Ectopic pregnancy rates in IUD users.

Aznar, R; Berry, C. L.; Cooke, I. D.; Cuadros, Alvaro; Gray, Ronald H.; McNicol, G. P.; Newton, Richard; Pizarro, E; Rowe, P.J.; Shaw, S.T.; Wagatsuma, T; Webb, F. T. G.; Wilson, Elaine H.

doi:10.1136/bmj.1.6115.785-b

Cited by 8 publications

(3 citation statements)

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“…In 1974 an IUD containing progesterone suspended as microcrystals in a fluid medium with a very low dose release rate of 65 μg/day was marketed (Progestasert ® ) . However, it was removed some years later, partly due to the possible increased risk of EP . The current study does not include information on the total number of pregnancies among LNG‐IUS users, hence a PI for all types of pregnancies is not estimated.…”

Section: Discussionmentioning

confidence: 99%

Levonorgestrel intrauterine contraceptive systems (13.5 mg and 52 mg) and risk of ectopic pregnancy

Graner

Taggart

Nordström

et al. 2019

Acta Obstet Gynecol Scand

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Introduction:The objective was to investigate the Pearl index for ectopic pregnancy in women using the levonorgestrel intrauterine system (LNG-IUS) at the time of conception. Material and methods:This was a substudy of a hospital-based historical cohort including women with an ectopic pregnancy diagnosed in 4 referral hospitals in Stockholm, Sweden between December 2013 and April 2017. Study participants and type of contraception at time of conception were identified through the electronic medical chart system. Cases were defined as women with LNG-IUS 13.5 or 52 mg in situ at the time of diagnosis of ectopic pregnancy who had their LNG-IUS inserted 1 January 2014 or later. Outcome was defined as the incidence rate for ectopic pregnancy during use per 100 woman-years (Pearl index) with 95% confidence interval (95% CI). Results:The study includes 35 cases with LNG-IUS 13.5 mg and 13 cases with LNG-IUS 52 mg, which occurred in 18 488 (13.5 mg) and 50 246 (52 mg) exposed woman-years. Pearl index for ectopic pregnancy was estimated at 0.19 (95% CI 0.15-0.28) for LNG-IUS 13.5 mg and to 0.006 (95% CI 0.00-0.01) for LNG-IUS 52 mg.The most cases for the LNG-IUS 13.5 mg (n = 26; 74%) occurred during the first year of use with a corresponding Pearl index at 0.23 (95% CI 0.14-0.35). Conclusions:The absolute risk of ectopic pregnancy during the use of LNG-IUS remains low. Our method may underestimate as well as overestimate the Pearl index for ectopic pregnancy. The findings underline the importance of identifying risk factors for ectopic pregnancy at insertion, and to rule out ectopic pregnancy for all women presenting with abdominal discomfort during the use of LNG-IUS. Longer observation periods and prospective studies in a general population are a priority for further research. K E Y W O R D SEctopic pregnancy, intrauterine contraception, levonorgestrel containing intrauterine system, levonorgestrel containing intrauterine system 13.5 mg, levonorgestrel containing intrauterine system 52 mg, Pearl index

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Section: Discussionmentioning

confidence: 99%

Levonorgestrel intrauterine contraceptive systems (13.5 mg and 52 mg) and risk of ectopic pregnancy

Graner

Taggart

Nordström

et al. 2019

Acta Obstet Gynecol Scand

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“…Recently, Aznar et al (1) have assessed the essential problems concerned in the evaluation of a possible association between ectopic pregnancy and the use of IUDs. They point out that the ratio of ectopic to intrauterine pregnancies, which is usually used to describe the incidence of the former, provides limited knowledge concerning the actual risk for users of these contraceptives.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of ectopic pregnancy is known to vary from population to population and also for users of different contraceptive methods, including no method (7). Apart from obvious differences in the mode of action for different contraceptive methods, this might in part be explained by differences in the prevalence of conditions predisposing to ectopic pregnancy (1). In this paper we report findings on the prevalence of ectopic-predisposing factors in women with ectopic pregnancy with and without an IUD; and present the incidence in a defined geographical area of Sweden, and the estimated risk rate for ectopic pregnancy for users of copper-bearing IUDs.…”

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confidence: 90%

Ectopic Pregnancy and IUDs; incidence, Risk Rate and Predisposing Factors

Meirik

Nygren

1980

Acta Obstet Gynecol Scand

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During a period of 4 years, 1974-77, in Uppsala county; Sweden, 203 women underwent surgery for ectopic pregnancy with histological proof of the diagnosis. For the female population of fertile age this corresponds to 0.11 ectopics per 100 women 15-44 years of age, or 1.08 per 100 notified pregnancies, or 1.53 per 100 births. Fifty-five of the women with ectopic pregnancy were using an intrauterine device (IUD) (48 a copper-bearing IUD and 7 some other type of device), and 6 women used a low dose progestogen contraceptive. For users of copper-bearing IUDs the risk of an ectopic pregnancy was estimated to be 0.15 per 100 women years. When comparing this latter risk rate with the overall incidence rate of 0.11, it must be observed that the populations forming the denominator in these two rates differ with respect to some crucial characteristics. Nulliparity and predisposing factors were found statistically significantly more often in non-IUD-users with an ectopic pregnancy than in IUD-users. Such predisposing factors may be less prevalent in IUD-users, as in other populations. This may explain why ectopic pregnancy has been found to occur less frequently than theoretically expected among IUD-users. The "ectopic preventing" capacity of the IUD may therefore be considerably lower than has been previously claimed.

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Preventing the Need for Second-Trimester Abortion

Connell¹

1981

Second-Trimester Abortion

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Ectopic pregnancy rates in IUD users.

Cited by 8 publications

References 0 publications

Levonorgestrel intrauterine contraceptive systems (13.5 mg and 52 mg) and risk of ectopic pregnancy

Levonorgestrel intrauterine contraceptive systems (13.5 mg and 52 mg) and risk of ectopic pregnancy

Ectopic Pregnancy and IUDs; incidence, Risk Rate and Predisposing Factors

Preventing the Need for Second-Trimester Abortion

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