Emergency Contraception + Termination

Question 1

What is the most effective method of emergency contraception?

Answer 1

-Copper IUD - >99%
-Ulipristal (EllaOne) - 98%
-Levonorgestrel (Levonelle)
–95% if <24h
–85% if 24-48h
–58% if 48-72h

Question 2

When can the copper IUD be used as emergency contraception?

Answer 2

-Within 5 days of UPSI
OR
-Within 5 days of earliest likely calculated ovulation

Question 3

How does the copper IUD work as a contraception?

Answer 3

-Prevents implantation (by affecting endometrium to make it toxic for the embryo)
-Spermicide properties

Question 4

In what patients is the copper IUD contraindicated?

Answer 4

-Pregnancy
-PID <3 months ago
-Gynae cancers
-Small uterine cavity
-Copper allergy

Question 5

What side effects are there for the copper IUD?

Answer 5

-Pain on insertion (give ibuprofen)
-Infection
-Menorrhagia
-Perforation (1 in 1000)
-Vasovagal episode (1 in 10)
-Expulsion (1 in 20)
Check up 6 weeks after insertion, can be removed after 4 weeks

Question 6

When can ulipristal / EllaOne be used?

Answer 6

-Within 5 days of UPSI
OR
-Within 5 days of earliest likely calculated ovulation

Question 7

How does ulipristal work?

Answer 7

-A selective progesterone receptor modulator
-Delays / inhibits ovulation (even if LH levels already rising)
-30mg single dose

Question 8

In what patients is ulipristal contraindicated?

Answer 8

-<18 y/o’s
-Severe asthma or liver disease
-Efficacy reduced if taking enzyme inducers or progestogen is taken 7 days before / 5 days after
-Breastfeeding (delay for 1 week)
-Efficacy reduced if already used in this cycle (can give multiple doses per cycle)

Question 9

What side effects can result from taking ulipristal?

Answer 9

-PV bleeding
-N+V (repeat dose with 10mg domperidone or use IUD if vomit within 3h)
-Headache
-Breast / pelvic pain
-May reduce efficacy of hormonal contraception - use barrier methods

Question 10

When can levonorgestrel be used?

Answer 10

-Within 72h after UPSI (efficacy reduces the longer you leave it)

Question 11

How does levonorgestrel work?

Answer 11

-Delays / inhibits ovulation
-Inhibits implantation
-1.5mg single dose given

Question 12

In what patients is levonorgestrel contraindicated?

Answer 12

-Porphyria
-Efficacy reduced if taking enzyme inducers
-Double / increase dose if above is true / BMI >26

Question 13

What side effects can occur with levonorgestrel?

Answer 13

-PV bleeding
-N+V (repeat dose with 10mg domperidone / consider IUD if vomiting within 3h)
-Headache
-Breast / pelvic pain
-Generally well tolerated

Question 14

How long should patients abstain from sex after taking ulipristal / levonorgestrel?

Answer 14

-2 weeks
-uPT after 3 weeks

Question 15

What different options are there for M-TOP?

Answer 15

-Early medical abortion <10/40
-Medical abortion >10/40

Question 16

What drugs are used in MTOP?

Answer 16

-200mg oral mifepristone (= anti-progestogen)
–Halts the pregnancy and relaxes cervix
-800mcg PB/ buccal/ SL misoprostol (= prostaglandin analogue)
–Soften cervix and stimulates contractions
–Given 1-2 days later
–If >10weeks - additional doses given every 3h until expulsion
-Anti-D (if >10w and Rh-)
-If <10/40 tablets can be taken at home
-If 10+1 - 12/40 tablets must be taken in clinic
-If >12/40 tablets must be taken as an inpatient

Question 17

What different options are there for S-TOP?

Answer 17

-Vacuum aspiration (<14 weeks)
-Cervical dilatation and evacuation (14-24 weeks)

Question 18

What is given to women prior to STOP?

Answer 18

-Either misoprostol, mifepristone or osmotic dilators
-Used to prime the cervix ie soften and dilate it in preparation for surgery

Question 19

What are the 5 grounds under which an abortion can be performed in the UK?

Answer 19

A. To save the woman’s life
B. To prevent grave permanent injury to the woman’s physical or mental health
C. An abortion is less risk to the physical / mental health of the woman than continuing the pregnancy
D. Abortion is less risk to the physical / mental health of existing children than continuing the pregnancy
E. Child is likely to be severely physically or mentally disabled

Question 20

What side effects can be expected from MTOP?

Answer 20

-Dizziness, hot flushed
-D+N
-Period-like cramping
-Vaginal bleeding - heavy and with clots, can continue for 2 weeks

Question 21

What red flag symptoms should women seek medical attention for following S-TOP?

Answer 21

-High fever
-Persistent pain
-Very heavy bleeding
-Unusual smelling vaginal discharge