"Morning after" contraception

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