8.08 "Morning after" contraception
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agk's Library of Common Simple Emergencies

Presentation
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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:
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- 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: 
     o norgestrel and ethinyl estradiol 
         (Ovral) po two now and two in 12 
         hours. Within 72 hours of inter-
         course the failure rate is 1.8%
     o diethylstilbesterol 25mg po bid for 5
         days
     o conjugated estrogen (Premarin) 30mg po 
         qd for five days
     o 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:
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Do not use this emergency rescue technique as a 
substitute for condoms, which also help prevent 
sexually transmitted infections.

References:
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- *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:
    https://ec.princeton.edu/providers/index.html
-   Emergency Contraceptive
    Pills:
    https://en.hesperian.org/hhg/New_Where_There_Is_No_Doctor:Family_Planning:Emergency_Family_Planning_(ECP,_emergency_contraceptive_pills)
    (wiki page from *New Where There Is No 
    Doctor*).

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 from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
 Longwood Information LLC 4822 Quebec St NW Wash DC
 1.202.237.0971 fax 1.202.244.8393 electra@clark.net
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