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EMERGENCY CONTRACEPTION

EMERGENCY CONTRACEPTION. Béla Veszprémi MD., PhD. University of Pécs Faculty of Medicine Department of Obste t rics and Gynecology.

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EMERGENCY CONTRACEPTION

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  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. 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 MECHANISM OF ACTION

  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 ethinylestradiol 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 37 - 48 49 - 60 61 - 72 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 WHO 1998.

  11. 1 4 3 3 4 6+1 4 2 2 3 2 3 2 4 2 4 5 3 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)

  17. 5812 fő 1470 1246 783 955 755 691 434 395 426 411 311 284 323 332 224 214 169 70 megye 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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