Contraceptive Use and the Risk of Ectopic Pregnancy: A Multi-Center Case-Control Study

Abstract

ObjectiveTo evaluate the association between the risk of ectopic pregnancy (EP) and the use of common contraceptives during the previous and current conception/menstrual cycle.MethodsA multi-center case-control study was conducted in Shanghai. Women diagnosed with EP were recruited as the case group (n = 2,411). Women with intrauterine pregnancy (IUP) (n = 2,416) and non-pregnant women (n = 2,419) were matched as controls at a ratio of 1∶1. Information regarding the previous and current use of contraceptives was collected. Multivariate logistic regression analyses were performed to calculate odds ratios (ORs) and the corresponding 95% confidential intervals (CIs).ResultsPrevious use of intrauterine devices (IUDs) was associated with a slight risk of ectopic pregnancy (AOR1 = 1.87 [95% CI: 1.48–2.37]; AOR2 = 1.84 [1.49–2.27]), and the risk increased with the duration of previous use (P1 for trend <10−4, P2 for trend <10−4). The current use of most contraceptives reduced the risk of both unwanted IUP (condom: AOR = 0.04 [0.03–0.05]; withdrawal method: AOR = 0.10 [0.07–0.13]; calendar rhythm method: AOR = 0.54 [0.40–0.73]; oral contraceptive pills [OCPs]: AOR = 0.03 [0.02–0.08]; levonorgestrel emergency contraception [LNG-EC]: AOR = 0.22 [0.16–0.30]; IUDs: AOR = 0.01 [0.005–0.012]; tubal sterilization: AOR = 0.01 [0.001–0.022]) and unwanted EP (condom: AOR1 = 0.05 [0.04–0.06]; withdrawal method: AOR1 = 0.13 [0.09–0.19]; calendar rhythm method: AOR1 = 0.66 [0.48–0.91]; OCPs: AOR1 = 0.14 [0.07–0.26]; IUDs: AOR1 = 0.17 [0.13–0.22]; tubal sterilization: AOR1 = 0.04 [0.02–0.08]). However, when contraception failed and pregnancy occurred, current use of OCPs (AOR2 = 4.06 [1.64–10.07]), LNG-EC (AOR2 = 4.87 [3.88–6.10]), IUDs (AOR2 = 21.08 [13.44–33.07]), and tubal sterilization (AOR2 = 7.68 [1.69–34.80]) increased the risk of EP compared with the non-use of contraceptives.ConclusionCurrent use of most contraceptives reduce the risk of both IUP and EP. However, if the contraceptive method fails, the proportions of EP may be higher than those of non-users. In the case of contraceptive failure in the current cycle, EP cases should be differentiated according to current use of OCPs, LNG-EC, IUDs, and tubal sterilization. In addition, attention should be paid to women with previous long-term use of IUDs.

Risk factors for recurrent ectopic pregnancy: a case–control study

“…Information was collected from each patient in a face‐to‐face interview and included: socio‐demographic characteristics (age, marital status, educational attainment, occupation, individual annual income, smoking status); history of reproduction and gynaecology [number of previous terminations of pregnancy (TOP), parity, history of infertility and tubal infertility, the mode of pregnancy including natural conception, in vitro fertilisation‐embryo transfer (IVF‐ET) or other ART (ovarian stimulation, intrauterine insemination, Chinese herbs, luteal phase support, combination of ovarian stimulation and luteal phase support)]; surgical history [history of caesarean section, adnexal surgery, appendectomy and treatment of last EP including expectant treatment, methotrexate, salpingectomy, salpingotomy and other surgical procedures (fimbrial ‘milking‐out’ of the ectopic gestation, removal of trophoblastic tissue in pelvic cavity and ovarian wedge resection)]; previous contraceptive experience [IUD, oral contraceptive pill (OCP), levonorgestrel emergency contraceptive (LNG‐EC), condom and other contraceptive methods (withdrawal method and calendar rhythm method)]; and current contraceptive experience [IUD, OCP, LNG‐EC, female sterilisation (bilateral salpingectomy and bilateral tubal ligation), condom and other contraceptive methods (rhythm method and withdrawal)]. The previous and current uses of a given contraceptive method were defined in the same way as in our previous study . If participants were unwilling to reply to a certain question they were allowed to skip it, and we treated this as missing information.…”

An Unusual Case of a Forgotten Intrauterine Contraceptive Device for 25 Years Presented with Ectopic Pregnancy at AMDA Hospital, Damak, Nepal

“…Studies have shown that device may be less effec ve for ectopic pregnancy preven on then for intrauterine 5 pregnancy preven on. The risk of ectopic pregnancy resul ng from contracep ve failure varies according to the contracep ve method used.…”

“…In recent decades, the incidence of ectopic pregnancy has increased; contracep ve failure has 5 been considered one of the factors. Ectopic pregnancy is simply a fer lized ovum implanted outside the uterine cavity, most common involvement being fallopian tube.…”

A study of the risk factors related to ectopic pregnancy in intrauterine device users

“…Some studies found that past use of IUD could mildly increase the risk of EP. [6,7] Other study recently found that current IUD use play dominant roles in the occurrence of EP. [8] The main reason may be pelvic infections, which could cause an ectopic implantation among past IUD users.…”