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

2. 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

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

4. BGY. Seminar 2003

5. 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

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

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

8. 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

9. 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

10. 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

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

12. 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

13. 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

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

15. 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

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

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