contraceptives--postcoital and Pregnancy--Ectopic

To evaluate the existing data to estimate the rate of ectopic pregnancy among emergency contraceptive pill treatment failures.. Our initial reference list was generated from a 2008 Cochrane review of emergency contraception. In August 2009, we searched Biosys Previews, the Cochrane Database of Systematic Reviews, Medline, Global Health Database, Health Source: Popline, and Wanfang Data (a Chinese database).. This study included data from 136 studies, which followed a defined population of women treated one time with emergency contraceptive pills (either mifepristone or levonorgestrel) and in which the number and location of pregnancies were ascertained.. Data from each article were abstracted independently by two reviewers. In the studies of mifepristone, 3 of 494 (0.6%) pregnancies were ectopic; in the levonorgestrel studies, 3 of 307 (1%) were ectopic.. The rate of ectopic pregnancy when treatment with emergency contraceptive pills fails does not exceed the rate observed in the general population. Because emergency contraceptive pills are effective in lowering the risk of pregnancy, their use will reduce the chance that an act of intercourse will result in ectopic pregnancy.. III.

Topics: Contraceptives, Postcoital; Female; Humans; Levonorgestrel; Mifepristone; Pregnancy; Pregnancy, Ectopic

Following the development of hormonal interception after coitus the post-coital insertion of an intrauterine contraceptive device was proposed by Tatum . The advantage of this treatment is the avoidance of the ingestion of large doses of estrogen which causes much nausea and vomiting although it is a very effective post-coital method of contraception. The recently proposed alternative administration of 200 micrograms Ethynol Estradiol combined with 2 mg of DL norgesterol in 2 equal doses at 12 hour intervals has the same disadvantage of a high percentage of side effects. The post-coital insertion of an intrauterine contraceptive device is the first method which is effective up to five days following unprotected intercourse which is three days longer than treatment by estrogen. In addition the method can be offered to women who would want to continue to wear the intrauterine contraceptive device for long term contraception. The disadvantage of the post-coital insertion of an intrauterine contraceptive device is the ability of serious complications if the patient has a vaginal or venereal infection or an asymptomatic cervicitis or salpingitis. Following appropriate physical examination women who present themselves for post-coital treatment are selected. Cases of rape are usually not suitable for treatment with intrauterine contraceptives devices. However, when cases of rape are seen early enough the appropriate investigations may be done and the treatment with the intrauterine device started within five days. The potential risk of future infertility must be considered since salpingitis is 7 times more common in nulliparous wearers of intrauterine devices than in nulliparous non-wearers. Young sexually active nulliparous women especially of lower socio economic background are patients with a high risk. Over 70% of the women who present themselves for interception treatment are nulliparous.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Coitus; Contraception; Contraceptives, Postcoital; Female; Humans; Infections; Infertility, Female; Intrauterine Devices, Copper; Pregnancy; Pregnancy, Ectopic; Risk; Time Factors

Topics: Contraception; Contraceptives, Postcoital; Drug Therapy, Combination; Estrogens; Female; Humans; Intrauterine Devices, Copper; Pregnancy; Pregnancy, Ectopic; Progesterone Congeners; Therapeutic Irrigation; Time Factors; Urogenital Neoplasms

Topics: Abnormalities, Drug-Induced; Arrhythmias, Cardiac; Breast Neoplasms; Contraception; Contraceptive Devices; Contraceptives, Oral, Synthetic; Contraceptives, Postcoital; Estradiol Congeners; Female; Humans; Intrauterine Devices; Lactation; Male; Pelvic Inflammatory Disease; Pregnancy; Pregnancy, Ectopic; Progesterone; Progesterone Congeners; Prospective Studies; Spermatocidal Agents; Thromboembolism; Time Factors; Uterine Cervical Neoplasms

ectopic pregnancy is one of the causes of maternal morbidity and mortality in sub-Saharan Africa. Levonorgestrel (LNG) only emergency contraceptive pill is a well-established emergency contraceptive pill that is administered within 72 hours after unprotected intercourse. This study aimed at determining whether or not there is a significant association between levonorgestrel emergency contraceptive use and the occurrence of ectopic pregnancy.. case-control (1:3) study among 79 women with ectopic pregnancy (cases) matched against 237 women without (controls) at Moi Teaching and Referral Hospital in Eldoret, Kenya; Sociodemographic and clinical data were collected using a questionnaire. Association between ectopic pregnancy and LNG-EC was assessed using Pearson chi-square test. The relationship between outcome and exposure (while adjusting for confounders) was assessed using logistic regression model.. The mean age was 27.15 years. Both cases and controls were similar by age (p = 0.990), educational level (p = 0.850), marital status (p = 0.559), employment status (p = 0.186) and parity (p = 0.999). Seventy-eight (24.7%) participants had a history of miscarriage. A higher proportion of the cases had history of using LNG-EC compared to the controls (32.9% vs. 7.2%, p < 0.001). The use of LNG-EC portended more than nine times increased odds of ectopic pregnancy compared to other contraceptive methods {OR = 9.34 (95% CI: 3.9 - 16.0)}.. levonorgestrel only emergency contraceptive use was associated with ectopic pregnancy. One of the limitations of this study is that we could not control for all confounders of ectopic pregnancy.

Topics: Adolescent; Adult; Case-Control Studies; Confounding Factors, Epidemiologic; Contraceptives, Postcoital; Female; Humans; Kenya; Levonorgestrel; Logistic Models; Pregnancy; Pregnancy, Ectopic; Risk Factors; Surveys and Questionnaires; Young Adult

To study the association between knowledge about levonorgestrel emergency contraception (LNG-EC) and the risk of ectopic pregnancy (EP) following LNG-EC failure.. This study included 600 women who had visited the hospital with LNG-EC failure. Of these, 300 with EP and 300 with intrauterine pregnancy (IUP) were recruited to the EP group and IUP group respectively. The participants were interviewed face-to-face using a standardized questionnaire.. Pearson's chi-square tests and t-test were used to compare the sociodemographic characteristics, reproductive and gynecological history, surgical history, previous contraceptive experience, and answers to 10 questions concerning the knowledge about LNG-EC.. Those who gave incorrect answers to the question regarding the basic mechanism and specific method of levonorgestrel emergency contraceptive pills (LNG-ECPs) were at a higher risk of EP after LNG-EC failure. Women who did not strictly follow instructions or advice from healthcare professionals were more likely to subsequently experience EP (p < 10(-4) ). Women with LNG-EC failure reported friends/peers, TV, and Internet as the main sources of information. No difference was observed with regard to the sources of knowledge on LNG-EC (p = 0.07).. The results illustrate the importance of strictly following the doctor's guidance or drug instructions when using LNG-ECPs. The media should be used to disseminate information about responsible EC, and pharmacy staff should receive regular educational training sessions in this regard. © 2016 The Authors. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons Ltd.

Topics: Adult; Contraception, Postcoital; Contraceptives, Postcoital; Female; Health Knowledge, Attitudes, Practice; Humans; Levonorgestrel; Patient Education as Topic; Pregnancy; Pregnancy, Ectopic; Surveys and Questionnaires; Treatment Failure; Young Adult

Pregnancy outcomes after emergency contraceptive use has been debated over time, but review of the literature includes mechanisms by which these medications may increase the chance of an ectopic pregnancy. Such cases are infrequently reported, and many emergency providers may not readily consider this possibility when treating patients.. This is a case presentation of ectopic pregnancy in a patient who had recently used Plan B (levonorgestrel) emergency contraceptive. She presented with abdominal pain and vaginal spotting, and was evaluated by serum testing and pelvic ultrasound. She was discovered to have a right adnexal pregnancy. She was treated initially with methotrexate, though she ultimately required surgery for definitive treatment. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case report aims to bring a unique clinical case to the attention of emergency providers. The goal is to review research on the topic of levonorgestrel use and the incidence of ectopic pregnancies. The mechanism of action of this emergency contraceptive is addressed, and though no definite causal relationship is known between levonorgestrel and ectopic pregnancies, there is a pharmacologic explanation for how this event may occur after use of this medication. Ultimately, the emergency provider will be reminded of the importance of educating the patient on the possible outcomes after its use, including failure of an emergency contraceptive and the potential of ectopic pregnancy.

Topics: Abortifacient Agents, Nonsteroidal; Contraceptives, Postcoital; Female; Humans; Levonorgestrel; Methotrexate; Pregnancy; Pregnancy, Ectopic; Young Adult

There have been numerous attempts to control fertility after unprotected sexual intercourse (UPSI). From very bizarre methods like the vaginal application of Coca Cola to the more serious attempts using calcium antagonists influencing fertility parameters in sperm to hormonal methods or intrauterine devices. So far, hormonal methods preventing or delaying ovulation have proved to be the most popular starting with the combination of ethinyl estradiol and levonorgestrel (LNG), known as the Yuzpe regimen. The first dose had to be taken within 72 hours of UPSI, a second one 12 hours later. Later on, LNG alone, at first in a regimen similar to the Yuzpe method (2 × 0.75 mg 12 hours apart) showed to be more successful, eventually resulting in the development of a 1.5 mg LNG pill that combined good efficacy with a high ease of use. Several efficacious and easy to use methods for emergency contraception (EC) are available on the market today with the most widely spread being LNG in a single dose of 1.5 mg (given as one tablet of 1.5 mg or 2 tablets of 0.75 mg each) for administration up to 3 days (according to WHO up to 5 days) after UPSI. Its limitations are the non-optimal efficacy which is decreasing the later the drug is taken and the fact that it is only approved for up to 72 hours after UPSI. This regimen has no effect on the endometrium, corpus luteum function and implantation, is not abortive and don't harm the fetus if accidentally taken in early pregnancy. It has no impact on the rate of ectopic pregnancies. It has become the standard method used up to this day in most countries. Since the mid 1970s copper IUDs have been used for EC, which show a high efficacy. Their disadvantages lie in the fact that EC is considered an off label use for most IUDs (not for the GynFix copper IUD in the European Union) and that they might not be acceptable for every patient. Furthermore IUD-insertion is an invasive procedure and it is required trained providers and sterilized facilities. Mifepristone in the dosages of 10 or 25 mg is used with good results as an emergency contraceptive in China for up to 120 hours after UPSI, but has never received any significant consideration in Western countries. While high doses of mifepristone has an effect on endometrial receptivity and will inhibit ovulation if given in the follicular phase and prevent implantation if given in the early luteal phase, low doses such as 10 mg has no impact on the endometrium. Mifepristone does not in

Topics: China; Contraception, Postcoital; Contraceptive Agents; Contraceptives, Postcoital; Contraceptives, Postcoital, Synthetic; Ethinyl Estradiol; European Union; Female; Humans; Intrauterine Devices, Copper; Levonorgestrel; Mifepristone; Norpregnadienes; Ovulation; Pregnancy; Pregnancy, Ectopic; Receptors, Progesterone; Time Factors

Topics: Contraceptives, Postcoital; Drug Monitoring; Europe; Female; Humans; Incidence; Levonorgestrel; New Zealand; Pregnancy; Pregnancy, Ectopic; Product Surveillance, Postmarketing; Risk Factors; United Kingdom; United States

This is believed to be the first reported case of an ectopic pregnancy following failed progestogen-only emergency contraception. The ectopic pregnancy was at the site of a previous caesarean section scar and was managed conservatively.

Topics: Adult; Cesarean Section; Cicatrix; Contraceptives, Postcoital; Female; Humans; Pregnancy; Pregnancy, Ectopic; Progesterone; Treatment Failure

A patient attended a clinic requesting Depo Provera after emergency contraception. She gave a history of normal menstruation, but a pregnancy test proved positive. Subsequently an ectopic pregnancy was diagnosed.

Topics: Adult; Contraceptives, Postcoital; Female; Humans; Pregnancy; Pregnancy, Ectopic

This discussion of ectopic pregnancy covers mortality, definition, etiology, diagnosis and management, and contraception. In the 1979-81 "Report on Confidential Enquiries into Maternal Deaths in England and Wales," ectopic pregnancy accounted for 11.4% of all maternal deaths. Avoidable factors were found in 64% of deaths from ectopic pregnancy, the most common being delay in diagnosis and operative intervention. Ectopic pregnancy is the implantation of the conceptus outside the uterus or in an abnormal location within the uterus. Tubal gestation invariably has a multifactorial etiology and occurs owing to delay in the transport of the fertilized ovum. Table 1 lists causes. Salpingitis is the main cause of tubal pregnancy and now is considered to be due primarily to chlamydia. The consequences of tubal surgery, for whatever reason, and hormonal treatment also are major etiological factors. Every woman of reproductive age, especially if she has 1 or more etiological factors in her past history, who presents with a history of a missed period and irregular vaginal bleeding or abdominal pain, must be considered to have an ectopic pregnancy until proved otherwise. Diagnosis still is essentially a clinical one. In difficult cases use should be made of radioimmunoassay of beta hCG, ultrasonic scanning, and laparoscopy. In 25% of cases, a correct diagnosis was made only at laparotomy. Culdocentesis and endometrial biopsy are of limited use. In cases of ruptured ectopic pregnancy with circulatory collapse, immediate operative intervention is essential. In regard to contraception, the combined oral contraceptive (OC), in suppressing ovulation and thickening the cervical mucus, has a protective effect. Method failure does not increase the incidence of extrauterline pregnancy above normal. The progestagen-only pill is associated with a small increase in the risk of an initial and recurrent ectopic pregnancy. It does not suppress ovulation and may affect tubal motility, but it can be considered if the combined OC is contraindicated, as it is more advisable than an IUD if ectopic pregnancy is feared. Barrier methods will not affect the incidence of ectopic pregnancy and may protect against pelvic infection. It is still being debated whether the absolute incidence of ectopic pregnancy in IUD users is increased. A woman has a 0.3-5% risk of having a 1st ectopic pregnancy and a 15% chance of having a recurrence when given postcoital contraception. As w

Topics: Contraception; Contraceptive Agents; Contraceptive Agents, Female; Contraceptives, Oral; Contraceptives, Oral, Combined; Contraceptives, Postcoital; Demography; Diagnosis; Disease; Family Planning Services; Incidence; Intrauterine Devices; Mortality; Population; Population Dynamics; Pregnancy Complications; Pregnancy, Ectopic; Research; Research Design; Sexual Abstinence; Sterilization, Reproductive

The experience of the Utrecht State University with postcoital estrogens in high and low combined doses and with postcoital placement of IUDs since 1964 with over 4000 patients is summarized. The high dose postcoital estrogen treatment consists of 5 mg ethinyl estradiol for 5 days, either orally, or in case of vomiting not controlled by an antiemetic, estradiol benzoate 30 mg by injection. Side effects recorded in 3016 women were nausea in 54%, vomiting in 24%, tender breasts in 23%, menorrhagia in 11%, altered cycle length in 24%. Complications were 1 case of non-fatal pulmonary edema and 1 case of an 8 kg weight gain during treatment. There were 3 pregnancies. The overall failure rate in the whole series was 0.15%, with 10% ectopic pregnancies. There were no thromboembolisms or teratogenic effects. The combined estrogen treatment consisted of 50 mc ethinyl estradiol with 250 mc levonorgestrel (Neogynon oral contraceptive), 2 pills followed by 2 pills 12 hours later. A double-blind randomized trial resulted in no significant differences in pregnancy rates or side effects between the high and low dose regimens. The alternate treatment, if the woman presents more than 72 hours after intercourse, or if estrogens are contraindicated, is postcoital insertion of an IUD. The Dept. of Obstetrics and Gynecology does not place an IUD in a woman with infection nor in case of rape unless there is time for a complete work-up. Nulliparas are informed of the increased risk of pelvic inflammatory disease. Recently, the Multiload-copper 250 and later ML 375 were used exclusively, to achieve better blastocidal effect and lower expulsion rates. The ethical debate over use of postcoital methods centers around the morality of "procuring a miscarriage," but this argument is not relevant since these methods will not terminate a pregnancy once implantation has occurred. In the Netherlands, 25% of all abortion clients become pregnant during their 1st intercourse. In 1982, 35,000 postcoital contraceptives were administered, (roughly 16% of all pregnancies), compared to 15,000 abortions (7% of pregnancies; a total of 23% of pregnancies terminated). Compare these figures with 29% unwanted pregnancies all terminated by abortion in Sweden in that year. The postcoital methods are cheap, effective, and invaluable in emergency cases of rape, incest, intoxication, failure of barrier contraceptives, or unwanted pregnancy in women fearful or opposed to abortion.

Topics: Biology; Birth Rate; Breast; Contraception; Contraception Behavior; Contraceptive Agents; Contraceptive Agents, Female; Contraceptives, Oral; Contraceptives, Oral, Combined; Contraceptives, Oral, Hormonal; Contraceptives, Postcoital; Demography; Developed Countries; Digestive System; Disease; Embryo Implantation; Embryonic Development; Endocrine System; Ethics; Ethinyl Estradiol; Europe; Family Planning Services; Fertility; Hormones; Infections; Intrauterine Devices; Intrauterine Devices, Copper; Levonorgestrel; Menstruation Disturbances; Nausea; Netherlands; Parity; Pelvic Inflammatory Disease; Physiology; Population; Population Dynamics; Pregnancy; Pregnancy Complications; Pregnancy Trimester, First; Pregnancy, Ectopic; Reproduction; Signs and Symptoms; Vomiting

Current interceptive methods of contraception utilizable between ovulation and nidation include hormonal methods and IUDs. Since the 1st clinical study of the use of high doses of estrogen as a postcoital contraceptive appeared in 1967, the remarkable efficacy of the method has been confirmed by numerous other studies. The most important series used 50 mg diethylstilbestrol (DES) or 5 mg ethinyl estradiol (EE) per day for 5 days beginning within 72 hours of unprotected intercourse. The mechanism by which estrogens exercise their interception are unclear, but there are probably several factors involved including luteolysis and anomalies in endometrial development. The method is highly effective but rates of nausea, vomiting, breast tenderness, and to a lesser degree menorrhagia are high. The incidence of extrauterine pregnancy is about 1 per 10 intrauterine pregnancies for any postcoital method. Estrogen postcoital contraception is preferable to DES because of the fear of genital adenosis or vaginal adenocarcinoma in case of failure of DES. Opinion is divided as to the teratogenic risks of high doses of estrogens in general. Postcoital contraception with a progestin, levonorgestrel, which renders the endometrium inhospitable to nidation, was 1st described in 1973. The efficacy of norgestrel alone depends on the dose used. The most common secondary effects are spotting and cycle shortening. The method has the advantage of requiring a very small dose, but the disadvantage of requiring administration in the 12 hours following intercourse. Several combinations of estrogens and progestins have been proposed for postcoital use, of which the most interesting consists of 1 mg of dl-norgestrel and 100 mcg of EE repeated exactly 12 hours later. The treatment should be administered within 12 hours of unprotected intercourse. A multicenter study of 692 women treated with this method gave a pregnancy rate of 1.6%, which would have been lower if 4 women not meeting the conditions of treatment had been excluded. 52.7% of women treated had nausea or vomiting. Compared to estrogens alone, the EE-Norgestrel combination takes less time, requires 4 pills instead of 50 or 60, is better tolerated overall, and requires much less estrogen. Postcoital insertion of an IUD is very effective and has the advantages that it can be used later than 72 hours following intercourse, it is the only method currently available in case OCs are contraindicated, it allows subsequ

Topics: Biology; Contraception; Contraceptive Agents; Contraceptive Agents, Female; Contraceptives, Oral, Hormonal; Contraceptives, Postcoital; Diethylstilbestrol; Disease; Endocrine System; Estrogens; Ethinyl Estradiol; Family Planning Services; Hormones; Intrauterine Devices; Levonorgestrel; Norgestrel; Physiology; Pregnancy Complications; Pregnancy, Ectopic; Reproductive Control Agents

Topics: Abortion, Legal; Contraceptives, Postcoital; England; Female; Humans; Infections; Intraoperative Complications; Menstruation Disturbances; Postoperative Complications; Pregnancy; Pregnancy, Ectopic; Progestins; Prostaglandins; Rh-Hr Blood-Group System; Sterilization, Reproductive; Uterine Hemorrhage; Uterus; Vacuum Extraction, Obstetrical; Wales

Low-dose progestin only contraceptive agents seem to respect the hypothalamo-hypophyso-ovarian system, thus respecting the physiology of the menstrual cycle, and to inhibit fertility simply by interfering with estrogen action at the level of the cervical mucus. The incidence of ectopic pregnancies is apparently greater with failure of this method than with failure of regular hormonal contraception. Postcoital single-dose progestin oral contraception acts at the level of the endometrium creating conditions unfavorable to nidation, and also on the cervical mucus and on the system of transport of the ovum. Both contraceptive methods are worth new and larger investigations to discover their limits and mode of action.

Topics: Contraception; Contraception Behavior; Contraceptive Agents; Contraceptive Agents, Female; Contraceptives, Postcoital; Disease; Evaluation Studies as Topic; Family Planning Services; Pregnancy; Pregnancy Complications; Pregnancy, Ectopic; Progesterone Congeners

After the development of postcoital hormonal interception, the postcoital use of IUDs to prevent pregnancy was proposed by Tatum. The major advantage of this treatment is that it avoids the use of the usual massive dose of estrogens (a very effective postcoital method) which is associated with nausea and vomiting. This is the 1st method to be effective up to 5 days after exposure, 3 days more than the estrogen treatment. It may also provide long-term contraception in women who wish to continue using the IUD. A major disadvantage of postcoital IUD use is that IUD insertion can produce serious complications if a patient has a vaginal or venereal infection or an asymptomatic cervicitis or even pelvic inflammatory disease (PID). After proper physical examination, suitable patients are selected from those requesting postcoital treatment. Cases involving rape are mostly excluded from these services; but, if they present early, proper work up and treatment can be performed within the time span of 5 days available for this method and it will still be possible to fit a postcoital IUD. The potential risk of future infertility should be considered as PID rates in nulliparous IUD users are up to 7 times higher than in nonusers. Young nulliparous, sexually active women--especially of the lower socioeconomic strata--are identified as high-risk patients. Over 70% of women requesting interception are nulliparous. Clients asking for postcoital insertion should be informed of its potential risk, as women under 25 years of age are more prone to infection. The risk of septic abortion exists if an IUD is inserted into a gravid uterus due to pregnancy resulting from unreported previous sexual intercourse. Septic abortion is a life-threatening condition. Out of several series, no pregnancies are reported in the month of treatment. The IUD preferred is the Multiload copper IUD or the copper T; the highest expulsion rate proved the Copper-7 Gravigard (Cu-7) inefficient. In suitable circumstances, the IUD can be the 1st choice in postcoital interception.

Topics: Age Factors; Contraception; Contraceptives, Postcoital; Copper; Evaluation Studies as Topic; Family Planning Services; Intrauterine Devices; Intrauterine Devices, Copper; Parity; Patient Acceptance of Health Care; Pelvic Inflammatory Disease; Pregnancy; Pregnancy, Ectopic; Research; Therapeutics

Topics: Animals; Contraceptives, Postcoital; Embryo Implantation; Estrogens; Female; Haplorhini; Humans; Macaca; Nausea; Ovulation; Pregnancy; Pregnancy, Ectopic; Pulmonary Edema

The use of diethylstilbestrol (DES) as a postcoital contraceptive agent is discussed. DES is associated with nausea, an increased risk of thrombosis, and is suspect in endometrial and breast cancer, and vaginal cancer in the progeny of mothers treated during pregnancy. Postcoital estrogens do not seem to be as effective as conventional oral contraceptives. Although DES is most likely not an abortifacient agent, its mode of action is not certain. Nonetheless, the relatively high number of ectopic pregnancies among method-failures suggests that DES delays ovum transport. It is concluded that routine postcoital use of DES is too hazardous, and that abortion is strongly indicated if the method fails.

Topics: Contraceptives, Postcoital; Diethylstilbestrol; Female; Humans; Neoplasms; Pregnancy; Pregnancy, Ectopic; Self Medication