EMERGENCY CONTRACEPTION

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EMERGENCY CONTRACEPTION

• Béla Veszprémi MD., PhD.
• University of Pécs
• Faculty of Medicine
• Department of Obstetrics and Gynecology

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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.)

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METHODS OF EMERGENCY CONTRACEPTION

• High-dose estrogen
• Ethinyl estradiol with levonorgestrel (Yuzpe
  regimen)
• Levonorgestrel alone
• IUD
• Mifepristone (Antiprogesterone)
• GnRh antagonists

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MECHANISM OF ACTION

• 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

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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.)

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Efficacy of postcoital contraceptive methods

• Yuzpe regimen 75
• Progesterone only 85
• Mifepristone 85
• IUD 90
• (Curr.Opin.Obstet.Gynecol. 2000.)

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Composition of EC pills

• (Richter Gedeon Rt.)
• Fertilan (Noral,Neogynon)
• 50 µg ethinyl estradiol
• 250 µg levonorgestrel
• Rigesoft
• 750 µg levonorgestrel

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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

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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
61 - 72
49 - 60
37 - 48
Delay between intercourse and time of treatment
with EC
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Percentage of expected pregnancies prevented in
relation to the delay between intercourse and
time of treatment with EC
WHO 1998.
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EC outpatient clinics in Hungary
2
5
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Telephone-number of EC out-patient clinics in
Hungary
06-30-30-30-456
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The number of deliveries and abortions in Hungary
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Number of abortions per 100 live births in Hungary
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Number of abortions over and under 20 years
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The number of pregnancy terminations (Dept. Of
Ob. Gyn., Univ. of Pécs)
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The number of treated patients in 2002 in Hungary
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Age distribution of patients at EC clinics In
2002 in Hungary
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The reason of seeking EC gynecological care In
2002 in Hungary
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Sales of Rigesoft in Hungary
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No women can call herself free who does not
controll her body

• Margaret Sanger 1920