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Emergency Contraception (Interceptives)

Agents that do not interfere with fertilization but act on the endometrium to prevent implantation are called "interceptive agents," and those that interfere with early gestation causing an abortion are called "contraceptives."



  1. Unplanned, unprotected intercourse
  2. After rape
  3. Rupture or tear in the condom at the time of intercourse.

Two methods of emergency contraception are available now: (1) hormonal and (2) mechanical (IUD). There are two types of hormonal emergency contraception (emergency window = 72 hours)

  1. LNG, only pills (most commonly used)
    One tablet of 0.75 mg LNG pill should be taken as soon as possible after unprotected intercourse, followed by a same dose taken 12 h later; both doses must be taken within 72 h of intercourse.
    Single 1.5 mg dose of LNG is as effective for emergency contraception as two 0.75 mg doses of LNG taken 12 h apart.
    Failure rate (pregnancy rate) = 0-1 %
  2. Combined Estrogen and Progestogen Pills (Also Known as the Yuzpe Regimen)
    High-dose pills contain 50 μg of EE and 250 μg LNG (or 500 μg norgestrel). Two pills should be taken as soon as possible, but not later than 72 h of unprotected coitus; this must be followed by two other pills 12 h later.
    When only low-dose pills containing 30 μg of EE and 150 μg of LNG (300 μg of norgestrel) are available, four pills should be taken as the first dose within 72 h of unprotected intercourse, followed by four more pills after 12 h.
    Main side effect is nausea and vomiting
    Failure rate = 0-2%
    The mechanism of action of emergency contraceptive pills has not b en clearly established. They may act through
    1. inhibition or delay of ovulation
    2. prevention of implantation in the altered endometrium (interception = main action)
    3. prevention of fertilization due to quick transport of sperms or ova. They cannot interrupt already established pregnancy

IUDs introduced postcoitally can prevent pregnancy very successfully. (Failure rate = 0.1 %).

IUDs can be used postcoitally up to 5 days following sexual exposure. Thus, this method can be used even after 48 h more delay than the hormonal methods allow.


Antiprogesterone (Mifepristone)


Latest WHO randomized trial has noted that a single dose of 10 mg mifepristone is as effective as LNG for emergency contraception, with no difference in side effects; periods start after 7 days-a bit delayed than after LNG regimen.


However, as of date low-dose mifepristone for emergency contraception has not been registered in any country.

Male Sterilization

Two methods of male sterilization are followed nowadays: (1) conventional vasectomy and (2) no-scalpel vasectomy.


Sterility does not occur immediately after the procedure. Sperms remain in the semen for 15-20 ejaculations, requiring continued contraception for about 3 months. Absence of sperms after 3 months must be confirmed with a microscope before confirmation of sterility.

No-Scalpel Vasectomy


This method of vasectomy "without the use of a scalpel" was introduced in China in 1974 by Dr. Li. Contraindications: No permanent contraindications. Failure rate of vasectomy is 0.1 per 100 women partners in first year when performed properly.


Reversal is possible with microsurgery, giving 90% return of sperm and about 70% of pregnancy rate. This declines with time, particularly after 7 years.

Female Sterilization

  1. Female sterilization is the most widely used contraceptive method in the world.
  2. It can be done by laparotomy or laparoscopy.

The following are the laparotomy methods:

  1. Pomeroy technique (most commonly done laparotomy method): After bringing out the fallopian tube through the incision, a clamp is placed about 4 cm lateral to the fundus and the tube is pulled up so as to form a loop. The Pomeroy operation is the most simple and safe procedure of tubal ligation. It has got a failure rate of 1 in 300....400 operation.
  2. Irving technique: This technique has a very low failure rate, less than 1 in 1000 cases.
  3. Uchida technique: Uchida claims no failure in 19,000 cases.
  4. Fimbriectomy (Kroener's technique): This technique has been abandoned at present due to high failure rate (2-3%).
  5. Madlener technique: The procedure is very simple but has a high failure rate of 0.3-2% and has been practically abandoned.
  6. Parkland technique: The failure rate of this technique is about 1 in 400 procedures.

NOTE: Least failure rate (among laparotomy techniques) = Uchida followed by Irving.

Laparoscopic Tubal Ligation

Female sterilization with the use of an operating laparoscope is getting more and more popular because it has been found to be a safe, simple, and effective procedure that can be performed through one or two very small incisions in the abdomen, mostly under sedation and local anesthesia on an outpatient basis. Verres needle: It is used to introduce gas or air for pneumoperitoneum.


Carbon dioxide is the most common gas used for distention. The intra-abdominal pressure during laparoscopy surgery should be kept between 10-15 mmHg and never exceed 20-25' mmHg.


Contraindications of Laparoscopic Tubal Ligation

Absolute Contraindications:

  1. Large abdominal mass (uterine or ovarian tumors) needing laparotomy.
  2. Decompensated heart disease.
  3. Severe respiratory dysfunction.
  4. Hiatus hernia.
  5. History of abdominal surgery, especially of the bowel.

Relative contraindications are:

  1. Gross obesity with thick abdominal wall and
  2. Pelvic adhesion due to previous pelvic infection or operations. Laparoscopic sterilization should not be done soon after delivery or abortion of more than 12 weeks pregnancy.

Method of Tubal Occlusion

Silastic bands (Yoon) or spring-loaded clip (Hulka-Clemens) are two methods used for occlusion. The electrocoagulation methods cause less pain but may produce serious gastrointestinal burns; bums of other organs, vessels, ana the abdominal wall may also occur. The incidence of bums after unipolar electrocoagulation method is greater, and as such this method has almost been given up.

  1. Falope ring / Silastic bands: At present in India, this Silastic band technique is most popular and most commonly used for laparoscopic tubal ligation.
  2. Clips: Two types of clips are mostly used: the spring-loaded clip (Hulka-Clemens clip) and silicone- titanium clip (Filshie clip). A clip is placed on the isthmus on each tube, 2-3 cm from the uterus, with a special straight- type laparoscope.
    The clips cause least damage to the tube (about 1 cm), whereas tubal damage is 3 cm with the Falope ring and 3-5 cm with the Pomeroy technique.

Failure rate of laparoscopic sterilization = 0.2-1.3%. Spring clips have the highest failure rate whereas unipolar coagulation has the least failure.


Hysteroscopic tubal ligation (with silastic plugs, quinacrine, and cautery) is still under research.


Essure (available in France, not yet in India): The micro coil Essure is a spring-like device. This is introduced using a hysteroscope inserter through the vagina into the uterus and then into each fallopian tube. In 3 months' time, scar tissue grows into the device and plugs the fallopian tube; hence, sperms cannot pass through to fertilize an egg.

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