Ectopic pregnancy with postcoital contraception – a case report

Abstract

The incidence of ectopic pregnancies is increasing. Common risk factors are tubal pathology, previous tubal surgery, previous ectopic pregnancy, intrauterine device use and embryo transfer. Levonelle-2, a progesterone-only postcoital contraceptive works by a combination of mechanisms including ovulation inhibition, prevention of fertilization, and inhibition of implantation. It is 85% effective and there have been 12 reported cases of ectopic pregnancy in the UK with its use. It is believed that progesterone slows the intratubal migration of the fertilized ovum. In the case reported here, a woman presented with an ectopic pregnancy after use of Levonelle-2 as postcoital contraception; there were no clinical predisposing risk factors. In the absence of any histological evidence of tubal damage, we suspect that the levonorgestrel from Levonelle-2 could have been responsible for delayed embryo transfer which resulted in the ectopic pregnancy.

Ectopic pregnancy following emergency contraception with ethinyloestradiol-levonorgestrel: A case report

“…One of the mechanisms of action of progestin-only EC is thought to be the reduction of activity of Fallopian tube cilia and tubal motility; this could result in an increased incidence of ectopic gestation after failure of this modality of EC 8 . Indeed, since levonorgestrel EC was first launched in 1999, more than 30 such cases have been reported in the literature [8][9][10][11][12][13][14][15] . However, the alleged greater risk of ectopic pregnancy following failure of levonorgestrel EC is controversial, since the total number of women who applied progestin-only EC is unknown.…”

Risk factors associated with ectopic pregnancy in our sociodemographic setup

“…Basu et al in a case presentation mentioned that a woman presented with an EP after use of levonelle-2 (a postcoital contraception) in absence of other predisposing risk factors. 29 Jain et al found that hormonal emergency contraceptive pills failure rate is high when used in periovulatory period with increased chance of EP. 30 Anorlu et al and Karaer et al reported that use of IUCD increased the risk of EP.…”

Clinical course of ectopic pregnancy: A single-center experience

“…[6] The risk factors for EP include pelvic inflammatory disease, previous tubal surgery, previous tubal pregnancy, progestin contraceptive, assisted reproduction, ovulation induction, induced abortion, salpingitis isthmica nodosa, smoking, and diethyl stilbestrol exposure. [78] Most of the tubal pregnancies become symptomatic within 12 weeks, but a small number of them progress beyond this gestation and are diagnosed late. [9]…”