8.08 “Morning after” contraception

agk’s Library of Common Simple Emergencies

Presentation

A woman has had unprotected sexual intercourse in the last 24 hours and wants to prevent an unplanned pregnancy. This may be part of the prophylactic treatment of a rape victim.

What to do:

• Obtain a urine or serum pregnancy test. If it is already positive, these measures will not be sufficient, and will harm the fetus.
• Prescribe a contraceptive in large doses for a short time to prevent implantation. Examples include:
  • norgestrel and ethinyl estradiol (Ovral) po two now and two in 12 hours. Within 72 hours of intercourse the failure rate is 1.8%
  • diethylstilbesterol 25mg po bid for five days
  • conjugated estrogen (Premarin) 30mg po qd for five days
  • conjugated estrogen (Premarin) 50mg iv qd for two days
• Ask about exposure to sexually transmitted diseases, which might require separate testing and prophylaxis.
• Arrange for follow up if this treatment fails to prevent pregnancy.

What not to do:

• Do not use this emergency rescue technique as a substitute for condoms, which also help prevent sexually transmitted infections.

References:

• Med Letter Drugs Ther: Ovral as a morning after contraceptive 1989;31:93.
• Association of Reproductive Health Professionals hotline (800) 584-9911
• Directory of emergency contraception providers.
• Emergency Contraceptive Pills wiki page from New Where There Is No Doctor includes more options.

-----------------------------------------------------
from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES © 
Longwood Information LLC 4822 Quebec St NW Washington DC 20016-3229 
1.202.237.0971 fax 1.202.244.8393 electra@clark.net
-----------------------------------------------------