Instructions: Listen to the podcast episode available below, and then submit your answers to the multiple choice questions. You will review the answers and the material covered during your next Continuity Clinic Session.
1. A 26 yo G2P2 comes to clinic on Monday. She and her husband just traveled and she forgot to bring her diaphragm. They had unprotected intercourse twice in the last 48 hours. Her BMI is 37. She has no major medical problems. You tell her that the best option for preventing pregnancy is immediate use of:
Copper IUD can be placed up to 120 hours after unprotected intercourse and has a pregnancy rate of less than 0.1%. It inhibits fertilization by affecting sperm and tubal motility
Combined oral contraceptive pills can be used- generally take two separate doses 12 hours apart, but the pregnancy rate is 2-3.5%. There are side effects of nausea and vomiting.
Levonorgestrel-only pills can be used up to 72 hours after intercourse with pregnancy rates of 0.6 to 3.1%
If not interested in an IUD, the next best option is ulipristal acetate. This is a selective progesterone receptor modulator with antagonist and partial agonist effects. Can be used up to 120 hours after unprotected intercourse. Pregnancy rate of 0.9-2.2%
Ulipristal acetate may work better than oral levonorgestrel in overweight and obese women, but no studies have been adequately powered to determine definitive thresholds for body weight and emergency contraception
EC should not be withheld from women who are overweight or obese
2. An 18 yo G0 returns home from visiting her boyfriend at college. On their last night together, they ran out of condoms. She does not have on Ob/Gyn, but she lives around the corner from a pharmacy. Which form of emergency contraception will be easiest for her to access?
Levonorgestrel-only pills (Plan B) can be purchased over the counter at a pharmacy. No prescription is needed. There are no age restrictions.
The sooner you take the levonorgestrel-only pill, the better it works. It needs to be taken within 72 hours of intercourse
3. A 32 yo G3P2012 is traveling in a remote location out of the country. She uses combined OCPs (Seasonale) for contraception, but she has been taking these irregularly. She contacts her Ob/Gyn back home because she had unprotected intercourse 1 day ago, and she wants to know if there are any options for pregnancy prevention. What does her Ob/Gyn recommend?
OCPs can be used via the Yuzpe method for emergency contraception
Only certain OCPs have been studied for this purpose. It depends on the type of progestin in the pill (i.e. levonorgestrel or not).
The number of tablets needed to maximize effectiveness varies depending on the specific pill. Reference charts can be found via bedsider.org or ec.princeton.edu