A 34-year-old woman with BMI 31 kg/m² presents 80 hours after unprotected intercourse. She took levonorgestrel emergency contraception once before and vomited. She wants the oral emergency contraceptive with the best efficacy for her situation. Which is the MOST appropriate choice?

• A Repeat levonorgestrel 1.5 mg with an antiemetic
• B Ulipristal acetate 30 mg single dose ✓
• C Double-dose levonorgestrel 3 mg
• D Mifepristone 600 mg single dose

Explanation

Ulipristal acetate, a selective progesterone receptor modulator given as a single 30 mg dose, remains effective up to 120 hours after intercourse and outperforms levonorgestrel between 72 and 120 hours and in obese women, both relevant here. Repeating or doubling levonorgestrel does not overcome its lower efficacy beyond 72 hours and reduced effect at higher BMI. Low-dose mifepristone is used for emergency contraception in some settings but is not the standard examined answer in India.

Reference: Williams Gynecology, 3rd ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.