Acil kontrasepsiyon

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.

Emergency contraception

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.

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