clinics in Hungary
2
5
12
Telephone-number of EC out-patient clinics in
Hungary
06-30-30-30-456
13
The number of deliveries and abortions in Hungary
14
Number of abortions per 100 live births in Hungary
15
Number of abortions over and under 20 years
16
The number of pregnancy terminations (Dept. Of
Ob. Gyn., Univ. of Pécs)
1997 1998 1999 2000 2001 2002
Patient 705 648 639 613 579 584
Under 18 years 57 (8) 53 (8.1) 48 (7.5) 50 (8.1) 37 (6.3) 27(4.6)
17
The number of treated patients in 2002 in Hungary
18
Age distribution of patients at EC clinics In
2002 in Hungary
19
The reason of seeking EC gynecological care In
2002 in Hungary
20
Sales of Rigesoft in Hungary
21
No women can call herself free who does not
controll her body
  • Margaret Sanger 1920
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