From SOGC (Nov 10, 2017):
“Mifegymiso was approved for use in Canada in January 2017. It is a combination of two drugs, mifepristone and misoprostol, and is used for the safe medical termination of early pregnancy. The Mifegymiso pill provides an important alternative to a surgical procedure for women, particularly for those who are unable to access abortion services in their area. We believe today’s announcement will improve access to the drug to women across the country.”
BUT THERE’S MORE!! Last week, after much
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Are you up-to-date on emergency contraception options?
UBC CPD has launched a new online module that outlines and compares the effectiveness of various oral EC agents and Cu-IUDs, and includes interactive case studies to help you counsel patients about EC options. This self-paced, 75-minute, interactive, mobile-friendly, and accredited online module is available free through UBC CPD eLearning.
Medical Eligibility Criteria & Hypertension
Hi, I coordinate our youth program and I have had some of the nurses needing further clarification on hypertension. If the client presents with hypertension at their visit, is that considered forever or can we re-evaluate at a different time to reassess. This came up with the last update on migraines and wondering if the scenarios are similar.
Let’s first look at what category the MEC classifies Hypertension:
For all categories of hypertension the MEC states CHC are a category 3 or 4 – the risks outweigh the benefits. However the MMWR does provide some clarifications:
- For all categories of hypertension, classifications are based on the assumption that no other risk factors for cardiovascular disease exist. When multiple risk factors do exist, risk for cardiovascular disease might increase substantially.
- Women adequately treated for hypertension are at reduced risk for acute myocardial infarction and stroke compared with untreated women. Although no data exist, CHC users with adequately controlled and monitored hypertension should be at reduced risk for acute myocardial infarction and stroke compared with untreated hypertensive CHC users. Evidence: Among women with hypertension, COC users were at higher risk than nonusers for stroke, acute myocardial infarction, and peripheral arterial disease.
- Discontinuation of COCs in women with hypertension
- A single reading of blood pressure level is not sufficient to classify a woman as hypertensive. (MMWR July 2016, p.21)
What does this mean for practice:
- A thorough history of the patient’s hypertension is warranted
- Is the hypertension current?
- Is the patient on medication? (i.e. well controlled = MEC 3)
- Was the hypertensive episode a one off?
- If the patient is no longer hypertensive and not requiring medicine should they be classified as hypertensive?
Back to the original question – the MMWR does not indicate that history only should be a restriction for CHC use – therefore if the patient is no longer on medication (this would be well controlled and still a MEC 3) and is not hypertensive consider discussing alternate options for contraception. If she still chooses COCs ensure you counsel her on risks. If the patient is currently hypertensive and wants COCs a referral must be made.
This community of practice website and support for the volunteer leadership group is from ARNBC. We are able to have teleconference and online meetings regularly and be able to post updates and administer this small website because of ARNBC. Without the ARNBC, the Contraceptive Management Community of Practice would have great difficulty carrying out it’s volunteer activities without significant cost. We would probably not exist. Where would you find local practice support and updates for this area of practice?
If you appreciate having the contraceptive management practice updates, being able to contact provincial leaders in the field and knowing that fellow nurses are involved in practice support, please consider voicing your concerns about the current happenings that threaten ARNBC. We are stronger when we work together.
See the recent video post from ARNBC about the 3rd court challenge launched against them from BCNU.
Hooray! Part 4 of the Canadian Contraceptive Consensus has finally been released. It will be published in the next issue of the Canadian Journal of Obstetrics and Gynaecology.
Part 4 addresses Combined Hormonal Contraception recommendations.
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