SEPSIS - Puerperal and post-abortion
Ministry of Health Timor-Leste
Ministry of Health Timor-Leste
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SEPSIS - Puerperal and post-abortion |
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|---|---|
| # | Method |
| Combined hormonal contraceptives Pill, patch, ring, injectable (COC,P,CVR,CIC) Progestogen-only pills POP Progestogen-only injectables DMPA (IM, SC) / NET-EN Implants LNG / ETG |
|
This wheel contains the medical eligibility criteria for starting use of
contraceptive methods, based on Medical Eligibility Criteria for Contraceptive
Use, 5th edition (2015), one of WHO’s evidence-based guidelines. It guides
family planning providers in recommending safe and effective contraception
methods for women with medical conditions or medically-relevant characteristics.
The wheel includes recommendations on initiating use of nine common types of
contraceptive methods:
1. Combined pills, COC (low dose combined oral contraceptives, with ≤ 35 μg
ethinyl estradiol)
2. Combined contraceptive patch, P
3. Combined contraceptive vaginal ring, CVR
4. Combined injectable contraceptives, CIC
5. Progestogen-only pills, POP
6. Progestogen-only injectables, DMPA (IM,SC)/NET-EN (depot medroxyprogesterone
acetate intramuscular or subcutaneous or norethisterone enantate intramuscular)
7. Progestogen-only implants, LNG/ETG (levonorgestrel or etonogestrel)
8. Levonorgestrel-releasing intrauterine device, LNG-IUD
9. Copper-bearing intrauterine device, Cu-IUD
The wheel matches up the contraceptive methods, shown on the inner disk, with specific medical conditions or characteristics shown around the outer rim. The numbers shown in the viewing slot tell you whether the woman who has this known condition or characteristic is able to start use of the contraceptive method:
| Category | With Clinical Judgement | With Limited Clinical Judgement |
| 1 | Use method in any circumstance | YES (Use the method) |
| 2 | Generally use method | |
| 3 | Use of method not usually recommended unless other more appropriate methods are not available or not acceptable | NO (Do not use the method) |
| 4 | Method not to be used |
Categories 1 and 4 are clearly defined recommendations. For categories 2 or 3,
greater clinical judgement will be needed and careful follow-up may be required.
If clinical judgement is limited, categories 1 and 2 both mean the method can be
used, and categories 3 and 4 both mean the method should not be used.
No restrictions for some conditions: there are many medical conditions when ALL
methods can be used (that is, all the methods are either a category 1 or 2).
Some of these conditions are listed on the back of the wheel.
With few exceptions, all women can safely use emergency contraception, barrier
and behavioural methods of contraception, including lactational amenorrhoea
method; for the complete list of recommendations, please see the full document.
Only correct and consistent use of condoms, male or female, protect against STI/HIV.
If there is a risk of STI/HIV, condom use is recommended.
|
Emergency contraceptive pills |
|||
| Condition | COC | LNG | UPA |
| Pregnancy | NA | NA | NA |
| Breastfeedinga | 1 | 1 | 1 |
| Past ectopic pregnancy | 1 | 1 | 1 |
| Obesityb(BMI ≥30 kg/m2) | 1 | 1 | 1 |
| History of severe cardiovascular disease (ischaemic heart disease, cerebrovascular attack, or other thromboembolic conditions) | 2 | 2 | 2 |
| Migraine | 2 | 2 | 2 |
| Severe liver disease (including jaundice) | 2 | 2 | 2 |
| CYP3A4 inducersc (e.g. rifampicin, phenytoin, phenobarbital, carbamazepine, efavirenz, fosphenytoin, nevirapine, oxcarbazepine, primidone, rifabutin, St John’s wort/hypericum perforatum) |
1 | 1 | 1 |
| Repeated emergency contraceptive pill used | 1 | 1 | 1 |
| Rape | 1 | 1 | 1 |
| This method is highly effective
for preventing pregnancy. It can be used within 5 days of unprotected
intercourse as an emergency contraceptive. However, when the time of
ovulation can be estimated, the Cu-IUD can be inserted beyond 5 days
after intercourse, if necessary, as long as the insertion does not occur more than 5 days after ovulation. The eligibility criteria for general Cu-IUD insertion also apply for the insertion of Cu-IUDs as emergency contraception. |
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| Condition | Cu-IUD | ||
| Pregnancy | 4 | ||
| Rape | |||
| a) High risk of STI | 3 | ||
| b) Low risk of STI | 1 | ||
| Abbreviations: NA = not applicable; COC = combined oral contraceptives; Cu-IUD = Copper intrauterine device; ECP = emergency contraceptive pill; LNG = levonorgestrel; UPA = ulipristal acetate a Breastfeeding is not recommended for one week after taking UPA since it is excreted in breast milk. Breast milk should be expressed and discarded during that time b ECPs may be less effective among women with BMI ≥ 30 kg/m2 than among women with BMI < 25 kg/m2. Despite this, there are no safety concerns. c Strong CYP3A4 inducers may reduce the effectiveness of emergency contraceptive pills. d Repeated ECP use is an indication that the woman requires further counselling on other contraceptive options. Frequently repeated ECP use may be harmful for women with conditions classified as 2, 3 or 4 for contraceptives containing hormones. |
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| A | If condition develops while using method, can continue using it during treatment. | |||
| B | If very high likelihood of exposure to gonorrhoea or chlamydia =3. | |||
| C | If past pelvic inflammatory disease (PID) all methods =1, including IUDs. | |||
| D | If <3 wks, not breastfeeding & no other VTE risk factors =3. | |||
| E | If not breastfeeding =1. | |||
| F | If 3 to <6 wks, not breastfeeding & no other VTE risk factors =2, with other VTE risk factors =3. | |||
| G | If ≥6 wks & not breastfeeding =1. | |||
| H | If uterine cavity distorted preventing insertion =4. | |||
| I | Refers to hepatocellular adenoma (benign) or carcinoma/ hepatoma (malignant). | |||
| J | If adenoma CIC =3, if carcinoma/hepatoma CIC =3/4. | |||
| K | CIC =3. | |||
| L | If established on anticoagulation therapy =2. | |||
| M | If condition developed while on this method, consider switching to non-hormonal method. | |||
| N | Risk factors: older age, smoking, diabetes, hypertension, obesity & known dyslipidaemias. | |||
| O | If cannot measure blood pressure & no known history of hypertension, can use all methods. Either systolic or diastolic blood pressure may be elevated. | |||
| P | If age <18 yrs & obese DMPA/NET-EN =2. | |||
| Q | For insulin-dependent & non-insulin-dependent. If complicated or >20 yrs duration, COC/P/CVR, CIC =3/4; DMPA, NET-EN =3. | |||
| R | If <15 cigarettes/day CIC =2. If ≥15 cigarettes/day COC/P/CVR =4. | |||
| S | Aura is focal neurological symptoms, such as flickering lights. If no aura & age <35 COC/P/CVR, CIC =2, POP =1. If no aura & age ≥35 COC/P/CVR, CIC =3, POP =1. | |||
| T | Barbituates, carbamazepine, oxcarbazepine, phenytoin, primidone, topiramate & lamotrigine. | |||
| U | If barbituates, carbamazepine, oxcarbazepine, phenytoin, primidone or topiramate CIC =2. | |||
| V | If lamotrigine =1. | |||
| W | DMPA =1, NET-EN =2. | |||
| X | CICs =2. | |||
| Y | If antiretroviral therapy with EFV, NVP, ATV/r, LPV/r, DRV/r, RTV: COC/P/CVR, CIC, POP, NET-ET, Implants =2; DMPA =1. For all NRTIs, ETR, RPV, RAL each method =1. See jacket for full names of medications. | |||
| Z | If WHO Stage 3 or 4 (severe or advanced HIV clinical disease) IUD =3. | |||
Conditions that are category 1 and 2
for all methods (method can be used)
Reproductive Conditions: Benign breast disease or undiagnosed mass •
Benign ovarian tumours, including cysts • Dysmenorrhoea • Endometriosis •
History of gestational diabetes • History of high blood pressure during
pregnancy • History of pelvic surgery, including caesarean delivery • Irregular,
heavy or prolonged menstrual bleeding (explained) • Past ectopic pregnancy •
Past pelvic inflammatory disease • Post-abortion (no sepsis) • Postpartum ≥ 6
months
Medical Conditions: Depression • Epilepsy • HIV asymptomatic or mild
clinical disease (WHO Stage 1 or 2) • Iron-deficiency anaemia, sickle-cell
disease and thalassaemia • Malaria • Mild cirrhosis • Schistosomiasis (bilharzia)
• Superficial venous disorders, including varicose veins • Thyroid disorders
•Tuberculosis (non-pelvic) • Uncomplicated valvular heart disease • Viral
hepatitis (carrier or chronic)
Other: Adolescents • Breast cancer family history • Venous
thromboembolism (VTE) family history • High risk for HIV
•Surgery without prolonged immobilization • Taking antibiotics (excluding
rifampicin/rifabutin)
With few exceptions, all women can safely use emergency contraception, barrier
and behavioural methods of contraception, including lactational amenorrhoea
method; for the complete list of recommendations, please see the full document.
“Combined” is a combination of ethinyl estradiol & a progestogen.
CIC: combined injectable contraceptive COC: combined oral
contraceptive pill
Cu-IUD: copper intrauterine device CVR: combined contraceptive
vaginal ring DMPA (IM, SC): depot medroxyprogesterone acetate,
intramuscular or subcutaneous ETG: etonogestrel LNG:
levonorgestrel LNG-IUD: levonorgestrel intrauterine device
NET-EN: norethisterone enanthate P: combined contraceptive patch
POP: progestogen-only pill
| Nucleoside reverse | |
| transcriptase inhibitors (NRTIs) | |
| ABC | Abacavir |
| TDF | Tenofovir |
| AZT | Zidovudine |
| 3TC | Lamivudine |
| DDI | Didanosine |
| FTC | Emtricitabine |
| D4T | Stavudine |
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Non-nucleoside reverse |
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transcriptase inhibitors (NNRTIs) |
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| EFV | Efavirenz |
| ETR | Etravirine |
| NVP | Nevirapine |
| RPV | Rilpivirine |
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Protease inhibitors (PIs) |
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| ATV/r | Ritonavir-boosted atazanavir |
| LPV/r | Ritonavir-boosted lopinavir |
| DRV/r | Ritonavir-boosted darunavir |
| RTV | Ritonavir |
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Integrase Inhibitors |
|
| RAL | Raltegravir |
WHO medical eligibility criteria wheel for contraceptive use – 2015 update.
1.Contraception - methods. 2.Family Planning Services - methods. 3.Eligibility
Determination - standards. I.World Health Organization.
ISBN 978 92 4 154925 7 (NLM classification: WP 630)
© World Health Organization 2015
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Printed in Italy
The Medical Eligibility Criteria for Contraceptive Use and this version of
the Medical Eligibility Criteria Wheel were developed by the Word Health
Organization’s Department of Reproductive Health and Research. This wheel is
based upon similar medical eligibility criteria wheels developed independently
in Ghana and Jordan. In particular, we would like to thank the University of
Ghana Medical School’s Department of Obstetrics
and Gynaecology; the Communication Partnership for Family Health in Jordan; and
the Johns Hopkins Bloomberg School of Public Health/ Center for Communications
Programs for their innovative work.
Dr Anna Altshuler was responsible for this 2015 edition, in collaboration with
Dr Erin Berry-Bibee, Dr Kathryn Curtis, Dr Monica Dragoman,
Dr Mary Lyn Gaffield, Dr Tara Jatlaoui, and Ms Halley Riley.
Layout and design: Ms Cath Hamill
Ordering copies and further information
Detailed information on the medical eligibility criteria, including guidance on
other contraceptive methods, appears in the Medical Eligibility Criteria for
Contraceptive Use, 5th edition (2015). This can be accessed at http://www.who.int/reproductivehealth/en/.
Bulk orders (20 wheels/package) to supply programmes or single orders can be
ordered from: WHO Press, World Health Organization, 1211 Geneva 27, Switzerland,
email: bookorders@who.int. Order online: http://apps.who. int/bookorders/