post abortion.pptx

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1. 1 EC, Post abortion FP and Post partum FP By Mulualem S. (MSc)

2. Objectives By the end of this module, you will be able to: To describe the different EC and their regimens To explain mechanism of action and effectiveness of EC To describe benefits and side effects of EC To describe options for post abortion and post partum FP 2

3. 3 Emergency contraceptive

4. 4 What is EC? A type of contraception that is used as an emergency to prevent unintended pregnancy following an unprotected sexual intercourse. Sometimes referred to as the “morning-after pill” or “post-coital contraception”.

5. 5 Types of EC Emergency contraceptive pills (ECPs): COC or POP Copper-releasing IUDs.

6. 6 Who can use EC? When no contraceptive has been used When there is a contraceptive accident/ misuse Condom rupture, slippage or misuse IUCD expulsion Three COC missed consecutively & late for DMPA injection by > 4 weeks POP contraceptive pill taken 3 or more hours late Failure of a spermicidal to melt before intercourse Failed coitus interruptus (withdrawal) Diaphragm dislodgement or early removal. Miscalculation of the safe period when using a fertility awareness based method. In case of Rape

7. 7 Not eligible for EC Client who is already pregnant

8. 8 ECP regimen Can be used up to five days following unprotected sexual intercourse. 1. Progesterone only pills Pills containing 0.75mg levonorgestrel such as postinor-2, Optinor . 1 pill as soon as possible after unprotected intercourse followed by a same dose taken 12 hours later. Pill containing 1.5mg levonorgestrel : 1 pill only as soon as possible after unprotected intercourse Pills containing 0.03mg levonorgestrel ( microlute , norgeston , ovrette ) 20 pills for the 1 st & 2 nd dose 8

9. 9 ECP regimen … 2 . Combined OCP/ Yuzpe's method High dose pills containing 50 µg of ethinyl oestradiol & 0.25mg levonorgestrel ( neogenon , ovran , eugynon ) 1 st dose: 2 pills as soon as possible after unprotected with in 5 days 2 nd dose: 2 pills 12 hours later Low dose pills containing 30 µg ethinyl oestradiol & 0.15 mg of levonorgestrel ( microgynon , nordate , lo/ femenal ) 4 pills for the 1 st & 2 nd dose 9

10. 10 How does EC work? Delay or inhibit ovulation Is the principal mechanism Prevent implantation Prevent transport of the sperm & ovum * Emergency contraceptives are not effective once implantation has occurred. * ECPs do not interrupt or abort an established pregnancy

11. 11 Safety and effectiveness Safety ECP are considered very safe In > 20 yrs no death or serious complication reported ECP is not associated with fetal malformation/ congenital defect ECP do not increase the possibility of ectopic pregnancy Effectiveness ECP reduce probability of becoming pregnant By 75% in case of COC & By 85% in case of POP Most effective if taken within 3 days (or 72 hours).

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13. 13 Side effects Nausea Most common More in COC user than POP users In about 50% of clients using combined ECPs and in 20% of women using progestogen -only ECPs Usually does not last > 24 hrs Management: Take the pill with food/ at bed time Prophylactic anti -emetic may be considered in women who had nausea in previous ECP use

14. 14 Side effects … Vomiting In 20% of women using COC & In 5% of women using pops as ECP Management- if vomiting occurs with in 2 hours, the dose should be repeated Irregular vaginal bleeding or spotting Inform that ECP do not bring menses immediately If the menstrual period is delayed for >1 week from the expected date, consider the possibility of pregnancy Breast tenderness, headache, dizziness & fatigue Management: pain reliever

15. 15 Instructions to the client Explain the correct use of the method Advise that emergency contraception does not protect against STIs including HIV. Counsel on regular contraception then after. Advise the client to drink milk or eat a snack with the pills to reduce nausea. Advise her to use a barrier method until her next menstruation if she has sexual intercourse. Explain that after the use of ECPs most women will have the next menstrual period early or on time. If the menstrual period is delayed for more than 1 week the possibility of pregnancy should be considered.

16. 16 Follow-up care If the client adopted a method of contraception for regular use no follow-up should be required in relation to the use of EC During the follow-up contact discuss suitable contraceptive options Oral contraception can be started the day after ECP is taken. Injectables , implants and IUCD can be given within 7 days of the beginning of the next menstrual cycle. In case of failure of ECP If the client decides to continue the pregnancy, reassure her that there is no risk of teratogenic effect following ECP.

17. 17 Copper-bearing IUCD A copper-bearing IUCD can be used within 7 days of unprotected intercourse as an EC. Failure rate: <1% of women become pregnant. Indications: in addition to those for EC The client is considering using an IUCD for continuous, long-term contraception.

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19. 19 19 Unsafe Abortion & Contraception Globally, approximately 500,000 maternal deaths each year Nearly 70,000 are from unsafe abortion A way to end unsafe abortion is through contraception

20. 20 20 Post-abortion FP Timing of counseling: Before or after treatment for abortion Safe methods to prevent pregnancy are available Most contraceptive methods can be used immediately following abortion Inform the client that she could become pregnant again within 10 days if not using contraception Provide or inform how she could obtain contraceptive services After abortion, the recommended minimum interval to next pregnancy is at least six months In order to reduce risks of adverse maternal and perinatal outcomes

21. 21 21 Post abortion FP Methods Uncomplicated abortion: Uterine Size up to 12 Wks : All methods can be used Uterine Size Greater > 12 Wks Most methods can be used immediately, IUCD can also generally be used (Category 2) Abortion with Complications: Infection or genital trauma Delay female sterilization and IU C D insertion Severe bleeding: Sterilization should be delayed

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23. 23 Unmet need for PP FP Only 3-8% of post partum woman want pregnancy with in 2 years Only 40% of post partum woman use FP A fter a live birth, the recommended interval before attempting the next pregnancy is at least 24 months.

24. 24 PP FP counselling Timing of counseling could be at any of the following visits: Preconceptional During a ntenatal care D uring the latent phase of labor Early in the postparum period During l ate postpartum period

25. 25 25 Breast-feeding- Contraception Breast-feeding (Lactational amenorrhea method/ LAM) can only be considered as a method of contraception if The women is amenorrheic Wtihin the first 6 months postpartum and Exclusively b reast-feeding Even in women who are breast-feeding properly 12% will ovulate within the first 6 months and 2% will get pregnant

26. 26 Thank you