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​Contraceptive emergencies and emergency contraception - Dr. Simonis

5/11/2017

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Picture
ASK, INFORM, and OFFER
  • Ask – reproductive aged females about unprotected intercourse and desire for pregnancy
  • Inform – about risk of pregnancy w/o contraception, and that emergency contraception is effective w/in 3-5 days after unprotected intercourse
  • Offer – discharge resources on contraception and family planning follow up 
 
Emergency Contraception
  • 2 FDA approved medications  + Copper IUD insertion: Progesterone receptor modulator (Ulipristal acetate “Ella”), progestin only (Levonorgestrel “Plan B”)
  • Plan B is available OTC, Ulipristal acetate requires Rx
  • Plan B effective up to 72 hours, Ulipristal up to 5 days
  • Some studies suggest Ella is more effective than planB
  • Recent survey shows ED infrequently prescribes ella
  • Copper IUD insertion, up to 5 days after unprotected intercourse
  • Side effects = nausea/vomiting, worse with ulipristal, irregular bleeding. No reported deaths or serious adverse effects. 
  • Very few (if any) contraindications to planB or Ella administration
  • EC has many barriers to use: insufficient knowledge, providers reluctant to discuss w/patients – especially teens. 
  • ED providers are good at offering EC to sexual assault victims, but not to patients who reports consensual, unprotected sex. 
 
Contraceptive emergencies
IUD related:
  • if expulsion suspected but not noted by user, need X-ray to eval for perforation
  • tx perforation with antimicrobials for PID, and consultation for laparoscopic removal 
  • IUD + STI (BV, trich, GC/CL) – do not need to remove IUD
  • IUD + PID: no immediate indication for IUD removal if improving on antimicrobial treatment, needs close f/u
  • Pelvic actinomyces: IUD users can be colonized, can cause PID/abscess requiring prolonged antimicrobials (w/ID involved) and IUD removal. Future IUD contraindicated. 
  • TSS: rare, but reported 

IUD  + ectopic:
  • IUD + first trimester gestation = IUD removal indicated
  • IUD + miscarriage = IUD removal and antibiotics

OCPs:
  • contraindications to combined OCPs (WHO/CDC) 

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  • RESIDENCY
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    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
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    • Program Leadership
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    • PGY-1
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    • EM Acting Internship
    • Healthcare Disparities Externship
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  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction