Acil kontrasepsiyon

ÇAPAR, Metin; KÖŞÜŞ, Aydın; KÖŞÜŞ, Nermin

Acil kontrasepsiyon

Aydın KÖŞÜŞ, (Gözde Hastanesi, Kadın Hastalıkları ve Doğum Kliniği, Malatya, Türkiye)

Nermin KÖŞÜŞ, (Gözde Hastanesi, Kadın Hastalıkları ve Doğum Kliniği, Malatya, Türkiye)

Metin ÇAPAR (Selçuk Üniversitesi, Meram Tıp Fakültesi, Kadın Hastalıkları ve Doğum Anabilim Dalı, Konya, Türkiye)

Genel Tıp Dergisi

30 5

Yıl: 2007 Cilt: 17 Sayı: 2 Sayfa Aralığı: 131 - 138 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Acil kontrasepsiyon

Öz:

Amaç: Kullanımda olan acil kontrasepsiyon yöntemlerini incelemek. Ana Bulgular: Güvenilir ve efektif bir acil kontrasepsiyon yöntemi kullanılarak ABD de her yıl 1 milyon tahliye, 2 milyon istenmeyen gebelik önlenmektedir. Her yıl kadınların % 2-3’ü gebeliği tahliye ile sonlandırırken sadece % 1’i acil kontrasepsiyon yöntemlerini kullanmaktadır. Korunmasız ilişki ile kullanılan kontrasepsiyon yönteminin zamanlaması arasında önemli bir ilişki mevcuttur. Tüm hormonal yöntemler, ilişki sonrası 72 saate kadar alınabilir. Ne kadar erken alınırsa koruyucu etkisi o kadar artmaktadır. Yapılan çalışmalarda 72 saate kadar başlanan kontrasepsiyonda başarısızlık oranı % 4’dür. Acil kontrasepsiyonda kullanılan tüm yöntemler değerlendirildiğinde başarı oranı ortalama % 75 (% 55-88) olarak bulunmuştur. Progesteron tek başına ya da estrojenle kombine (Yuzpe rejimi) olarak ilk 72 saat içinde kullanıldığında gebelik oranlarını % 75-88 oranında azaltmaktadır. Sadece progesteron içeren yöntemler kombine hormonal yöntemlere göre daha etkili görünmektedir. RİA ilişki sonrası 5-7. günlerde bile kullanılabilir ve gebeliği % 99 oranında engellemektedir. Yapılan çalışmalarda mifepristonun etkinliği % 95-99 iken danazolün etkinliği % 73-86 oranında tesbit edilmiştir. Acil kontrasepsiyon yöntemlerinin gebelik haricinde kesin bir kontrendikasyonu yoktur. Sonuç: Yuzpe rejimi, tek başına progesteron ve mifepriston oldukça etkili ve çok iyi tolere edilebilen yöntemlerdir. Korunmasız ilişki sonrası ilk 72 saat içerisinde kullanıldıklarında gebeliği önleme oranları oldukça yüksektir. İstenmeyen gebelikleri ve gereksiz küretajları önlemek amacıyla acil kontrasepsiyon hakkında özellikle kadınların bilgilendirilmesi çok önemlidir.

Anahtar Kelime:

Konular: Genel ve Dahili Tıp

Emergency contraception

Öz:

Objective: To evaluate emergency contraceptive methods in use. Main Findings: Two billion unwanted pregnancy and 1 billion abortuses are prevented in United States by usage of an effective and safe emergency contraceptive method. Every year 2-3% of pregnancies are ended by intended abortuses and only 1% of women use an emergency contraceptive method. There is an important relationship between unprotected sexual intercourse and timing of contraceptive method. All of the hormonal methods must be used in first 72 hours after the intercourse. Taking the contraceptive method earlier increases the effectiveness of it. Failure rate was found to be 4% if method is used within 72 hours of unprotected intercourse. Mean success rate is found as 75% (55-88%) if all methods of emergency contraception are evaluated. Only progesterone or combined with estrogen (Yuzpe regimen) decrease pregnancy rate 75-88% if taken in first 72 hours. Only progesterone is seem to be more effective than combined hormonal methods. Intrauterine device can be used up to 5-7th days and prevents 99 % of pregnancy. Efficiency of mifepristone and danasol were found to be 95-99% and 73-86% respectively in the studies. There isn’t any contraindication for emergency contraception except pregnancy. Conclusion: Yuzpe regimen, only progesterone and mifepristone are very effective and well-tolerated methods. Efficiency is very high if used during first 72 hours after unprotected sexual intercourse. All women must be informed about emergency contraception in order to decrease unwanted pregnancies and intended abortuses.

Anahtar Kelime:

Konular: Genel ve Dahili Tıp

Belge Türü: Makale Makale Türü: Derleme Erişim Türü: Erişime Açık

1. Wilcox AJ, Weinberg CR, Baird DD. Timing of sexual intercourse in relation to ovulation. Effects on the probability of conception, survival of the pregnancy, and sex of the baby. N Engl J Med 1995; 333:1517-21.
2. Trussell J, Stewart F. The effectiveness of postcoital hormonal contraception. Fam Plann Perspect 1992;24:262-4.
3. Grimes DA. Emergency contraception--expanding opportunities for primary prevention. N Engl J Med 1997;337:1078-9.
4. Glasier A. Emergency postcoital contraception. N Engl J Med 1997;337:1058-64.
5. Piaggio G, von Hertzen H, Grimes DA, Van Look PF. Timing of emergency contraception with levonorgestrel or the Yuzpe regimen. Task Force on Postovulatory Methods of Fertility Regulation. Lancet 1999;353:721.
6. Task Force on Postovulatory Methods of Fertility Regulation. Randomised controlled trial of levonorgestrel versus the Yuzpe regimen of combined oral contraceptives for emergency contraception. Lancet 1998;352:428-33.
7. Fasoli M, Parazzini F, Cecchetti G, La Vecchia C. Post-coital contraception: an overview of published studies [published correction appears in Contraception 1989;39:699]. Contraception 1989;39:459-68.
8. Ellertson C. History and Efficiency of Emergency Contraception: Beyond Coca-Cola. Fam Plan Perspect 1996;28:44-8.
9. Trussell J, Ellertson C. Efficacy of emergency contraception. Fert Control Rev 1995;4:8-11.
10. Family Health International. Adolescents and Emergency Contraceptive Pills in Developing Countries. Research Triangle Park, NC: Family Health International Working Paper Series, May 2005.
11. United States Government Accountability Office. Food and Drug Administration Decision Process to Deny Initial Application for Over-the-Counter Marketing of Emergency Contraceptive Drug Plan B Was Unusual. November 2005.
12. Wesley E. Emergency Contraception: A Global Overview. JAMWA Fall 1998;53.
13. Webb AMC, Russell J, Elstein M. Comparison of Yuzpe regimen, danazol, and mifepristone (RU 486) in oral postcoital contraception. BMJ 1992;305:927-31.
14. Zuliani G, Colombo UF, Molla R. Hormonal postcoital contraception with an ethinyl estradiol-norgestrel combination and two danazol regimens. Eur J Obstet Gynecol Reprod Biol 1990;37:253-60.
15. Trussell J, Koeniq J, Ellertson C, Stewart F. Preventing Unintended Pregnancy: The Cost-Effectiveness of Three Methods of Emergency Contraception. American Journal of Public Health, 1997, 87: 932-5.
16. Bracken MB. Oral contraception and congenital malformations in offspring: a review and meta-analysis of the prospective studies. Obstet Gynecol 1990;76:552-7.
17. Bennett W, Petraitis C, D’Anella A, Marcella S. Pharmacists’ knowledge and the difficulty of obtaining emergency contraception. Contraception 2003;68:261-7.
18. Ellertson C, Evans M, Ferden S, Leadbetter C, Spears A, Johnstone K, et al. Extending the time limit for starting the Yuzpe regimen of emergency contraception up to 120 hours. Obstet Gynecol 2003;101:1168-71.
19. Yuzpe AA, Lancee WJ. Ethiny lestradiol and dl-norgestrel as a postcoital contraceptive. Fertil Steril 1977;28:932-6.
20. Trussell J, Rodriguez G, Ellertson C. Updated estimates of the effectiveness of the Yuzpe regimen of emergency contraception. Contraception 1999;59: 147-51.
21. American College of Obstetricians and Gynecologists ( ACOG) practice bulletin. Emergency oral contraception. Number 25, March 2001. (Replace Practice Practice Patterns No. 3. December 1996). Int J Gynaecol Obstet. 2002;78(2):191-19.
22. Suneeta Mittal. Interventions for emergency contraception: RHL commentary (last revised: 23 September 2004). The WHO Reproductive Health Library, No 9, Update Software Ltd, Oxford, 2006. www.rhlibrary.com
23. Vasilakis C, Jick SS, Jick H. The risk of venous thromboembolism in users of postcoital contraceptive pills. Contraception 1999;59:79-83.
24. Haspels AA. Interception: post-coital estrogens in 3016 women. Contraception 1976:14:375-81.
25. Van Santen MR, Haspels AA. A comparison of high-dose estrogens versus low-dose ethinyl estradiol and norgestrel combination in postcoital interception: a study of 493 women. Fertil Steril 1985;43:2043-53.
26. Barnhart KT, Sondheimer SJ: Emergency contraception. Curr Opin Obstet Gynecol. 1994;6:559-63.
27. Ling WY, Wrixon W, Acorn T, Wilson E, Collins J. Mode of action of dl-norgestrel and ethinyl-estradiol combination in postcoital contraception. III. Effect of pre-ovulatory administration following the luteinizing hormone surge on ovarian steroidogenesis. Fertil Steril 1983;40:631-6.
28. Ling WY, Wrixon W, Zayid I, Acorn T, Popat R, Wilson E. Mode of action of dl-norgestrel and ethinyl-estradiol combination in postcoital contraception. II. Effect of postovulatory administration on ovarian function and endometrium. Fertil Steril 1983;39:292-7.
29. The Kaiser Family Foundation. Women's health care providers experiences with emergency contraception, June 2003. Available at URL: http://www.kff.org/womenshealth/3343-index.cfm.
30. Ho PC, Kwan MSW. A prospective randomized comparison of levonorgestrel with the Yuzpe regimen in post-coital contraception. Hum Reprod 1993;8:389-92.
31. Goldberg JR, Plescia MG, Anastasio GD. Mifepristone (RU 486): current knowledge and future prospects. Arch Fam Med 1998;7:219-22.
32. Spitz IM, Bardin CW. Mifepristone (RU 486): A modulator of progestin and glucocorticoid action. N Engl J Med 1993;329:404-12.
33. Weiss BD. RU 486: The progesterone antagonist. Arch Fam Med 1993;2:63-70.
34. Glasier A, Thong KJ, Dewar M, Mackie M, Baird D. Mifepristone (RU 486) compared with high-dose estrogen and progestogen for emergency postcoital contraception. N Engl J Med 1992;327:1041-4.
35. Swahn ML, Westlund P, Johannisson E, Bydeman M. Effect of post-coital contraceptive methods on the endometrium and the menstrual cycle. Acta Obstet Gynecol Scand 1996;75:738-44.
36. Barbieri RL, Ryan KJ. Danazol: endocrine pharmacology and therapeutic applications. Am J Obstet Gynecol 1981;141: 453-63
37. Trussell, J. Ellertson C, Stewart F, Koenig J, Raymond EG. Emergency contraception: A cost-effective approach to preventing unintended pregnancy. Womens Health Prim Care 1998;1:55-69 38-
38. Gottardi G, Spreafico A, de Orchi L. The postcoital IUD as an effective continuing contraceptive method. Contraception 1986; 34:549-58
39. Omnia M Sarma. Emergency Intrauterine Device. E-Medicine Health. December 24, 2006 http://www.emedicinehealth.com/ emergency_contraception 40. Pasquale S. Clinical experience with today’s IUDs. Obstet Gynecol Surv 1996;51: 25-9.
41. Webb AMC: Intrauterine contraceptive devices and antigestagens as emergency contraception. Bur ] Contracept Reprod Health Care. 1997;2:243-6.
42. American Medical Association. Policy Statement H-75.985: Access to emergency contraception. Chicago: American Medical Association.
43. FIGO Committee Report: Ethical guidelines regarding privacy and confidentiality in reproductive medicine. Testing for genetic predispositionto adult unsetdisease. Guidelines in emergency contraception. FIGO Committee for the Ethical Aspects of Human Reproduction and Women’s Health. Int J Gynecol Obstet 2002; 77:171-5.
44. Statement of the American College of Obstetricians and Gynecologists supporting the availability of over-the-counter emergency contraception. Washington, D.C.:Ameri Coll Obstetricians Gynecolo, February 2001.

APA	KÖŞÜŞ A, KÖŞÜŞ N, ÇAPAR M (2007). Acil kontrasepsiyon. , 131 - 138.
Chicago	KÖŞÜŞ Aydın,KÖŞÜŞ Nermin,ÇAPAR Metin Acil kontrasepsiyon. (2007): 131 - 138.
MLA	KÖŞÜŞ Aydın,KÖŞÜŞ Nermin,ÇAPAR Metin Acil kontrasepsiyon. , 2007, ss.131 - 138.
AMA	KÖŞÜŞ A,KÖŞÜŞ N,ÇAPAR M Acil kontrasepsiyon. . 2007; 131 - 138.
Vancouver	KÖŞÜŞ A,KÖŞÜŞ N,ÇAPAR M Acil kontrasepsiyon. . 2007; 131 - 138.
IEEE	KÖŞÜŞ A,KÖŞÜŞ N,ÇAPAR M "Acil kontrasepsiyon." , ss.131 - 138, 2007.
ISNAD	KÖŞÜŞ, Aydın vd. "Acil kontrasepsiyon". (2007), 131-138.

APA	KÖŞÜŞ A, KÖŞÜŞ N, ÇAPAR M (2007). Acil kontrasepsiyon. Genel Tıp Dergisi, 17(2), 131 - 138.
Chicago	KÖŞÜŞ Aydın,KÖŞÜŞ Nermin,ÇAPAR Metin Acil kontrasepsiyon. Genel Tıp Dergisi 17, no.2 (2007): 131 - 138.
MLA	KÖŞÜŞ Aydın,KÖŞÜŞ Nermin,ÇAPAR Metin Acil kontrasepsiyon. Genel Tıp Dergisi, vol.17, no.2, 2007, ss.131 - 138.
AMA	KÖŞÜŞ A,KÖŞÜŞ N,ÇAPAR M Acil kontrasepsiyon. Genel Tıp Dergisi. 2007; 17(2): 131 - 138.
Vancouver	KÖŞÜŞ A,KÖŞÜŞ N,ÇAPAR M Acil kontrasepsiyon. Genel Tıp Dergisi. 2007; 17(2): 131 - 138.
IEEE	KÖŞÜŞ A,KÖŞÜŞ N,ÇAPAR M "Acil kontrasepsiyon." Genel Tıp Dergisi, 17, ss.131 - 138, 2007.
ISNAD	KÖŞÜŞ, Aydın vd. "Acil kontrasepsiyon". Genel Tıp Dergisi 17/2 (2007), 131-138.