Emergency is helpful in preventing pregnancies post unprotected sexual activity. It can be used in case of contraceptive failure, in case of sexual assault, incorrect use of contraceptives and unprotected sex.

Emergency contraception can be done by three methods. These are emergency contraceptive pills, combined oral contraceptive pills and copper intrauterine devices.



The copper IUD is considered to be one of the most effective forms of emergency contraception, when it is inserted within 5 days of unprotected sexual activity.

However, the emergency contraceptive pill regimen as per WHO is:

1 dose of levonorgestrel 1.5 mg, or 1 dose of ulipristal 30 mg, taken within 5 days (120 hours) of unprotected intercourse

The Yuzpe regimen which consists of 2 doses of combined oral contraceptive pills

What is Emergency Contraception?

Emergency contraception is usually referred to as the contraception which is used to prevent a pregnancy within the first 5 days after an unprotected sexual activity. It is used post failures of contraception, coerced unprotected sex, rape or misuse of contraception.

Emergency contraception is only effective in the first few days after an intercourse and before the egg has released from the ovary, and before there is fertilization between the egg and the sperm. The emergency contraception can do no harm to an interrupted pregnancy and a developing embryo.

Who needs emergency contraception?

Any girl or woman who is at her reproductive age might need an emergency contraception in case of an unprotected sexual intercourse.

Uses
1 Breakage , slippage or displacement of barrier methods 
2. Three or more missed OCPills for more than 12 hours 
3. Missed Mini pill for more than 3 hours 
4. Missed Desoestrel pills for more than 12 hours 
5. DMPA injections taken more than 2 weeks late 
6. Miscalculated dates of last period and present ovulation side effects 
These are meant only for emergency contraception and NOT AS A REGULAR CONTRACEPTIVE. It involves pumping of a hormone inside your body at levels which are 5 times higher than normal. hence excessive and unnecessary use may cause irregularity in the period cycles and an adverse effect on the menstrual health over a period of time. Ideally it should be taken under guided medical supervision.


In what situations should emergency contraception be used?

Emergency contraception can be used after a sexual intercourse. These include:

In case of no use of contraceptives

If it is a case of rape or coerced sex, where the woman was not protected

When there is a contraceptive failure, like

breakage

incorrect use or slippage

OCPILLS,

mini pills

DMPA

3 or more missed combined oral contraceptives, progestogen-only pill (minipill) taken more than 3 hours late, desogestrel-containing pill 12 hours or more, norethisterone enanthate (NET-EN) progestogen-only injection taken more than 2 weeks late

Delay in placing or dislodgement or early removal of the skin patch or the hormonal ring

Breaking, dislodgement, tearing or early removal of cervical cap or diaphragm

Failure of withdrawal that is ejaculation the external genitalia or vagina

The spermicide tablet failure

Miscalculating the periods, failure from using a barrier on the fertile days

Expulsion of an intrauterine contraceptive device (IUD)

Methods of Emergency Contraception:

There are three emergency contraception methods:

Copper-bearing intrauterine devices (IUDs)

Emergency contraception pills (ECPs)

Combined oral contraceptive pills or the Yuzpe method



Safety of Emergency Contraception

When it comes to giving birth, vaginal delivery is considered to be the most natural process. However, several women nowadays opt for C-section or Cesarean section to avoid the labour pain that accompanies natural birth.If you are pregnant and weighing the pros and cons of natural and C-section delivery, here are a few things to consider.

Vaginal Delivery
The Pros of this method of delivery are as follows:

1. From the psychological perspective, women who undertake a vaginal delivery have a positive birth giving experience. Women undergoing this method think they should be present in the process. 
2. The recovery time for women opting for vaginal delivery is shorter. The mother and the baby can make skin contact right after the delivery, which enhances the bonding process.
3. Babies who are born through vaginal delivery develop much fewer medical complications. There are fewer respiratory problems, allergies and the baby can start breastfeeding soon.

The Cons of vaginal delivery are as follows:
1. Vaginal delivery is a stressful process for the women undergoing it and the time required cannot be predicted. Some deliveries take less time, while others may take hours.
2. Usually, there are no cons for the babies who are born via vaginal delivery. In very rare cases, brain injury can be experienced.

Cesarean Section
The pros of this type of delivery method are as follows:
1. Many women choose Caesarean sections to avoid long labor hours. Planned C-section surgeries enable the mother to plan the birth. Better control is acquired over the delivery, which can be predicted properly.
2. In case your baby is large, or if you are carrying twins, C-section is the best delivery option. 
3. If the mother has diseases such as HIV or the mother's blood has a high viral load, C-section surgeries should be opted as the risk of the infection being passed on to the baby is decreased.

The cons of Cesarean section surgery are as follows:
1. C-section is a major surgery and a long time is required for recovery. There may be risks of infection, but they can be prevented by caring for the surgical wound properly. C-section delays the breastfeeding process and the mother cannot have immediate contact with her baby, which can affect the bonding.

2. Some babies, delivered through C-section may have respiratory problems. C-sections may also cause complications, such as problems with anaesthesia.

While both processes have their pros and cons, it is best to discuss with your doctor to understand which process will suit you more. Depending on your pregnancy and whether there are any complications involved, your doctor will suggest the best way possible.

Vaginal Birth Vs C-section - Pros and Cons

It's normal to be concerned with your fertility after early miscarriage. Many couples want to try to conceive again right away, while others need time to heal. Ultimately, though, fertility following a miscarriage is an issue of concern for most couples.

Once you are ready to start trying for a child again, there are a number of things you can do to increase your chances of having a successful pregnancy.

Rest and Recuperate- Many women want to hurry and start trying to get pregnant again right away after their miscarriage. This is a perfectly normal response, but may not be the best way to guarantee a healthy pregnancy. Give your body a chance to rest so your menstrual cycle can get back to normal. You also want to give yourself plenty of time for your mental balance to return so you are ready to take on the trials of trying to become pregnant. Be gentle and give yourself time to rest and focus on taking care of your physical and emotional needs until you are ready to try again.
Change Lifestyle- Eliminating unhealthy habits can help increase your chances of conceiving later. Eliminate drug or alcohol use and quit smoking before you start trying for pregnancy. Cutting down or eliminating caffeine can also help you conceive a healthy pregnancy.
Eliminate Stress- Eliminating stress can also make conceiving easier. Stress can reduce fertility levels, making it harder to get pregnant. Practicing meditation, yoga or taking time to relax after dealing with tough issues in your life can make it much easier to conceive.
Eat Healthy- Eating a healthy diet is also essential to having a healthy pregnancy. This can also help women manage the depression caused by their miscarriage. Getting a variety of vitamins and minerals and cutting down on saturated fats and processed foods can help you get pregnant and maintain a healthy pregnancy.
Take Fertility Drugs or Therapies- There are various fertility drugs and therapies on the market today. Your doctor will prescribe different medications based on your overall health and age.
Use an Ovulation Predictor- An ovulation predictor can help you map out your cycle. This will allow you to determine which days in your cycle will be the most likely for you to conceive. 
Support the Uterus and Liver- Performing a fertility cleanse after your period has stopped can help support the uterus and liver, promoting overall fertility health. Sometimes stagnant blood can get left behind after your period which can cause discomfort or health issues. Following a fertility diet to help rid your body of the excess blood and hormones in your system can help your conceive more easily.
Massage the Uterus- When you have stopped bleeding after your miscarriage, performing a uterus massage can help your body relax. This massage will help bring fresh blood to the area and soothe the body so you can relax. 
If you have been having trouble conceiving it may be time to talk to a fertility expert. Your doctor can perform fertility tests on you and your partner to determine if there are any underlying issues present. Then you can work together to determine if any additional medical treatment is necessary to help you get pregnant.

Ways to Increase Fertility after Miscarriage

Ectopic pregnancy: Causes and symptoms

Ectopic pregnancy happens if the egg implants itself in the fallopian tube in place of the uterus. That's why this form of pregnancy is called a tubal pregnancy as well. Many a time, it may also implant itself in the belly, ovary or the cervix. If the egg is allowed to develop in the fallopian tube, it brings about the bursting of the tube, leading to instances of heavy bleeding.

What really causes this condition?

In this type of pregnancy, the cause isn't always easy to arrive at. In many cases, certain conditions have been found to bring about this pregnancy and these are:

- Damages to the fallopian tubes in the form of scarring and inflammation due to a preceding medical infection, condition or surgery

- Imbalances in the body's hormone levels

- Abnormalities in the genes

- Birth defects

- Medical problems that have an effect on the shape and condition of the reproductive organs and fallopian tubes

- Though it's rare, ectopic pregnancy can occur while using an intrauterine device or system for birth control

- Inflammation of your reproductive system such as pelvic inflammatory disease

How do you know that you suffer from one?

In terms of signs that will help you to easily identify whether you're having an ectopic pregnancy, the initial signs are:

- Light bleeding from your vagina

- Pain in the abdomen or in the pelvic region, which tends to occur after 6-8 weeks of a missed period

The other symptoms of this condition reveal themselves as you progress through the pregnancy and include,

- Dizziness or fainting as a result of internal bleeding

- Shoulder pain brought on by bleeding in the abdominal region

- Signs of shock

- Worsening of pelvic or belly pain

- Heavy vaginal bleeding

Additionally, a person with ectopic pregnancy also experience signs associated with early pregnancy such as:

- Nausea

- Tender breasts

- Fatigue

- Missed period

- Increased in frequency of urination



What is Ectopic Pregnancy the Most Difficult Type of Pregnancy?

When a person is aroused there are a host of hormonal changes within the person's body. These changes do manifest on the surface in the form of certain physical variations. Sexual stimulation happens to alter the state of human genitalia and that too in obvious ways. The blood flow to the concerned area increases, there is enough of natural lubrication in and around the organ and for women, the vagina loosens up and the clitoris swells. Intercourse followed by a climactic release will make the clitoris regain its original size. However, worries crop up when that is not the case with every single female. This serious medical condition of a swollen clitoris should never be overlooked; it must be treated by seeking experienced medical assistance.	 

1. Trauma: Any slight scratch or one wrong touch can cause a swollen clitoris. Even a scratch of your fingernail while you are masturbating or a rough sexual intercourse can and is enough to create trauma in your clitoris.

2. Hair: Hair grows normally around your genital area. It is very common for a woman to have pubic hair. But sometimes small hair splinters lead to trouble and hair gets stuck into your clitoris and causes swelling. This is a very annoying process, sometimes you may have to use a magnifying glass to remove the hair from your clitoris.

3. Clothing: sometimes your tight clothes can result in a swollen clitoris. The friction from your rough clothing material can cause your clitoris to swell. Sometimes you may be using a detergent that is not suitable for you or you may be wearing a dress material, which you're allergic to. You should always wash your clothes in plain water and dry it before using.

4. Infection: you may also have some bacterial and fungal infection in your clitoris, which can cause a swollen clitoris. This infection can also invite itchiness and redness and these can make it even worse. If it doesn't subside within some days then you should definitely see a doctor.

5. Cysts: small cysts known as Bartholomew's cysts can grow on the clitoris. This thing hampers the natural lubrication of the body.  If you are having clitoris swelling because of cysts then you should seek medical attention immediately.

Your clitoris is naturally sensitive and if you are having a swollen clitoris after intercourse then you should pull back from sexual intercourse for a few days. At times the swelling goes away on its own.

Swollen Clitoris - 5 Main Reason Behind Enlarged Clitoral  

What is recurrent miscarriage?

If you have three or more miscarriages in a row, doctors call it recurrent miscarriage. If you have experienced recurrent miscarriage, your GP or midwife will refer you to a gynaecologist. Your gynaecologist will try to identify the reason for your losses.

Having miscarriage after miscarriage may leave you feeling utterly drained of hope. At times, it may be hard to keep trusting in the future. This experience affects every aspect of a woman s life from her mental and emotional health to her physical health and social well-being. 

If you can, try to draw comfort from the fact that most women who experience recurrent losses do go on to have a baby. This is especially the case if tests can find no reason for the losses. Six out of 10 women who have had three miscarriages will go on to have a baby in their next pregnancy.

Treatment of Recurrent Pregnancy Loss

Treatment for anatomic abnormalities of the uterus involves surgical restoration through removal of local lesions such as fibroids, scar tissue and endometrial polyps or timely insertion of a cervical cerclage (a stitch placed around the neck of the weakened cervix) or the excision of a uterine septum when indicated.

A thin endometrial lining has been shown to correlate with compromised pregnancy outcome. Often times this will be associated with reduced resistance to blood flow to the endometrium. Such decreased blood flow to the uterus can be improved through treatment with sildenafil (Viagra), Terbutaline and possibly aspirin.

Sildenafil (Viagra) Therapy Viagra has been used successfully to increase uterine blood flow. However, to be effective it must be administered starting as soon as the period stops up until the day of ovulation and it must be administered vaginally (not orally). Viagra in the form of vaginal suppositories given in the dosage of 25 mg four times a day has been shown to increase uterine blood flow as well as thickness of the uterine lining. To date, we have seen significant improvement of the thickness of the uterine lining in about 70% of women treated. Successful pregnancy resulted in 42% of women who responded to the Viagra. It should be remembered that most of these women had previously experienced repeated IVF failures.

Terbutaline this is a medication that relaxes the muscle in the uterine wall and so permits improved hormone delivery to the endometrium. The use of Terbutaline will often cause an increase in heart rate. It should not be prescribed to women who have irregular heart beats (arrhythmias), and women who have decreased cardiac reserve.

Aspirin this is an antiprostaglandin that improves blood flow to the endometrium. It is administered at a dosage of 81mg orally, daily from the beginning of the cycle until ovulation.

Selective Immunotherapy Using Intralipid, heparin, aspirin and corticosteroid

Many causes of pregnancy loss or failure can be treated with immunotherapy comprising combinations of aspirin and heparin and corticosteroids (dexamethasone or prednisone) and Intralipid (IL) to regulate increased NKa. Achievement of optimal success with Intralipid/corticosteroid therapy requires that the treatment be initiated well before ovulation takes place (about 7-14 days prior to anticipated implantation). Given the fact that only 10-15% of natural cycles (with or without the use of insemination and/or fertility drugs) will result in a pregnancy, it follows that repeated administration of Intralipid will be required in most cases before a pregnancy will occur. IVF achieves pregnancy rates that are often 2-3 times higher. This often makes IVF a treatment of choice in cases of immunologic recurrent pregnancy loss.

Role of IVF

Preimplantation genetic diagnosis (PGD) a procedure whereby the embryo can be tested for genetic or structural chromosomal abnormalities requires the use of IVF to select the best embryo(s) for transfer to the uterus. In cases of structural chromosomal (translocations) egg or sperm donation is often another option worth considering.

In those cases where due to intractable anatomical or alloimmune dysfunction IVF repeatedly is unsuccessful or is not an option, Gestational Surrogacy might represent the only recourse other than adoption.
If a couple with Recurrent Pregnancy Loss is open to all of the diagnostic and treatment options referred to above, a live birth rate of 70%   80% is ultimately achievable.

Recurrent Miscarriage - How to Deal With It?

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