An adolescent with unprotected intercourse 4 days ago is worried about pregnancy. What will the nurse practitioner do?

An adolescent with unprotected intercourse 4 days ago is worried about pregnancy. What will the nurse practitioner do?

• A. Prescribe ulipristal acetate (Ella).
• B. Recommend levonorgestrel (Plan B One Step).
• C. Start a combination OCP at regular doses.
• D. Suggest using the less expensive After Pill preparation.

Answer: (A)

Emergency contraception options depend strongly on timing. Four days after unprotected intercourse is still within the window where an effective EC can prevent pregnancy, but the choice matters because the later you are in the window, the more important the method is to have the strongest efficacy. Ulipristal acetate (Ella) is a selective progesterone receptor modulator that delays ovulation and prevents fertilization. It remains reliably effective up to five days after intercourse, making it the best option at day four. It tends to maintain higher efficacy than levonorgestrel-based pills (Plan B) as you move past the third day and works well across a range of body weights, though all EC methods are less effective if pregnancy has already begun. Starting a regular combination oral contraceptive at a high dose is not an appropriate emergency strategy, and the cheaper “After Pill” option is generally less effective than ulipristal in this time frame. Counseling should also cover that emergency contraception does not terminate an established pregnancy, and if the expected period is delayed, a pregnancy test should be considered.

Emergency contraception options depend strongly on timing. Four days after unprotected intercourse is still within the window where an effective EC can prevent pregnancy, but the choice matters because the later you are in the window, the more important the method is to have the strongest efficacy. Ulipristal acetate (Ella) is a selective progesterone receptor modulator that delays ovulation and prevents fertilization. It remains reliably effective up to five days after intercourse, making it the best option at day four. It tends to maintain higher efficacy than levonorgestrel-based pills (Plan B) as you move past the third day and works well across a range of body weights, though all EC methods are less effective if pregnancy has already begun.

Starting a regular combination oral contraceptive at a high dose is not an appropriate emergency strategy, and the cheaper “After Pill” option is generally less effective than ulipristal in this time frame. Counseling should also cover that emergency contraception does not terminate an established pregnancy, and if the expected period is delayed, a pregnancy test should be considered.