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Emergency Contraception > Emergency Contraception > Flashcards

Emergency Contraception Flashcards

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1
Q

What is the most effective emergency contraception

A

Copper intrauterine device Cu-IUD

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2
Q

Following an episode of UPSI or incorrect contraceptive use what two other concerns should be considered

A
  1. Sexually transmitted infection
  2. Ongoing contraception
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3
Q

Which days in a cycle is conception extremely unlikely

A

First 3 days of a cycle

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4
Q

What is the risk of pregnancy following a single episode of UPSI during her fertile period

A

30%

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5
Q

What is the chance that a single UPSI will occur during the woman’s fertile period

A

25% chance

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6
Q

What is considered the woman’s fertile period

A

6 days up to and including the day of ovulation

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7
Q

Why should EC be offered following UPSI on any day in a woman’s natural cycle

A

Estimating the fertile period using cycle length and date of last menstrual period may be imprecise and unreliable

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8
Q

Which days of the cycle does the uterine lining thicken

A

Days 6-10

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9
Q

What days does ovulation usually occur

A

Days 11-18 (14 days prior to the next menstruation)

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10
Q

On what day post partum should EC be offered for UPSI on or after this day

A

Day 21 post partum (unless lactational amenorrhoea conditions fully met)

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11
Q

If there has been UPSI in the 28 days following use of liver enzyme inducing drugs, what can be used for EC

A
  1. cu-IUD
  2. Double dose (3mg) of LNG-EC
    UPA-EC not recommended in this situation
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12
Q

EC should be offered for UPSI from day — after abortion, miscarriage, ectopic pregnancy or uterine evacuation for gestational trophoblastic disease

A

5

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13
Q

If a woman is referred on for fitting of Cu-IUD for EC what should be given at the time of referral

A

Oral EC should be given in case the Cu-IUD cannot be inserted or woman changes her mind

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14
Q

How many hours after UPSI is ulipristal acetate (UPA-EC) effective for

A

120 hours (5 days)

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15
Q

How many hours after UPSI is levonorgestrel EC licensed to be given

A

Up to 72 hours after UPSI
Evidence suggests it is ineffective if taken more than 96 hours (4days) after UPSI

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16
Q

Is UPA or LNG more effective as EC

A

UPA-EC

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17
Q

When is oral EC ineffective

A

After ovulation
LNG ineffective if on or recently finished (28d) liver enzyme inducing drugs

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18
Q

Which ECs effectiveness may be reduced by increased BMI

A

Oral EC in particular LNG-EC

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19
Q

What should not be taken in the 5 days after taking UPA-EC

A

Progesterone as it reduces the effectiveness of the EC

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20
Q

The effectiveness of UPA-EC could theoretically be reduced if a woman has taken progesterone in the — days prior to taking UPA-EC

A

7 days prior

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21
Q

Which method of EC is contraindicated for women who have severe asthma controlled by oral glucocorticoids

A

UPA-EC

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22
Q

What are the contraindications for Cu-IUD EC (4)

A

Same as for routine IUD insertion:
1. <28 days post partum
2. Uterine anatomical distortion
3. Active pelvic infection
4. Wilson’s or copper allergy
5. Undiagnosed uterine bleeding
6. Endometrial or cervical cancer
7. Currently pregnant
8. Trophoblastic disease
9. Post septic abortion
10. Puerperal sepsis

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23
Q

breastfeeding women - Oral EC - what advice would you give

A

UPA-EC pump and dump for 7 days
LNG-EC available limited evidence indicates no adverse effects on breastfeeding or their infants

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24
Q

When does the egg usually reach the uterus after ovulation

A

Usually around the sixth day

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25
Q

What are the mechanism of action of the copper IUD (2)

A
  1. Toxic to sperm and egg inhibit fertilisation
  2. Endometrial inflammatory reaction preventing implantation
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26
Q

Which is the only method of emergency contraception that is effective after ovulation

A

Copper IUD

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27
Q

When can the copper IUD be used for emergency contraception

A

Within 5 days of the first UPSI in a cycle or within 5 days of the earliest estimated date of ovulation

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28
Q

Why can copper IUD be used within the 5 days of earliest estimate date of ovulation

A

This would be before the earliest expected implantation allowing it to impede implantation of any fertilised egg

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29
Q

What is the effect of Copper ions on sperm and ovum

A

Direct effect on ovum motility and survival
Secondary effect on endometrium to impede implantation and increase sperm phagocytosis

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30
Q

What do you need to use to calculate the latest day in a women’s cycle when an IUD can be used for EV

A

The shorted normal cycle length
Assuming the patient has regular cycles and knowledge of her last menstrual period

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31
Q

For a 26 day cycle on which day is the last day that an cuIUD can be fitted for emergency contraception

A

Day 17

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32
Q

For a 28 day cycle when is the latest day an cuIUD can be fitted for EM contraception

A

Day 19

33
Q

For a 30 day cycle when is the latest day an cuIUD can be fitted for EM contraception

A

Day 21

34
Q

For a 32 day cycle when is the latest day an cuIUD can be fitted for EM contraception

A

Day 23

35
Q

When can cuIUD be fitted for em contraception

A

Whichever is later out of…
Up to 5 days after the first UPSI
Or up to 5 days after earliest ovulation date expected

36
Q

UPA-EC Could be potentially less effective with a BMI >__ or >__kg

A

BMI >30 or >85kg

37
Q

When should a double dose (3mg) of LNG-EC be considered

A
  1. After liver enzyme inducing drug use
  2. BMI>26 or weight >70
38
Q

When is LNG effective for EM contraception

A

Effective if administered up to the start of the LH surge (36hrs before ovulation)

39
Q

How does LNG work for Emergency contraception (EC)

A

Delaying ovulation

40
Q

How does UPA-EC work for EC

A

Slaying ovulation for at least 5 days until sperm are no longer viable

41
Q

When is UPA-EM effective in the cycle

A

If administered during the LH surge but cannot inhibit ovulation if taken after the LH peak

42
Q

What are the side effects of Oral EC

A
  1. Headaches nausea dysmenorrhea reported 10%
  2. vomiting
  3. Menstrual disturbances
    - after UPA 75% of women had their next period at or within 7 days of the expected time
    - a small number we’re >7 d early
    - 20% were > 7 d late
    - 4% were > 20 days late
43
Q

Within what time scale is vomiting and issue after taking oral EC and a further dose needed

A

Within 3hrs of taking oral EC

44
Q

When should a pregnancy test be performed following EC

A

If menses are delayed more than 7 days

45
Q

Is ectopic pregnancy risk increased with UPA EC if pregnancy is not prevented

A

No higher risk than general population risk

46
Q

Is there a higher risk of ectopics with LNG EM that has failed to preven pregnancy

A

Yes however the numbers are small and overall use of LNG reduces the chance by reducing the chance of pregnancy in the first place

47
Q

Is long term fertility affected by EC

A

No
No evidence of adverse pregnancy outcomes or fetal anomaly despite oral EC too

48
Q

What is the percentage chance of pregnancy using IUD for EC

A

<0.1%

49
Q

What is the percentage chance of pregnancy using UPA-EC

A

1-2% overall pregnancy rate. This does NOT mean that a woman who has taken UPA-EC after UPSI just prior to ovulation has a 1-2% chance of pregnancy

50
Q

What is the percentage chance of pregnancy using LNG-EC

A

Overall pregnancy rate of 0.6-2.6%

51
Q

Which oral EC is significantly more effective when taken 0-120hrs after UPSI

A

UPA-EC

52
Q

Porphyria carries a UKMEC 2 for which method of EC

A

LNG-EC may be linked to an acute attack as it is a progestogen that can pracipitate this. However, naturism fluctuations in oestrogen and progestogen appear to be associated with acute attacks rather than exogenous hormones

53
Q

Asthma on oral glucocorticoids means which method of EC should be avoided

A

UPA-EC as it has an anti-glucocorticoid effect therefore it should be avoided for severe asthma controlled by oral steroids

54
Q

Hepatic impairment causes an issue for which EC

A

UPA in the SPC advises it should be avoided but faculty guidance advises pregnancy poses a significant risk and thus UPA 30mg is acceptable

55
Q

Do CYP450 enzyme inducing drugs cause an issue for LNG-EC

A

Yes - reduce effectiveness and double dose recommended 3mg but effectiveness of this is not known

56
Q

Drugs that increase gastric pH can they effect the efficacy of EC

A

It is not known if UPA effectiveness is reduced

57
Q

Menstrual disturbance after UPA-EC what percentage of women had their next period at or within 7 days of the expected time?

A

75%

58
Q

Menstrual disturbance after UPA-EC what percentage of women had their next period > 7 days late of the expected time?

A

20%

59
Q

4% of women were how many days late after taking UPA-EC

A

20 days

60
Q

How many were more than 7 days early after taking UPA-EC

A

A small number 1%

61
Q

What might happen with EC oral is there is malabsorption or small bowel resection?

A

Reduced absorption and less effective

62
Q

At what weight or BMI is the LMG-EC thought to be less effective

A

> 70kg or BMI >26 double dose recommended but not known if this is more effective

63
Q

At what weight or bmi is UPA-EC thought to be less effective

A

> 85kg BMI >30

64
Q

Can a Cu-IUD be inserted when there is known chlamydia infection

A

Yes if asymptomatic only, give abx at time of insertion or sooner if possible

65
Q

If there is chlamydia or gonorrhoea infection can cu-IUD be fitted for EC

A

Not is symptomatic chlamydia, not with any gonorrhoea. Complete abx first

66
Q

Postpartum when can cu-IUD be used for EC

A

Not between 48hrs-28 days after delivery due to increased risk of expulsion or perforation

67
Q

Can UPA-EC be used in breastfeeding mums

A

Yes but it is excreted and safety not known so advise is to pump and dump for 1 week after taking it

68
Q

What is the risk of perforation with cu-IUD insertion for breastfeeding mother <9 month’s (36wks) postpartum >28days

A

1 in 200 risk (5.6 in 1000)

69
Q

What is the risk of perforation with cu-IUD insertion for breastfeeding mother >9 month’s (36wks) postpartum

A

1.6 per 1000 (1:700)

70
Q

What is the risk of perforation with cu-IUD insertion for non breastfeeding mother <9 month’s (36wks)

A

1.7 per 1000 (1:700)

71
Q

What is the risk of perforation with cu-IUD insertion for non breastfeeding mother >9 month’s (36wks) postpartum
EURAS-IUD study

A

0.7 per 1000 (less than 1 in a 1000)

72
Q

If a women is over 50 does she need EC

A

Not if she is amenorrhoeic for 1 year and not caused by hormone contraction or HRT

73
Q

How many years does a women need to be amenorrhoic for to not need EC <50yrs

A

2 years amenorrhoea and not due to hormonal therapy

74
Q

Can oral EC be repeated if there are more UPSI in the same cycle

A

Yes but don’t give LNG if less than 7 days after UPA and don’t give UPA if LNG was taken up to 7 days ago

75
Q

What safety questions should be asked when someone asks for EC (4)

A

Was it consensual
Drugs or alcohol involved
Learning disabilities ?valid consent
Domestic violence - may not be able to use ongoing contraception but may not report the sex as non-consensual

76
Q

Do you have to pay for EC

A

No Although some pharmacies charge

77
Q

Apart from GP pharmacy & SH clinics where can you get oral EC

A

School nurses
Emergency dept
NHS walk in
Minor injury units
Online pharmacies

78
Q

What advice should you give following EC (7)

A
  1. If vomits within 3hrs of oral EC she will need to return for a further dose
  2. Her next period may be early or late
  3. Urine pregnancy test at 21days post UPSI (unless normal menstrual bleed)
  4. If Oral EC fails it is not thought to be harmful to pregnancy
  5. Return if further UPSI
  6. Further contraception advice
  7. Full STI screen and sexual history - when and how to get tested

Emergency Contraception (1 decks)

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