A 24-year-old woman presents to the emergency department 18 hours after unprotected intercourse. She has no contraindications to hormonal methods. What is the drug of choice for emergency contraception in this scenario?

Explanation

## Emergency Contraception: Drug of Choice in India **Key Point:** Levonorgestrel 1.5 mg as a single oral dose is the **first-line / drug of choice for emergency contraception in India** when presented within 72 hours of unprotected intercourse, as per Indian national guidelines and WHO recommendations for resource-limited settings. ### Why Levonorgestrel (Option D) is Correct - **Timing:** The patient presents at 18 hours — well within the optimal ≤72-hour window for levonorgestrel. - **Availability:** Levonorgestrel is widely available over-the-counter in India (e.g., i-Pill, Unwanted-72), making it the practical first-line choice. - **Safety:** No significant contraindications in women without hormonal method restrictions; the stem explicitly states no contraindications. - **Efficacy at 18 hours:** Approximately 85% effective in the 12–24-hour window — clinically excellent. - **Single-dose regimen (1.5 mg):** Preferred over the older two-dose schedule (0.75 mg × 2) for better compliance with equivalent efficacy (WHO EC Guidelines, 2012). ### Mechanism of Action Levonorgestrel is a synthetic progestin that prevents or delays ovulation primarily by suppressing the LH surge. It does **not** interrupt an established pregnancy. ### Efficacy Timeline | Time from intercourse | Efficacy | |---|---| | 0–12 hours | ~95% | | 12–24 hours | ~85% | | 24–72 hours | ~58% | ### Why the Other Options Are Less Appropriate Here | Agent | Issue | |---|---| | **Ulipristal acetate (A)** | Superior efficacy at 72–120 hrs; at 18 hrs, levonorgestrel is equally effective and is the established DOC in Indian/NEET context. Ulipristal is not widely available OTC in India. | | **Copper IUD (B)** | Most effective overall (>99%), but requires clinical insertion — not a pharmacological "drug of choice." | | **Mifepristone 10 mg daily × 3 days (C)** | **Incorrect dosing** — mifepristone for EC is given as a **single dose of 10 mg**, not daily for 3 days. This option is factually wrong and thus an invalid choice. | **Clinical Pearl:** Ulipristal acetate (selective progesterone receptor modulator, ≤120 hrs) has superior efficacy especially in the 72–120-hour window and in women with higher BMI. However, for NEET PG / INI-CET purposes and Indian clinical practice, **levonorgestrel remains the drug of choice** for EC within 72 hours, per Shaw's Textbook of Gynaecology and Indian national family planning guidelines. **High-Yield Mnemonic:** **LNG-EC** = **L**evonorgestrel **N**eeds to be **G**iven **E**arly and **C**onsistently (within 72 hours). > *Reference: Shaw's Textbook of Gynaecology, 17th ed.; WHO Emergency Contraception Fact Sheet, 2021; MoHFW India Family Planning Guidelines.*