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Emergency Contraception - Coggle Diagram

- - - - Lower failure rate
      - Works after ovulation
      - Ongoing contreception
      - Non-hormonal
    - - Requires procedure with complications
- - - - Cu-IUCD may disrupt ealy pregnancy if inserted after implantation and cause termination
      - Oral EC does not disrupt / is not teratogenic to early pregnancy
  - - - A. Multifactorial - clinical studies of efficacy
        UPA-EC acts before and after LH surge
        LNG acts only before the LH surge
- - - - Reason for request - no contraception / incorrect use
      - Key EC details - SOLP-C
    - - Contraceptive hx
      - Menstrual hx
      - Sexual hx
      - Gyae conditions
      - Cervical screen
      - STI screening hx
    - - Athma
      - Liver disease
      - UPA-EC may be c/i
    - - Progestogens
      - Liver enzyme inducing durgs
      - Allergies (prophylactic abx if Inserting Cu-IUCD / STI risk)
    - - Relationship status - risk of failure / STIs if multiple
  - - - Date and time of last UPSI
      - Calculate number of hours since last episode
    - - Any date of other UPSI in this cycle
    - - Calculate current day of menstrual cycle
    - - Establish period regularity and frequecny
      - Calculate Earliest likley date of ovulation and implantation
    - - Current contraception use - particularly progestogens
  - - - ↑ LNG-EC dose in BMI ≥ 26 / 70kg
    - - Only if Inserting Cu-IUCD / gynae issues
    - - Reliable if taken 21 days after last UPSI
  - - - Advise patient to start suitable ongoing contraception immediately (for LNG-EC) or after 5 days (for UPA-EC) as there is a risk from future episodes of UPSI (including in this cycle)
      - Advise STI screen / consider prophylactic abx
  - - - Unknown
        
        Currently this cycle up to or on D5 following earliest likely date of ovulation
        
        Yes
        
        Offer Cu-IUCD
        If not acceptable : Oral EC and Ongoing contraception
        
        No / Unknown
        
        Offer Oral EC and Ongoing contraception
        
        Ovulation occured
        
        EC unlikely to be effective
  - - - No / Unknown
        
        Offer UPA-EC
      - Yes
        
        UPSI likely ≤5 days before estimated date of ovulation
        
        Yes / Unkown
        
        Offer UPA-EC
        Offer LNG-EC if UPA-EC not suitable
        
        No
        
        BMI >26 /Weiht >70kg?
        
        Yes
        
        Offer UPA-EC of 3mg LNG-EC
        
        No
        
        Offer UPA-EC or 1.5mg LNG-EC