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Routine follow-up visits after abortion are intended to confirm that the abortion h complete and to diagnose and treat complications. Many clinicians also take advantage of the follow-up visit to provide general reproductive health care: discussing contraceptive plans and providing family planning services; diagnosing sexually transmitted infections; performing a Pap test or discussing abnormal Pap results. We reviewed the evidence related to the routine postabortion follow-up visit. Other than mifepristone medical abortion performed at 50 days of gestation or later and methotrexate medical abortion, we found little evidence that mandatory follow-up visits typically detect conditions that women themselves could not be taught to recognize. In addition, the natural history of the most severe complications after abortion-infection and unrecognized ectopic pregnancy-have time courses inconsistent with the usual timing of the follow-up visit. Costs associated with this visit can be great. These include travel expenses, lost wages, child-care expenses, privacy and emotional burdens for women and scheduling disruptions and the related opportunity costs caused by ‘no-shows’ for the provider. Follow-up appointments should be scheduled for those women likely to benefit from a physical examination. For the remainder of women, simple instructions and advice about detecting complications, possibly coupled with telephone follow-up, might suffice. Although arguably valuable in their own right, counseling family planning services, or sexually transmitted infection diagnosis and treatment should not be so inflexibly bundled with postabortion care. Protocols that require in-person follow-up after abortion may not make the best use of a women's time or abilities, or of the medical system. [ABSTRACT FROM AUTHOR]

: ObjectiveEmergency contraceptives can prevent unintended pregnancy after unprotected intercourse. The best-studied regimen (“Yuzpe”) consists of ordinary combined oral contraceptives containing levonorgestrel and ethinyl estradiol. Women traditionally take one dose within 72 hours after unprotected intercourse, and a second dose 12 hours later. Historically, half experience nausea and a fifth vomit. The purpose of this study was to determine whether 1) women could use combined oral contraceptives other than those containing levonorgestrel and 2) eliminating the second dose improves comfort and convenience.: MethodsWomen presenting within 72 hours after unprotected intercourse were randomized to receive 1) standard two-dose Yuzpe, 2) a variant of Yuzpe substituting norethindrone for levonorgestrel, or 3) only the first dose of Yuzpe, followed 12 hours later by a placebo.: ResultsPerfect-use failure rates were low in all groups and did not differ in a statistically significant way (standard Yuzpe 2.0% [n = 589], norethindrone–ethinyl estradiol 2.7% [n = 547], single dose of Yuzpe 2.9% [n = 546]). Typical-use failure rates were slightly higher but similarly did not differ significantly. Side effects were similar across groups, except that women taking the single dose reported half the vomiting. Taking the pills with food did not seem to reduce nausea or vomiting, and the pills were not more effective when started sooner after unprotected intercourse.: ConclusionOral contraceptives containing norethindrone–ethinyl estradiol work approximately as well for emergency contraception as levonorgestrel–ethinyl estradiol formulations and should be offered when first-line therapies are not available. [Copyright &y& Elsevier]

: ObjectiveCurrent protocols state that the Yuzpe regimen of emergency contraception can be initiated up to 72 hours after unprotected intercourse. The purpose of this study was to determine whether the window for emergency hormonal contraception can be extended to 120 hours.: MethodsIn an observational study, we tracked 111 women who requested emergency contraception between 72 and 120 hours after unprotected sex but refused postcoital copper intrauterine devices (IUDs), preferring instead the Yuzpe regimen. We compared failure rates for this group with rates among 675 otherwise similar women who started the same therapy within 72 hours.: ResultsBoth perfect use (1.9%) and typical use (3.6%) failure rates were low among women presenting between 72 and 120 hours after unprotected intercourse. These rates did not statistically differ from failure rates for the standard Yuzpe regimen (2.0% during perfect use and 2.5% during typical use). Our small sample size of 111, however, gave us just 25% power to detect a doubling in the failure rates (2% to 4%) and 59% power to detect a tripling in the failure rates (2% to 6%).: ConclusionThe 72-hour cutoff for the Yuzpe regimen of emergency contraception appears needlessly restrictive. Women who request this therapy more than 72 hours after unprotected sex should be allowed to receive it, particularly if they decline postcoital insertion of a copper IUD and would otherwise have no options for reducing pregnancy risk. [Copyright &y& Elsevier]