Ectopic Pregnancy Following Levonorgesterol-Only Emergency Contraception: The First Malaysian Case Report
Ectopic Pregnancy Following LNG-EC
Vol. 7 No. 2 : 2012 (107-111)
Abstract
Levonorgestrel (LNG) is a well-known safe and efficacious emergency contraception (EC). However, ectopic pregnancy following the failure of LNG-only EC has been reported. The exact incidence of ectopic pregnancy has been hindered by lack of data due to the fact that LNG-only EC is accessible at pharmacies without a prescription. We describe a case of ectopic pregnancy in an 18 year-old single woman who took LNG-only EC within 48 hours of unprotected sexual intercourse. She presented to the emergency department at 8 weeks period of amenorrhoea with an acute abdomen and hypovolaemic shock. Laparotomy confirmed a ruptured right tubal pregnancy and salpingectomy was performed. The patient was discharged well after 2 days. We aim to highlight this potential adverse effect and to discuss the plausible causality of ectopic pregnancy following administration of LNG-only EC.
Keywords :
ectopic pregnancy,
emergency contraception,
Levonogrestrel,
Correspondance Address
Dr. Natasha Ain Mohd Nor, Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000, Kuala Lumpur. Tel: 603-91455949. Fax: 603- 91456672. Email: nat170975@yahoo.com
References
Camp, S. L., Wilkerson, D.S., & Raine, T. 2003. The benefits and risks of over-the-counter availability of levonorgestrel emergency contraception. Contraception 68(5): 309-317.
Cheng, L., Gulmezoglu, A.M., Oel, C.J., Piaggio, G., Ezcurra, E., & Look, P.F. 2004. Interventions for emergency contraception. Cochrane Database Syst Rev (3) CD001324.
Cleland , K., Raymond, E., Trussell , J., Cheng , L., & Zhu , H. 2010. Ectopic pregnancy and emergency contraceptive pills: a systemic review. Obstet Gynecol 115(6): 1263-1266.
Croxatto, H.B., Brache, V., Pavez, M., Cochon, L., Forcelledo, M.L., Alvarez, F., Massai, R., Faundes, A. & Salvatierra, A.M. 2004. Pituitary-ovarian function following the standard levonorgestrel emergency contraceptive dose or a single 0.75-mg dose given on the days preceding ovulation. Contraception 70(6): 442-450.
Croxatto, H.B., Ortiz, M.E., & Muller, A.L. 2003. Mechanisms of action of emergency contraception. Steroids 68(10-13): 1095-1098.
Gainer, E., Mery, C., & Ulmann, A. 2001. Levonorgestrel-only emergency contraception: real-world tolerance and efficacy. Contraception 64(1): 17-21.
Gemzell-Danielsson, K. 2010. Mechanism of action of emergency contraception. Contraception 82(5): 404-409.
Ghosh, B., Dadhwal, V., Deka, D., Ramesan, CK., & Mittal, S. 2009. Ectopic pregnancy following levonorgestrel emergency contraception: a case report. Contraception 79(2):155-157.
Johansson, E., Brache, V., Alvarez, F., Faundes, A., Cochon, L., Ranta, S., Lovern, M. & Kumar, N. 2002. Pharmacokinetic study of different dosing regimens of levonorgestrel for emergency contraception in healthy women. Hum Reprod, 17(6): 1472-1476.
Kozinszky, Z., Bakken, RT., & Lieng, M. 2011. Ectopic pregnancy after levonorgestrel emergency contraception. Contraception 83(3): 281-283.
Marion, L.L., & Meeks, G.R. 2012. Ectopic pregnancy: history, incidence, epidemiology, and risk factors. Clin Obstet and Gynecol 55(2): 376-386.
Mikolajczyk, R.T., & Stanford, J.B. 2007. Levonorgestrel emergency contraception: a joint analysis of effectiveness and mechanism of action. Fertil Steril 88(3), 565-571.
Noe, G., Croxatto, H.B., Salvatierra, A.M., Reyes, V., Villarroel, C., Munoz, C., Morales, G. & Retamales, A. 2011. Contraceptive efficacy of emergency contraception with levonorgestrel given before or after ovulation. Contraception 84(5): 486-492.
Paltieli, Y., Eibschitz, I., Ziskind, G., Ohel, G., Silbermann, M., & Weichselbaum, A. 2000. High progesterone levels and ciliary dysfunction -a possible cause of ectopic pregnancy. J Assist Repro Genet 17(2): 103-106.
Shaw, J.L., Dey, S.K., Critchley, H.O., & Horne, A.W. 2010. Current knowledge of the aetiology of human tubal ectopic pregnancy. Hum Reprod Update 16(4): 432-444.
Sheffer-Mimouni, G., Pauzner, D., Maslovitch, S., Lessing, B., & Gamzu, R. 2003. Ectopic pregnancies following emergency levonorgestrel contraception. Contraception 67(4): 267-269.
Varma, R., & Gupta, J. 2009. Tubal ectopic pregnancy. Clin Evid (Online) doi:pii: 1406.
Wanggren, K., Stavreus-Evers, A., Olsson, C., Andersson, E., & Gemzell-Danielsson, K. 2008. Regulation of muscular contractions in the human fallopian tube through prostaglandins and progestagens. Hum Reprod 23(10), 2359-2368.
Xiong, X., Buekens, P., & Wollast, E. 1995. IUD use and the risk of ectopic pregnancy: a meta analysis of case-control studies. Contraception 52(1), 23-34.
