453
Emergency contraception provision: a survey of emergency department practitioners.
Acad Emerg Med 2002 Jan;9(1):69-74
Keshavarz R, Merchant RC, McGreal J. Department of Emergency Medicine, the Mount Sinai School of Medicine (RK, RCM, JM), New York, NY. Dr. Merchant is currently in the Section of Emergency Medicine, Brown University School of Medicine, Providence, RI.
OBJECTIVES: To determine emergency department (ED) practitioner willingness to offer emergency contraception (EC) following sexual assault and consensual sex, and to compare responses of practitioners from states whose laws permit the refusal, discussion, counseling, and referral of patients for abortions (often called "opt-out" or "abortion-related conscience clauses") with those of practitioners from states without these laws. METHODS: Using a structured questionnaire, a convenience sample of ED practitioners attending a national emergency medicine meeting was surveyed. RESULTS: The 600 respondents were: 71% male, 29% female; 34% academic, 26% community, and 33% resident physicians; and 7% nurse practitioners and physician assistants. Many respondents (88%) were inclined to offer EC to those sexually assaulted by unknown assailants. More practitioners said they were willing to offer EC if the assailant was known to be HIV-infected rather than if the assailant had low HIV risk factors (90% vs. 79%, p < 0.01). More respondents would prescribe EC after sexual assault than consensual sex (88% vs. 73%, p < 0.01). The rates of willingness to offer EC were the same for practitioners in states with "abortion-related conscience clauses" and those from other states. CONCLUSIONS: Most ED practitioners said they were willing to offer EC. Although the risk of pregnancy exists after consensual sex, practitioners were less willing to prescribe EC after those exposures than for sexual assault. "Abortion-related conscience clauses" did not seem to influence willingness to offer EC.
Timing of emergency contraception.
Am J Obstet Gynecol 2002 Jan;186(1):167-8
Raymond E, Taylor D.
LETTER
453
Hormonal emergency contraception.
Pharmacotherapy 2002 Jan;22(1):43-53
Wanner MS, Couchenour RL. Department of Pharmacy Practice, School of Pharmacy, Temple University, Philadelphia, Pennsylvania, USA.
In the 1960s, high-dose estrogen was identified as a highly effective emergency contraceptive but was associated with a high frequency of nausea and vomiting. The combination of low-dose estrogen and a progestin (the Yuzpe regimen) is highly effective and much better tolerated. Recently, a progestin-only regimen containing levonorgestrel was found to be more effective than the Yuzpe regimen and caused significantly less nausea and vomiting. Danazol, an antigonadotropin, is well tolerated but has questionable efficacy Mifepristone has several pharmacologic actions that make it highly effective with an adverse-effect profile similar to that of the Yuzpe regimen. Progress has been made in the last 3 years toward increasing the number of emergency contraceptives that are accessible to women in the United States, and several highly effective options are available. The most effective and well-tolerated regimen available is levonorgestrel. However, the barriers to access and low patient and provider awareness limit the impact of emergency contraception on the rate of unintended pregnancies.
REVIEW, TUTORIAL
Emergency contraception provision: a survey of emergency department practitioners.
Acad Emerg Med 2002 Jan;9(1):69-74
Keshavarz R, Merchant RC, McGreal J. Department of Emergency Medicine, the Mount Sinai School of Medicine, New York, NY 10029, USA.
OBJECTIVES: To determine emergency department (ED) practitioner willingness to offer emergency contraception (EC) following sexual assault and consensual sex, and to compare responses of practitioners from states whose laws permit the refusal, discussion, counseling, and referral of patients for abortions (often called "opt-out" or "abortion-related conscience clauses") with those of practitioners from states without these laws. METHODS: Using a structured questionnaire, a convenience sample of ED practitioners attending a national emergency medicine meeting was surveyed. RESULTS: The 600 respondents were: 71% male, 29% female; 34% academic, 26% community, and 33% resident physicians; and 7% nurse practitioners and physician assistants. Many respondents (88%) were inclined to offer EC to those sexually assaulted by unknown assailants. More practitioners said they were willing to offer EC if the assailant was known to be HIV-infected rather than if the assailant had low HIV risk factors (90% vs. 79%, p < 0.01). More respondents would prescribe EC after sexual assault than consensual sex (88% vs. 73%, p < 0.01). The rates of willingness to offer EC were the same for practitioners in states with "abortion-related conscience clauses" and those from other states. CONCLUSIONS: Most ED practitioners said they were willing to offer EC. Although the risk of pregnancy exists after consensual sex, practitioners were less willing to prescribe EC after those exposures than for sexual assault. "Abortion-related conscience clauses" did not seem to influence willingness to offer EC.
453
Adolescents and emergency contraception.
J Pediatr Health Care 2002 Jan-Feb;16(1):3-9
Roye CF, Johnsen JR. Hunter College Schools of the Health Professions, New York, NY 10010, USA.
The United States has a high rate of teen pregnancies. The Food and Drug Administration recently approved hormonal emergency contraception (EC), which can be used after unprotected intercourse to reduce the likelihood that a pregnancy will occur. Several pill regimens that are now available by prescription only are safe and effective if used within 72 hours of unprotected intercourse. However, teens generally have a low level of awareness of EC, and because the pills are available only by prescription, teens must request a prescription from their pediatric nurse practitioner quickly. Therefore, it may be prudent to provide EC to sexually active teens before the need for it arises.
REVIEW, TUTORIAL
Emergency contraception. Information for patients
[Article in Spanish]
Aten Primaria 2002 Feb 15;29(2):124-5
Almodovar CG, Fernandez Pacheco L.
LETTER
Contraception endangered by legal challenge to emergency pill.
BMJ 2002 Feb 16;324(7334):381
Dyer C.
NEWS
Knowledge, use and attitudes towards emergency contraceptive pills among Swedish women presenting for induced abortion.
BJOG 2002 Feb;109(2):155-60
Aneblom G, Larsson M, Odlind V, Tyden T. Department of Public Health and Caring Sciences, University of Uppsala, Sweden.
OBJECTIVE: To investigate the knowledge, experiences and attitudes towards emergency contraceptive pills (ECP) among women presenting for induced abortion. DESIGN: Survey by self-administered waiting room questionnaires. SETTING: Three large hospitals in the cities of Uppsala, Vasteras and Orebro in Sweden. POPULATION: 591 Swedish-speaking women consecutively attending the clinics for an induced abortion during a four-month period in 2000. RESULTS: The response rate was 88% (n = 518). As many as 43% had a history of one or more previous abortions and 43% were daily smokers. Four out of five women, 83%, were aware of ECP, but only 15 women used it to prevent this pregnancy. Fewer, 38%, knew the recommended timeframes for use and 54% had knowledge of the mode of action. The two most common sources of information about ECP were media and friends. One out of five, 22%, had previously used the method, and at the time of conception, 55% would have taken ECP if it had been available at home, and 52% were positive to having ECP available over the counter. CONCLUSIONS: Emergency contraception is well known but is still underused. Lack of awareness of pregnancy risk may be one limiting factor for its use. Making ECP available over the counter may be an important measure towards better availability. Information strategies to the public are needed before ECP will be a widely used back-up method.
MULTICENTER STUDY
Policy climate, scholarship, and provision of emergency contraception at affiliates of the International Planned Parenthood Federation in Latin America and the Caribbean.
Contraception 2002 Feb;65(2):143-9
Diaz-Olavarrieta C, Turner AN, Ellertson C, Helzner JF, Ezcurra E. Population Council, Latin America and Caribbean Regional Office, Mexico City, Mexico.
Emergency contraception (EC) has great potential to decrease the incidence and resulting consequences of unwanted pregnancy, including unsafe abortion. We conducted this study to understand EC practices in Latin America and the Caribbean (LAC). We contacted 43 International Planned Parenthood Federation affiliates in LAC to interview them about EC availability. We collected family planning norms and researched registered EC products in LAC. We searched English- and Spanish-language sources to compile EC literature reviews. Thirty-seven affiliates (86%) responded to the survey, and 62% offer EC. Central and South American affiliates are more likely to offer EC than are Caribbean affiliates. Of those offering EC, 96% offer cut-up packets of oral contraceptives, whereas six affiliates offer dedicated products. Of those not offering EC, 79% believe it constitutes abortion. EC availability and support for the method appear to be increasing in LAC, and clearer distinctions between EC and abortion in medical and policy guidelines should increase acceptance further.
Postfertilization effect of hormonal emergency contraception.
Ann Pharmacother 2002 Mar;36(3):465-70
Kahlenborn C, Stanford JB, Larimore WL. Department of Internal Medicine, Altoona Hospital, PA, USA.
OBJECTIVE: To assess the possibility of a postfertilization effect in regard to the most common types of hormonal emergency contraception (EC) used in the US and to explore the ethical impact of this possibility. DATA SOURCES AND STUDY SELECTION: A MEDLINE search (1966-November 2001) was done to identify all pertinent English-language journal articles. A review of reference sections of the major review articles was performed to identify additional articles. Search terms included emergency contraception, postcoital contraception, postfertilization effect, Yuzpe regimen, levonorgestrel, mechanism of action, Plan B. DATA SYNTHESIS: The 2 most common types of hormonal EC used in the US are the Yuzpe regimen (high-dose ethinyl estradiol with high-dose levonorgestrel) and Plan B (high-dose levonorgestrel alone). Although both methods sometimes stop ovulation, they may also act by reducing the probability of implantation, due to their adverse effect on the endometrium (a postfertilization effect). The available evidence for a postfertilization effect is moderately strong, whether hormonal EC is used in the preovulatory, ovulatory, or postovulatory phase of the menstrual cycle. CONCLUSIONS: Based on the present theoretical and empirical evidence, both the Yuzpe regimen and Plan B likely act at times by causing a postfertilization effect, regardless of when in the menstrual cycle they are used. These findings have potential implications in such areas as informed consent, emergency department protocols, and conscience clauses.
Adolescent emergency contraception: attitudes and practices of certified nurse-midwives.
J Midwifery Womens Health 2002 Mar-Apr;47(2):68-73
Kettyle EP, Klima C. Yale University's Nurse-Midwifery program and School of Public Health, USA.
Teenage pregnancy has reached epidemic proportions in the United States with I million pregnancies and more than 500,000 live births occurring each year among women under the age of 20. The safety and efficacy of postcoital administration of oral contraceptives, commonly called "emergency contraception" (EC), have been well documented. However, EC is dramatically underused in the United States. Because low use of EC may be attributable, in part, to both lack of knowledge, as well as misinformation on the part of health care providers, further research in this area is warranted. Because midwives play a significant role in the provision of reproductive health care to adolescents, their attitudes about the use of EC among teens may impact the availability of emergency contraception options to these clients. This article presents results of a survey of certified nurse-midwives with respect to their attitudes, practices, and policies related to EC and provides recommendations specific to this provider population.
Court rules that emergency contraception is lawful.
BMJ 2002 Apr 27;324(7344):995
Mayor S.
NEWS
453
Commentary: Judicial review of the pharmacy provision of emergency contraception in the UK.
J Fam Plann Reprod Health Care 2002 Apr;28(2):105-6
Weyman A.
453
Emergency contraception.
Best Pract Res Clin Obstet Gynaecol 2002 Apr;16(2):181-91
Glasier A. Lothian Primary Care NHS Trust Family Planning and Well Woman Services, University of Edinburgh Department of Obstetrics and Gynaecology, 18 Dean Terrace, Edinburgh, EH4 1NL, UK
The last decade has seen a huge interest in emergency contraception (EC) because of the potential it has to reduce abortion rates. A variety of hormonal methods is available although mifepristone-arguably the best method-is only licensed in China. The intrauterine device is highly effective but its use is limited because of the technical skill required for successful insertion. The mechanism of action of both the Yuzpe regimen of EC and of levonorgestrel is poorly understood and for all methods there are serious methodological difficulties involved with calculating efficacy. Nevertheless the risks and side-effects of EC are negligible and the practicalities of prescribing it are extremely simple. Research and programmatic efforts should concentrate on improving availability if EC is to fulfil its promise as a public health intervention to reduce unwanted pregnancy. Copyright 2002 Elsevier Science Ltd.
453
How to improve use of emergency contraception by adolescents?
[Article in French]
J Gynecol Obstet Biol Reprod (Paris) 2002 Apr;31(2 Pt 1):144-51
Ottesen S, Narring F, Renteria SC, Michaud PA. Institut Universitaire de Medecine Sociale et Preventive, Groupe de recherche sur la sante des adolescents, 17, rue du Bugnon, 1005 Lausanne, Suisse.
OBJECTIVES: To give an overview of knowledge on emergency contraception (EC) and its utilization in the adolescent population, and to present the practical guidelines useful for EC prescription. METHODS: Review of the literature on EC and results of a survey on sexual behavior of 16-20-year-olds in Switzerland are used. RESULTS: Both estrogen-progestin and estrogen are used for EC. Condom breakage, lack of compliance in oral contraception and failure in contraceptive use are the main reasons for using EC. Sexually active adolescents are aware of CPC and 20% of girls have used it in Switzerland. However, insufficient information and low quality of services in emergency situation could be important barriers to the use of EC. DISCUSSION: and conclusion. Practical knowledge and information on EC must be disseminated among adolescents and both professional training and development of the quality of services have to provide better access to EC.
REVIEW, TUTORIAL
453
Emergency contraception in the community.
J Fam Plann Reprod Health Care 2002 Apr;28(2):94
Rowlands S, Lawrenson R. Reproductive & Sexual Health Services, East & North Herts NHS Trust, Health Centre, Hitchin, UK.
LETTER
Alterations in gonadotropin levels following oral and vaginal administration of the Yuzpe regimen and plan B for emergency contraception.
Fertil Steril 2002 Apr;77 Suppl 3:S6-7