Emergency contraception (EC
) is a term that encompasses more than the name implies. Rather than being simply a postcoital form of birth control, this method can be used, in certain circumstances, as long as 8 days after the act of unprotected intercourse in hopes of preventing pregnancy. EC
can be accomplished by oral route and through the insertion of a copper intrauterine device (IUD
). The oral regimens available in the United States include a second-generation antiprogestin, progestin-only pills, and levonorgestrel-containing oral contraceptives. The current second-generation antiprogestin (ella) available in the United States is only available by prescription. The most common regimen is a dedicated progestin-only product that is concentrated so that fewer pills have to be swallowed. The history of U.S. public policy toward EC
is convoluted at best. Suffice to say that as of August 2013, Plan B One-Step became available in the United States without prescription to males and females with no age restriction. The generic one-pill products are also now approved for over-the-counter sale. There is an excellent Internet site devoted to EC
that was developed by Dr. James Trussell, Princeton University (ec.princeton.edu
), in collaboration with the Association of Reproductive Health Professions. It contains complete, detailed information on EC
for providers as well as resources for patients. See Table 16-1
Effectiveness rates are difficult to ascertain. All in all, the insertion of a copper-containing IUD
has the highest effectiveness rate. The effectiveness rate of oral contraceptive pill (OCP) use varies based on the time in the cycle of unprotected intercourse and study variations. In general, it is usually stated that EC
will prevent about 75% of the unintended pregnancies that would have resulted had no treatment been given in those circumstances. The impact of obesity on effectiveness of levonorgestrel products is presently being researched but no current recommendations exist. This is a topic that requires watching.
It is important to remember that acts of unprotected intercourse do not always happen because patients were unprepared. In many cases, the condom breaks, the woman discovers that her diaphragm slipped, or the IUD
string can’t be felt. It is important for triage nurses to avoid being judgmental when patients call for help.
You will need to discuss with your providers how they will handle calls for this service. For example, not all practices offer IUD
insertion for this purpose. For specific information, including the names of local providers and pharmacies where patients can get assistance if not offered through your practice, refer to the Princeton website (ec.princeton.edu/questions/index.html
) or the EC
National Hotline (1-888-NOT-2-LATE).