Table of Contents
Overview – Emergency Contraception and Abortion
Emergency contraception and abortion are critical components of reproductive healthcare. Final-year medical students must understand the indications, mechanisms, and legal/ethical considerations surrounding both urgent contraception and pregnancy termination. This guide outlines the key clinical protocols, drug regimens, and safety information for managing unplanned or failed pregnancies.
Emergency Contraception
Goal
- To prevent pregnancy after unprotected intercourse or contraceptive failure (e.g. condom breakage).
Timing
- Must be administered as soon as possible after unprotected sex.
- Maximum efficacy window: <120 hours (5 days).
- Ineffective after implantation of the embryo.
Methods
1. Progesterone-Only Pill (“Plan B”)
- Levonorgestrel 1.5 mg, single dose.
- Most effective within 72 hours of unprotected sex.
- Minimal side effects.
- Not effective after implantation.
2. Copper Intrauterine Device (IUD)
- Most effective method overall.
- Can be inserted up to 5 days post-intercourse.
- Still effective after fertilisation, possibly even after implantation.
- More invasive and less convenient.
Abortion Pre-Requisites
Before any abortion procedure, ensure the following are completed:
- Counselling – Options including continuation, adoption, or abortion.
- Informed Consent – Must meet legal requirements for age, gestational limits, and decision-making capacity.
- Comprehensive History – Medical, obstetric, and social.
- Post-Abortion Contraception Discussion – To prevent recurrence.
- STI Screening and Education
- Prophylactic Antibiotics – To reduce post-procedure infection risk.
Abortion Methods
Early Medical Abortion (<6 Weeks Gestation)
- Drug of choice: Mifepristone (RU486)
- A progesterone receptor antagonist.
- Disrupts endometrial support → prevents implantation.
- Effective up to 63 days (9 weeks) since LMP.
- Does not require hospitalisation.
- Methotrexate may be used instead, especially in ectopic pregnancies.
Early Surgical Abortion (<14 Weeks Gestation)
- Dilation and Suction Curettage:
- Performed up to 14 weeks.
- Fast and generally safe.
Late Medical Abortion (14–20 Weeks Gestation)
- Step 1: Mifepristone
- Administered to stop hormonal support to the endometrium.
- Step 2 (48 hours later): Vaginal Misoprostol
- A synthetic prostaglandin.
- Induces cervical ripening and uterine contractions.
- Often paired with analgesia, ± anti-emetics, ± Anti-D Ig for Rh-negative women.
- Highly safe; risk of major complications like death is <1 in 100,000.
**Abortion beyond 20 weeks is generally restricted and only permitted under specific legal exceptions (e.g., severe fetal anomaly, maternal danger).
Summary – Emergency Contraception and Abortion
Emergency contraception and abortion are essential clinical tools in reproductive medicine. Timely intervention, proper counselling, and safe medical or surgical methods help reduce maternal morbidity and improve patient autonomy. For a broader context, see our Obstetrics Overview page.