Quick Start Contraception

  • Quick start contraception can be started any time in the cycle
  • It can be used if it is reasonably certain the women is not pregnant

When pregnancy can’t be excluded

  • pregnancy can’t be excluded with high sensitivity pregnancy test until more than 21 days after the UPSI
  • emergency contraception may be required
  • These can be used without delay:
    • Combined Hormonal Contraceptive (CHC)
    • Progesterone Only Pill (POP)
    • Progesterone only implant (IMP)
  • The depot (depot medroxyprogesterone acetate – DMPA) implant can be used if others are unsuitable / unacceptable
  • Don’t use the mirena (levonogesterol intrauterine system) can’t be used unless we’re reasonably sure they’re not pregnant
  • CHCs which contain cyproterone can’t be used unless not pregnant
  • Copper IUD can be used but only if it’s indications for emergency contraction are met
  • After emergency contraception with LNG-EC, the CHC, POP, IMP (and DMPA) can be started immediately
  • After emergency contraception with UPA-EC, one should wait five days before starting – so they’ve got to use barrier or abstinence before then

 

Pregnancy on contraception

  • if they become pregnant on contraception the contraceptive hormones are not thought to harm the fetus – they certainly shouldn’t terminate just on the grounds of exposure
  • if the do get pregnant, then stop or remove the contraception

If a women on contraception gets pregnant and choses to terminate

  • IMP (progesterone only implant) and DMPA (depot) should continue
  • Stop POP an CHC and restart immediately afterwards

Women on DMPA are slightly higher risk of the termination failing if the DMPA is given at the same time as the mifepristone.

 

  • If she gets pregnant with an interuterine device insitu this needs to come out – even if she’s not planning to continue with the pregnancy (as long as threads visable and it’s easy to remove)
  •  If the IUD  remains in situ there’s a small chance of it causing adverse pregnancy
  • Removing it in the first trimester carries a small risk of miscarriage but a chance of a better pregnancy outcome.