Emergency Contraception
Key Points
- Emergency contraception (EC) prevents pregnancy before implantation; it does not terminate an established pregnancy.
- EC effectiveness is highest when initiated as soon as possible after unprotected intercourse.
- Available methods include oral agents and copper IUD pathways with different timing windows and access requirements.
- Nursing care must be trauma-informed, nonjudgmental, and include STI screening and ongoing contraception planning.
Pathophysiology
Emergency contraception interrupts progression toward pregnancy by delaying or preventing ovulation and reducing fertilization likelihood, depending on method and timing in the cycle. Effectiveness falls as time from intercourse increases, so rapid access is clinically critical.
The source highlights common EC indications: condomless intercourse, contraceptive failure, missed doses/injections, expired barrier use, and sexual assault. Oral options have method-specific windows, with some extending to 120 hours. Copper IUD insertion is also used in selected EC pathways.
EC visits are high-value opportunities to address immediate risk and future prevention through contraception counseling, STI assessment, and safety screening.
Classification
- Oral levonorgestrel approaches: Over-the-counter or prescribed, earlier use preferred.
- Selective progesterone receptor modulator approach: Ulipristal acetate with extended timing window.
- Combined-hormone emergency regimen: Yuzpe-type high-dose strategy in specific settings.
- Device-based emergency method: Copper IUD insertion via clinician procedure.
Nursing Assessment
NCLEX Focus
Prioritize time since intercourse, current pregnancy risk, and identification of red-flag symptoms suggesting ectopic pregnancy or serious adverse effects.
- Determine timing of unprotected intercourse and potential contraceptive failure mechanism.
- Review menstrual history and current pregnancy likelihood.
- Screen for sexual assault and intimate partner violence with trauma-informed communication.
- Assess STI exposure risk and immediate testing/referral needs.
- Identify patient concerns, privacy needs, and emotional support requirements.
Nursing Interventions
- Provide urgent, clear counseling on EC options and method-specific time windows.
- Explain expected short-term effects: menstrual change, nausea, cramping, fatigue, and headache.
- Teach warning signs requiring urgent evaluation (delayed menses, severe abdominal pain, fever, heavy bleeding).
- Arrange follow-up pregnancy testing when menstruation is delayed.
- Transition from EC to a reliable ongoing contraceptive plan and safer-sex strategy.
Delayed-Access Failure Risk
Waiting to initiate EC can significantly reduce effectiveness and increase risk of unintended pregnancy.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| levonorgestrel-emergency-contraception | Plan B One-Step contexts | Most effective with earliest use; review timing, expected bleeding changes, and next-step contraception. |
| ulipristal-acetate | Ella contexts | Extended postcoital window option requiring prescription pathways in many settings. |
Clinical Judgment Application
Clinical Scenario
A patient presents 60 hours after condom failure, reports anxiety about pregnancy, and declines detailed discussion in a crowded triage area.
Recognize Cues: Time-sensitive EC need and strong privacy/psychological safety concerns. Analyze Cues: Delayed action could reduce EC efficacy and increase distress. Prioritize Hypotheses: Priority is rapid EC access with confidential, nonjudgmental counseling. Generate Solutions: Move to private setting, provide method options, and explain immediate next steps. Take Action: Administer/arrange EC promptly and set follow-up plan for menses delay or warning symptoms. Evaluate Outcomes: Patient receives timely EC, understands follow-up, and engages in ongoing contraception planning.
Related Concepts
- contraception-the-nurses-role - EC counseling should connect to long-term contraceptive decision-making.
- barrier-methods-of-contraception - Barrier failure is a common EC trigger and prevention target.
- short-acting-reversible-hormonal-methods-of-contraception - Missed-dose events in short-acting methods often prompt EC use.
- long-acting-reversible-contraception - LARC may reduce repeat EC need in high-risk situations.
- therapeutic-communication - EC care requires privacy, respect, and trauma-informed language.
Self-Check
- Why is rapid access the most important determinant of EC effectiveness?
- Which clinical findings after EC require urgent reassessment?
- How can EC visits be used to reduce future unintended pregnancy risk?