Assuntos
Dispositivos Intrauterinos Medicados/normas , Levanogestrel/administração & dosagem , Levanogestrel/efeitos adversos , Hemorragia Uterina/etiologia , Ensaios Clínicos Fase II como Assunto , Ensaios Clínicos Fase III como Assunto , Análise de Falha de Equipamento , Segurança de Equipamentos , Feminino , Humanos , Dispositivos Intrauterinos Medicados/efeitos adversos , Gravidez , Taxa de Gravidez/tendências , Gravidez Ectópica/epidemiologia , Gravidez Ectópica/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Reino Unido , Hemorragia Uterina/epidemiologia , Hemorragia Uterina/fisiopatologiaRESUMO
OBJECTIVE: When initiating contraception after emergency contraception (EC), conventional practice had been to wait until the next menses. Since 2010, UK guidelines have endorsed quick starting (QS) contraception, namely offering immediate start when requested. We conducted an audit to assess clinical practice before and after QS guidance publication. METHODS: A full cycle audit was performed on the clinical notes of women requesting EC during two 2-month periods in 2010 and 2011 in an Integrated Sexual Health Service. All case notes were identified using the National Sexual Health database of sexual health records (Scotland). Information was collated and interpreted using Microsoft Excel and SPSS V.17. RESULTS: During January and February 2010 and 2011, 190 and 180 women, respectively, attended for EC, of whom 96 and 97 were identified as potential quick starters. Between 2010 and 2011, a statistically significant increase in QS practice was noted from 20.8% (n=20) to 37.1% (n=36) (p=0.011), with a corresponding decrease in the percentage of women traditionally started on hormonal contraception (HC): 24% (n=23) and 14.6% (n=14), respectively. There was also a decrease in those advised to return for commencement of HC [55.2% (n=53) vs 49% (n=47)]. Of those advised to return, 26.4% (n=14) and 31.9% (n=15) had no further contact with the service within at least 6 months. CONCLUSIONS: QS practice increased after the introduction of clinical guidelines. However, overall provision of HC remained low, with only around half of women prescribed a hormonal method.
Assuntos
Anticoncepcionais Orais Hormonais/administração & dosagem , Anticoncepcionais Pós-Coito/administração & dosagem , Levanogestrel/administração & dosagem , Padrões de Prática Médica , Adolescente , Adulto , Anticoncepção Pós-Coito/métodos , Uso de Medicamentos , Feminino , Seguimentos , Humanos , Auditoria Médica , Preferência do Paciente , Guias de Prática Clínica como Assunto , Gravidez , Taxa de Gravidez , Retratamento , Estudos Retrospectivos , Medição de Risco , Escócia , Fatores de Tempo , Resultado do Tratamento , Adulto JovemAssuntos
Anticoncepção Pós-Coito/efeitos adversos , Anticoncepcionais Pós-Coito/efeitos adversos , Norpregnadienos/administração & dosagem , Anticoncepção Pós-Coito/economia , Anticoncepcionais Pós-Coito/economia , Anticoncepcionais Pós-Coito/uso terapêutico , Feminino , Humanos , Dispositivos Intrauterinos , Levanogestrel/uso terapêutico , Hormônio Luteinizante/sangue , Norpregnadienos/economia , Norpregnadienos/uso terapêutico , Fatores de RiscoAssuntos
Confidencialidade/ética , Emigração e Imigração/legislação & jurisprudência , Medicina de Família e Comunidade/ética , Acessibilidade aos Serviços de Saúde/ética , Necessidades e Demandas de Serviços de Saúde/ética , Refugiados/psicologia , Acesso à Informação , Adulto , Medicina de Família e Comunidade/legislação & jurisprudência , Feminino , Humanos , Direitos do Paciente/ética , Refugiados/legislação & jurisprudência , Ruanda/etnologia , Medicina Estatal , Reino UnidoAssuntos
Atitude do Pessoal de Saúde , Síndrome de Down/psicologia , Serviços de Planejamento Familiar/ética , Deficiências da Aprendizagem/psicologia , Pais/psicologia , Pessoas com Deficiência Mental , Direitos Sexuais e Reprodutivos/ética , Adulto , Atitude Frente a Saúde , Ética Médica , Feminino , Humanos , Competência MentalRESUMO
OBJECTIVE: To compare 100 mg mifepristone with the standard Yuzpe regimen for emergency contraception. DESIGN: Randomised controlled trial. SETTING: Family Planning Clinic, Aberdeen. SAMPLE: One thousand women seeking emergency contraception within 72 hours after an episode of unprotected sexual intercourse. METHODS: Women were randomised to receive either 100 mg (half tablet) of mifepristone as a single dose or the Yuzpe regimen (two tablets each with 50 microg ethinyloestradiol and 0.25 mg levonorgestrel, to be repeated 12 hours later). OUTCOME MEASURES: Crude pregnancy rates, proportion of pregnancies prevented, side effects and patient acceptability. RESULTS: The crude pregnancy rates (95% CI) for the Yuzpe regimen and mifepristone were 3.6% (2.3-5.7) and 0.6% (0.2-1.8), respectively, with a significant difference between the two groups (RR 6.04; 95% CI 1.75-20.75). Mifepristone prevented 92% of pregnancies and the Yuzpe regimen preventing 56%. An increasing coitus to treatment interval was associated with contraceptive failure in the Yuzpe group (P = 0.03) with no association seen with mifepristone. Following administration of mifepristone 24.5% and 13.1% given the Yuzpe regimen had a delayed period (RR 2.14; 95% CI 1.46-3.15). Overall, mifepristone was better tolerated than the Yuzpe regimen with significantly fewer side effects. More women were satisfied (P < 0.0001) with mifepristone as an emergency contraceptive and would recommend it to a friend (P = 0.02). CONCLUSION: Mifepristone administered in a 100 mg dose is a highly effective post-coital contraceptive with high patient acceptability and fewer side effects compared with the standard Yuzpe regimen. Delay in the onset of menstruation did not decrease patient acceptability.
