8.08 "Morning after" contraception
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
Table of Contents
from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES ©
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