Quick starting contraception

Question 1

Criteria to be ‘reasonably certain that a woman is not pregnant’

Answer 1

• no sex since last normal period, since childbirth, abortion, miscarriage, ectopic
• reliably using contraception
• on d1-5 of period
• <21d post partum
• using LAM
• within first 5d of abortion
• no sex for 21d AND neg PT

Question 2

women is pregnant after quick starting - wants to have an abortion - advice for contraception continuation?

Answer 2

if LARC and in - continue. If pill, stop and then restart after abortion

Question 3

women with IUC that are pregnant - what happens to IUC

Answer 3

• if preg <12w gestation then remove IUC if can see strings (regardless if wanting to keep baby or not)- is assoc with small risk of miscarriage but removing in first trimester could improve preg outcomes
• explain that risk of adverse outcomes is higher than that fr pregnancies without IUC

Question 4

Method:
COC
Day of cycle: a) 1-5 b) 6 onwards
How many days additional contraception?

Answer 4

a) 0
b) 7

Question 5

Method:
combined transdermal patch or vaginal ring
Day of cycle: a) 1-5 b) 6 onwards
How many days additional contraception?

Answer 5

a) 0
b) 7

Question 6

Method:
POP - traditional/ desogestrel
Day of cycle: a) 1-5 b) 6 onwards
How many days additional contraception?

Answer 6

a) 0
b) 2

Question 7

Method:
projesterone only injection
Day of cycle: a) 1-5 b) 6 onwards
How many days additional contraception?

Answer 7

a) 0
b) 7

Question 8

Method:
progesterone only implant
Day of cycle: a) 1-5 b) 6 onwards
How many days additional contraception?

Answer 8

a) 0
b) 7

Question 9

Method:
Mirena
Day of cycle: a) 1-7 b) 8 onwards
How many days additional contraception?

Answer 9

a) 0
b) 7

Question 10

Method:
Cu-IUD
Day of cycle: a) 1-7 b) 8 onwards
How many days additional contraception?

Answer 10

a) 0
b) 0

Question 11

If you cant exclude pregnancy what methods can be used for quick start?

Answer 11

POP, implant, injection, CHC
Cu-IUD if in windows for EC
Can’t use mirena

Question 12

How long to wait after LNG-EC to quick start

Answer 12

Can start immediately

Question 13

How long to wait after UPA-EC to quick start

Answer 13

5 days

Question 14

Advice to give when quick starting

Answer 14

• Do PT at 21d
• Additional contraception for X amount of days
• consider EC