Emergency contraception in Hungary György Bártfai MD, DSci Department of Obstetrics and Gynecology, University of Szeged, Hungary

History Postcoital hormonal contraception with high-dose diethylstilboestrol or ethinyl estradiol for rape victims in 1960s van Wagenen, Morris, Haspels Combined regimen (E2 & P) early 1970s (Yuzpe) IUD as an EC has been applied first in 1976 (Lippes) LNG only 1980s RU 486, mifepristone 1990s BGy., Seminar 2003

Effectiveness of Postinor® cycle 8815 coitus 27253 pregnancy 23 Pearl index 0,83+/-0,44 effectiveness coitus/pregnancy 99,9% Gy. Seregely, 1986 BGy., 2003 Seminar

BGY. Seminar 2003

Questionnaire survey after abortion (n=500) Awareness of EC* 96% 480 Lack of awareness 4% 20 years 15 > 18 years 5 *Postinor®=480 Fertilan® =113 BGy. Seminar 2003

Outpatient clinics supported by the Industry: 58 < 20 yrs 7468 > 20 yrs 8177  15545/year  1295/month No previous contraception 6285 (40.43%) BGY. Seminar 2003

Licenced products Rigesoft (2x1), Levonelle, Postinor 2: 0,75 mg LNG Fertilan (2x2): levonorgestrel 0,25 mg + etinilösztradiol 0,05 mg BGy. Seminar 2003

Indications for emergency contraception 1. Unprotected intercourse no method-especially first-time intercourse coitus interruptus/failed coitus interruptus ejaculation on external genitalia miscalculation of the rhythm method spermicide use alone in woman at high risk of pregnancy BGy. Seminar 2003

Indications for emergency contraception (cont) 2. Potential barrier method failures condom rupture, dislodgement or misuse diaphragm or cap inserted incorrectly, dislodged during intercourse, found to be torn or removed too early 3. Potential pill failures missed pills 4. Potential IUD failures complete or partial expulsion of an IUD midcycle IUD removal considered absolutely necessary BGy. Seminar 2003

Indications for emergency contraception (cont) 5. Sexual assault is an important indication for EC. Providers must be aware of STI. Police involvement-forensic tests. woman may require long-term emotional support. 6. Recent use of suspected teratogens drugs, e.g. cytotoxics live vaccines such as yellow fever BGy. Seminar 2003

Contraindications to emergency contraception Royal College Obst. Gyna. 2000. BGy. Seminar 2003

Flow chart (1) Yes Patient requests emergency contraception Pregnancy test, vaginal examination ultrasound and manage accordingly Could she be pregnant already? Yes No Enquire last menstrual period, cycle length and exposure day of cycle. Assess risk IUD an option as long as within 5 days of earliest ovulation Did intercourse take place within the previous 72 h? 120 h Counsel, screen for infection and fit copper IUD Yes BGy. Seminar 2003

Flow chart (2) Is there a history of thromboembolism or current migraine with past history of migraine with focal aura Yes No Emergency combined pills or LNG suitable Yes 1. Check blood presure 2. Give verbal information and patient information leaflet 3. Prescribe pills and consider antiemetic use 4. Arrange ongoing contraception 5. Arrange follow-up 6. Complete records Recommend IUD or progestogen only method BGy. Seminar 2003

Against OTC Dangerous Encourages promiscuity Discourages safe sex Improper use /abuse/ misuse Recurrent use Abandon more reliable methods BGy. Seminar 2003

Why OTC ? Limits to Access to EC 72 hour time limit Prescribed by a doctor Often required at a weekend Embarrassment Fear about confidentiality Inertia BGy. Seminar 2003

EC provision: a survey of pharmacist (January 2002) BGy.,Seminar 2003

EC provision: a survey of pharmacist (January 2002) BGy., Seminar 2003