Contraceptive emergencies and emergency contraception

ASK, INFORM, and OFFER

Ask – reproductive aged females about unprotected intercourse and desire for pregnancy
Inform – about risk of pregnancy w/o contraception, and that emergency contraception is effective w/in 3-5 days after unprotected intercourse
Offer – discharge resources on contraception and family planning follow up

Emergency Contraception

2 FDA approved medications + Copper IUD insertion: Progesterone receptor modulator (Ulipristal acetate “Ella”), progestin only (Levonorgestrel “Plan B”)
Plan B is available OTC, Ulipristal acetate requires Rx
Plan B effective up to 72 hours, Ulipristal up to 5 days
Some studies suggest Ella is more effective than planB
Recent survey shows ED infrequently prescribes ella
Copper IUD insertion, up to 5 days after unprotected intercourse
Side effects = nausea/vomiting, worse with ulipristal, irregular bleeding. No reported deaths or serious adverse effects.
Very few (if any) contraindications to planB or Ella administration
EC has many barriers to use: insufficient knowledge, providers reluctant to discuss w/patients – especially teens.
ED providers are good at offering EC to sexual assault victims, but not to patients who reports consensual, unprotected sex.

Contraceptive emergencies
IUD related:

if expulsion suspected but not noted by user, need X-ray to eval for perforation
tx perforation with antimicrobials for PID, and consultation for laparoscopic removal
IUD + STI (BV, trich, GC/CL) – do not need to remove IUD
IUD + PID: no immediate indication for IUD removal if improving on antimicrobial treatment, needs close f/u
Pelvic actinomyces: IUD users can be colonized, can cause PID/abscess requiring prolonged antimicrobials (w/ID involved) and IUD removal. Future IUD contraindicated.
TSS: rare, but reported

IUD + ectopic:

OCPs:

Contraceptive emergencies and emergency contraception - Dr. Simonis