Pregnancy Prophylaxis

When treating postmenarcheal female rape victims, physicians must consider pregnancy prophylaxis. Although the risk of pregnancy after an isolated sexual encounter during nonfertile periods of the menstrual cycle is thought to be less than 1 percent, it may rise to as high as 25 percent at midcycle. 15 Although the Food and Drug Administration has no approved medication for postcoital contraception, various regimens of high-dose estrogens are often used. Pregnancy prophylaxis must be initiated within 72 h of the sexual assault in order to be most effective.16 Currently accepted therapy is the birth control pill Ovral (norgestrel plus ethinyl estradiol) 2 tablets orally initially and 2 tablets 12 h later. 17 Many women will experience nausea as a side effect of this regimen; prescribing an antiemetic is advised.16 This regimen replaces the older 5-day diethylstilbestrol regimen, which had more side effects, lower compliance, and an increased risk of carcinogenesis.

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