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  #1  
Old 11-21-2012
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Default Emergency contraceptive

A 24-year-old G0 woman presents to the ED of a local hospital stating that she was sexually assaulted. The patient is alone, and she is sobbing and is clearly anxious. She states that her last menstrual period was 3.5 weeks ago and asks the physician to please help her prevent a possible pregnancy from the assault. Physical examination is significant for bruised external labia and a .5-cm laceration in the vaginal vault. There is no vaginal discharge or cervical motion tenderness. After the appropriate psychological support is provided and a social worker is consulted, she is given one dose of 600 mg of mifepristone. Mifepristone contains which of the following?

(A) Estrogen and progestin
(B) High-dose estrogen only
(C) Progestin only
(D) Progesterone antagonist
(E) Prostaglandin
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Old 11-21-2012
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Quote:
Originally Posted by heartbeat View Post
A 24-year-old G0 woman presents to the ED of a local hospital stating that she was sexually assaulted. The patient is alone, and she is sobbing and is clearly anxious. She states that her last menstrual period was 3.5 weeks ago and asks the physician to please help her prevent a possible pregnancy from the assault. Physical examination is significant for bruised external labia and a .5-cm laceration in the vaginal vault. There is no vaginal discharge or cervical motion tenderness. After the appropriate psychological support is provided and a social worker is consulted, she is given one dose of 600 mg of mifepristone. Mifepristone contains which of the following?

(A) Estrogen and progestin
(B) High-dose estrogen only
(C) Progestin only
(D) Progesterone antagonist
(E) Prostaglandin
D. Progesterone Antagonist. (Usually given along with Misoprostol which is a PG).
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D it is an anti progestin . it blocks the action of progesterone. prevents implantation in the uterus. and given with misoprostol which is a prostaglandin analogue which increases uterine contractions to expel it out.
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(D) Progesterone antagonist

But the real question (s) :
1. How can she be given Mifepristone without doing a pregnancy test first?
2. She is almost at the end of her menstrual cycle (26th day) so a menstrual history (cycle length) will be useful before giving her Mifepristone.
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The correct answer is D.
Mifepristone is an antiprogestin that has been shown to be 100% effective at preventing pregnancy when given within 72 hours of intercourse at a one-time dose of 600 mg.
Quote:
Originally Posted by Novobiocin View Post
But the real question (s) :
1. How can she be given Mifepristone without doing a pregnancy test first?
2. She is almost at the end of her menstrual cycle (26th day) so a menstrual history (cycle length) will be useful before giving her Mifepristone.
The high efficacy of mifepristone compared to other regimens is likely secondary to its ability to inhibit implantation( if fertilization occurred) as well as ovulation(if not).
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D) Progesterone antagonist
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Old 11-22-2012
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even if she is pregnant. it will prevent the implantation and along with misoprostol will cause expulsion. either ways shez a win win!!
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Originally Posted by slamdunk View Post
even if she is pregnant. it will prevent the implantation and along with misoprostol will cause expulsion. either ways shez a win win!!
u need at least one week to do serum beta hcg.
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Old 11-22-2012
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Quote:
Originally Posted by heartbeat View Post
The correct answer is D.
Mifepristone is an antiprogestin that has been shown to be 100% effective at preventing pregnancy when given within 72 hours of intercourse at a one-time dose of 600 mg.

The high efficacy of mifepristone compared to other regimens is likely secondary to its ability to inhibit implantation( if fertilization occurred) as well as ovulation(if not).
I was actually thinking about the possibility of her being pregnant prior to this sexual assault.
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