Emergency contraception scenario
- Ensure confidentiality (consider Gillick competence and Fraser guidelines if age <16 without parental consent)
- Enquires about nature of UPSI
- Abuse or assault?
- When it happened
- LMP
- Any childbirth or miscarriage
- Any existing contraception methods
- Any additional UPSI in same menstrual cycle
- Enquires about current STI symptoms
- Past medical history
- Gynae history including investigations awaited for suspected cancer (contraindication for Cu-IUD)
- Current STI and pelvic TB (contraindication for Cu-IUD)
- Current DVT/PE on anticoagulation (UKMEC2 for ulipristal/levonorgesterel)
- Severe asthma requiring PO steroids (caution for ulipristal)
- Drug history and allergies
- Social history including risk factors for sexual violence
- Explains choices of EC available
- Copper IUD - most effective; within 120h (5 days) of UPSI or within 5 days of ovulation
- Oral ulipristal acetate 30 mg - within 120h (5 days) of UPSI/contraception failure
- Oral levonorgestrel 1.5 mg tablet - within 72h (3 days) of UPSI/contraception
- Use at 72-96h is off-label and less effective
- Chooses appropriate EC method
- Allows time for patient to decide, or suggests taking some time to decide
- Explains plan
- Consider STI screening
- Explains f/up measures
- Counsels re regular contraception
- Invites questions
- Addresses patient's concerns
- Global mark
Adapted from CKS and ACCS survivors
sources/links
EC is indicated if unprotected sexual intercourse happens: (CKS)
- On any day of a natural menstrual cycle.
- After regular hormonal contraception has been compromised or used incorrectly.
- From day 21 after childbirth, unless all the lactational amenorrhea method (LAM) criteria are met. The LAM criteria are:
- Fully or nearly fully breastfeeding day and night (no other liquids given or only water, juice or vitamins given infrequently in addition to breastfeeds; no long intervals between feeds day or night, for example, more than 4 hours during the day and more than 6 hours at night).
- Complete amenorrhoea.
- Less than 6 months postpartum.
- From day 5 after miscarriage, abortion, ectopic pregnancy, or uterine evacuation for gestational trophoblastic disease (GTD).