Association between knowledge about levonorgestrel emergency contraception and the risk of ectopic pregnancy following levonorgestrel emergency contraception failure: a comparative survey

Zhang, Duo; Yan, Ming-Xing; Ma, Jue; Xia, Wei; Xue, Rui-Hong; Sun, Jing; Zhang, Jian

doi:10.1002/pds.3946

Cited by 4 publications

(6 citation statements)

References 32 publications

(46 reference statements)

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“…However, there could be women who use it without strictly adhering to the guidelines [3, 18]. Studies done in china showed 5 and 4 times increased odds of developing ectopic pregnancy in those who had used Levonorgestrel emergency contraceptive pill compared to non-users respectively [12, 13]. Although the use of Levonorgestrel only pills for emergency contraception significantly influenced occurrence of ectopic pregnancy (p < 0.001) among the cases; the findings of this study clearly indicate that occurrence of ectopic pregnancy could also be influenced by the use of other contraceptives such as depo Provera (< 0.001).…”

Section: Discussionmentioning

confidence: 99%

“…However, most studies on contraception failure and pregnancy as the primary endpoint; did not report whether pregnancies following LNG-EC failure were intrauterine or extra-uterine [11]. Ectopic pregnancy is one of the causes of maternal morbidity and mortality in sub-Saharan Africa [12]. The incidence of ectopic pregnancy in Western Kenya continues to be a major cause of admission in health facilities [13].…”

Section: Introductionmentioning

confidence: 99%

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Levonorgestrel only emergency contraceptive use and risk of ectopic pregnancy in Eldoret Kenya: a case-control study

Shurie¹,

Were²,

Orang’o³

et al. 2018

Pan Afr Med J

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Introduction 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. Methods 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. Results 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)}. Conclusion 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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Levonorgestrel only emergency contraceptive use and risk of ectopic pregnancy in Eldoret Kenya: a case-control study

Shurie¹,

Were²,

Orang’o³

et al. 2018

Pan Afr Med J

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“…In general, Chlamydia infection, which is one of the most common risk factors for an ectopic pregnancy, also decreases ciliary movement and causes tubal damage. Although it was reported that a previous C. trachomatis infection, detected with a serum C. trachomatis immunoglobulin G test, was not greater in those who had an ectopic pregnancy compared with those who had an intrauterine pregnancy following LNG‐EC failure, other factors including incorrect emergency contraception use might affect these results . In any case, repeat testing for reinfection of C. trachomatis should be recommended .…”

Section: Discussionmentioning

confidence: 99%

Ectopic pregnancy following oral levonorgestrel emergency contraception use

Kitani

Ishiguro

Kobayashi

et al. 2018

J of Obstet and Gynaecol

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Levonorgestrel is used worldwide as an emergency oral contraceptive. There have been occasional reports of ectopic pregnancy after oral levonorgestrel use. We present a case of ectopic tubal pregnancy after the use of oral levonorgestrel as an emergency contraceptive in a 37-year-old woman with a history of treatment for Chlamydia trachomatis infection. She conceived after sexual intercourse on menstrual day 14 of the first menstrual cycle following a normal delivery. After salpingectomy for this right tubal pregnancy, her following pregnancy was an ectopic pregnancy in the contralateral tube, which was treated with laparoscopic salpingectomy. Histopathological examination revealed endometriosis. We should be aware of ectopic pregnancy even after emergency contraceptive use, especially in patients with risk factors, such as Chlamydia infection and endometriosis. Because the efficacy of levonorgestrel decreases after ovulation, we should check the stage of the cycle before prescription.

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“…113 A study found that among women with LNG-EC failure, the primary sources of information included friends, TV, and the Internet. 114 Social networks, including family, friends, and media, were shown to be important for the contraceptive decision-making in African American and Latina women. 115 An analysis of information on EC using a Google search in April 2020 found that the information showed low credibility overall and many web sites were too complex for regular consumers.…”

Section: Areas Of Uncertaintymentioning

confidence: 99%

Emergency Contraception: Access and Challenges at Times of Uncertainty

Stein¹,

Deverakonda²,

Katz

et al. 2022

American Journal of Therapeutics

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Background:The UN Commission on Life-Saving Commodities for Women and Children identified emergency contraceptive pills as 1 of the 13 essential underused, low-cost, and high-impact commodities that could save the lives of millions of women and children worldwide. In the US, 2 emergency contraceptive regimens are currently approved, and their most plausible mechanism of action involves delaying and/or inhibiting ovulation.Areas of uncertainty:Abortion and contraception are recognized as essential components of reproductive health care. In the US, in the wake of the Dobbs v. Jackson Women's Health Organization Supreme Court decision on June 24, 2022, 26 states began to or are expected to severely restrict abortion. It is anticipated that these restrictions will increase the demand for emergency contraception (EC). Several obstacles to EC access have been described, and these include cost, hurdles to over-the-counter purchase, low awareness, myths about their mechanisms of action, widespread misinformation, and barriers that special populations face in accessing them. The politicization of EC is a major factor limiting access. Improving sex education and health literacy, along with eHealth literacy, are important initiatives to improve EC uptake and access.Data Sources:PubMed, The Guttmacher Institute, Society of Family Planning, American College of Obstetricians and Gynecologists, the World Health Organization, The United Nations.Therapeutic Advances:A randomized noninferiority trial showed that the 52 mg levonorgestrel intrauterine device was noninferior to the copper intrauterine device when used as an EC method in the first 5 days after unprotected intercourse. This is a promising and highly effective emergency contraceptive option, particularly for overweight and obese patients, and a contraceptive option with a different bleeding profile than the copper intrauterine device.Conclusions:EC represents an important facet of medicine and public health. The 2 medical regimens currently approved in the US are very effective, have virtually no medical contraindications, and novel formulations are actively being investigated to make them more convenient and effective for all patient populations. Barriers to accessing EC, including the widespread presence of contraception deserts, threaten to broaden and accentuate the already existing inequities and disparities in society, at a time when they have reached the dimensions of a public health crisis.

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Association between knowledge about levonorgestrel emergency contraception and the risk of ectopic pregnancy following levonorgestrel emergency contraception failure: a comparative survey

Cited by 4 publications

References 32 publications

Levonorgestrel only emergency contraceptive use and risk of ectopic pregnancy in Eldoret Kenya: a case-control study

Levonorgestrel only emergency contraceptive use and risk of ectopic pregnancy in Eldoret Kenya: a case-control study

Ectopic pregnancy following oral levonorgestrel emergency contraception use

Emergency Contraception: Access and Challenges at Times of Uncertainty

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