l the importance of emergency contraception.ppt
TRANSCRIPT
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
7/17/2019 L The Importance of Emergency Contraception.ppt
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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.
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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.
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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.
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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
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+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.
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&)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.
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&)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
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&)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)
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&)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.
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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.
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+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
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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)
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<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.
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<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)
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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.
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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.
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The World’s BestContraceptive Secret !!
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&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