Ectopic pregnancy with use of progestin-only injectables and contraceptive implants: a systematic review

Callahan, Rebecca L.; Yacobson, Irina; Halpern, Vera; Nanda, Kavita

doi:10.1016/j.contraception.2015.08.016

Cited by 28 publications

(23 citation statements)

References 96 publications

(88 reference statements)

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“…Progestin-only contraceptive products, including LARC, have an established increased relative-risk for ectopic pregnancy, if fertilization does occur [12,13,29]. The pathophysiology is thought to be related to decreased smooth muscle contraction of fallopian tubes [13,29]. Fortunately, in our case the pregnancy was an ultrasound confirmed intra-uterine pregnancy, and Nexplanon was removed at 9 weeks gestation.…”

Section: Discussionmentioning

confidence: 87%

“…Serious complications such as ectopic pregnancy have been linked to contraceptive therapy. Progestin-only contraceptive products, including LARC, have an established increased relative-risk for ectopic pregnancy, if fertilization does occur [12,13,29]. The pathophysiology is thought to be related to decreased smooth muscle contraction of fallopian tubes [13,29].…”

Section: Discussionmentioning

confidence: 99%

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Unintended Pregnancy with Implantable Subdermal Contraceptive Device (Nexplanon): A Case Report

Rezai¹,

Patel²,

Hughes³

et al. 2018

OGIJ

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Background: In 2006, Implanon (68 mg), a synthetic subcutaneous progestin etonogestrel eluting capsule, was approved for use in the U.S. to provide longacting reversible contraception (LARC). The next generation LARC, Nexplanon (68 mg), a progestin-only etonogestrel subdermal implant, was available in 2001. Currently, Nexplanon is advertised to provide 99% effective contraception, up to 4 years. Removal of the capsule will revert back to normal menstruation and fertility. Unlike Implanon, cases of unintended uterine pregnancy with proper and successful insertion have not been reported using Nexplanon. Case:A 24-year-old female, G2P1001, with obstetrical history of one spontaneous vaginal delivery (2015), and gynecological history of low grade squamous intraepithelial lesion (LSIL) on Pap smear (2014), was found to have an intrauterine pregnancy while using Nexplanon. Initially, urine pregnancy testing assured that she was not pregnant before placement of the Nexplanon. Nexplanon was inserted ~2 months post-partum after the birth of her first child.17 months post-Nexplanon insertion, patient experienced irregular spotting, cramping, and reported positive home pregnancy test. Transvaginal ultrasound confirmed an intrauterine pregnancy at 9 weeks and 3 days. The Nexplanon implant was removed intact. Routine prenatal care was initiated and no issues were identified. Conclusion:Newer LARCs provide an alternative to lifestyle adaptive contraception, with ease of use and compliance. Although LARCs prove to be more effective, known factors linked to human error during placement, cytochrome P450 induction, and BMI, have shown to decrease their efficacy, leading to failed contraception. be associated with an unintended uterine pregnancy with proper and successful insertion. Keywords:Contraindications for the implant include; known or suspected pregnancy, current or past history of thrombosis or thromboembolic disorders, liver tumors (benign or malignant), active liver disease, undiagnosed abnormal genital bleeding, known or suspected breast cancer, personal history of breast cancer, other progestin-sensitive cancer and allergies to the components of Nexplanon [12,13]. Side effects of Nexplanon include; irregular menses, headache, vaginitis, breast pain, weight gain, acne, abdominal pain, and pharyngitis [12,13]. Although Nexplanon is used to prevent pregnancy, if the implant fails, there is an increased risk for ectopic pregnancy [12]. We present the first case of intrauterine pregnancy while using Nexplanon [14]. Case ReportThis patient is a 24-year-old female, G2P1001, with past medical history of asthma controlled with albuterol, asthmatic bronchitis treated with amoxicillin, and iron deficiency anemia was found to have an intrauterine pregnancy while using Nexplanon. Obstetrical history is significant for one spontaneous vaginal delivery in 2015, and gynecological history includes low grade squamous intraepithelial lesion (LSIL) on pap smear in 2014, with no further abnormal pap smears. She had used Nexplanon ...

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Unintended Pregnancy with Implantable Subdermal Contraceptive Device (Nexplanon): A Case Report

Rezai¹,

Patel²,

Hughes³

et al. 2018

OGIJ

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“…Association between low progesterone level and EP have long been described, low serum progesterone influences the oviduct electrophysiological characteristics leading to poor ovum transfer, low probability of pro-uterine propagation of the activity at the fimbria end of the tube; high frequency but low number of electrical bursts, reflecting possible weak propulsive force and consequently increasing the rate of ovum retention and ectopic pregnancy (12,13) . The long term use of the progestin containing implant also causes myorelaxation and further increasing the rate of EP (4) . This together with multiparty are plausible mechanisms for the development of EP in our indexed cases.…”

Section: Discussionmentioning

confidence: 99%

“…Several original research and case reports have been published on the relationship between LNG as emergency contraception and ectopic pregnancy (EP) (1,5,6) . A recent systematic review in 2015 showed EP is more common if LNG containing implants is used compared to implants containing other hormones (4) . In this article the authors describes 2 cases of ectopic pregnancies diagnosed at 8 and 7 weeks of amenorrhea after the removal of levonorgestrel (LNG) -containing implants.…”

Section: Introductionmentioning

confidence: 99%

“…After insertion, the implant may remain in place for up to 5 years during which LNG is released from the implant initially at 100 μg/day that later becomes stable maintaining a relatively stable daily drug concentration (3) . Prolonged exposure to LNG in implants for a long period of time may lead to mucosal damage and decreased ciliary motility (4) . Several original research and case reports have been published on the relationship between LNG as emergency contraception and ectopic pregnancy (EP) (1,5,6) .…”

Section: Introductionmentioning

confidence: 99%

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Ectopic Pregnancy After Removal of Levonorgestrel Implants: a Review of Two Case Series in a Resource Low-setting in Sub-Sahara Africa

Theophile

Tchente

Tolefac

et al. 2017

IAM

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Background: Contraception has been practice in the last few decades in order to prevent unwanted pregnancies and to safe women from criminal abortions and its complications. Case presentation: We report 2 cases of ectopic pregnancies diagnosed at 8 and 7 weeks of amenorrhea after the removal of levonorgestrel -containing implants in two females 28 and 32 years old respectively. The ectopic pregnancies occurred between 4-6 weeks following the removal of the implants. The patients were both manged with laparoscopy in Douala general hospital. Conclusion: Due to the limited data on the relationship between progestin implants and ectopic pregnancy, the authors advise that, after removal of the implants patients should not have unprotected sexual intercourse for about three months so as to allow ciliary functions to return to normal.

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Hormonale Kontrazeption

Wiegratz

2024

Klinische Endokrinologie Für Frauenärzte

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Ectopic pregnancy with use of progestin-only injectables and contraceptive implants: a systematic review

Cited by 28 publications

References 96 publications

Unintended Pregnancy with Implantable Subdermal Contraceptive Device (Nexplanon): A Case Report

Unintended Pregnancy with Implantable Subdermal Contraceptive Device (Nexplanon): A Case Report

Ectopic Pregnancy After Removal of Levonorgestrel Implants: a Review of Two Case Series in a Resource Low-setting in Sub-Sahara Africa

Hormonale Kontrazeption

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