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Description : Risk of Ectopic Pregnancy after using contraceptive Devices

Tags : Ectopic Pregnancy,Pregnancy

Published on : Jan 07, 2021 | Views : 32 | Downloads : 1

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Risk of Ectopic Pregnancy after Using Contraceptive Devices
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Ectopic pregnancy occurs when the fetus develops outside of the uterus. These pregnancies occur in different areas. About 70% of tubal pregnancies take place in the ampulla. Other pregnancies occur in the cornua, fimbria, and isthmus. What is Ectopic Pregnancy?
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Figure 1. Types of Ectopic Pregnancy (americanpregency.org)
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Signs & Symptoyms Vaginal Bleeding Late or Missed Period Abdominal Pain (similar to cramps) Syncope Shoulder Tip Pain Dizziness or Fatigue Figure 2. Lower Abdominal Pain (idependent.co.uk)
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Diagnosing Ectopic Pregnancy HCG Blood Test (human chronic gonadotropin) Transvaginal Ultrasound Pelvic exam – to check size of uterus and rule out any growths Figure 3. Transvaginal Ultrasound Diagram (medicalnewstoday.com)
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Treatment Methotrexate (chemotherapy drug) Leucovorine (chemotherapy protective drug against methotrexate) Surgical laparotomy and laparoscopies. Expectant Management Figure 4. (A) Left tubal ectopic pregnancy at laparoscopy. (B) Tubal ectopic pregnancy has been removed by salpingectomy. (8)
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Risk Factors of Ectopic Pregnancy Previous Diagnosis of PID (Pelvic Inflammatory Disease) Previously diagnosed with Chlamydia and Gonorrhea “Chlamydia has been linked to 30-50% of all ectopic pregnancies.” (8) Damaged Fallopian Tube Age Tubal ligation, ovarian cyst removal, or C-sections Previous abortions or ectopic pregnancies Endometriosis Cigarette Smoking In-vitro Fertilization or Assisted reproductive technology IUD’s
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Methods Different case studies have been analyzed. Browsing through Pubmed, Google Scholar, as well as some peer review journals has aided in this research.
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Hypothesis The previous use of intrauterine devices (IUD) will increase the occurrence of ectopic pregnancy during the first three months after their use.
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Case Study #1 A study was conducted in China to evaluate risks for ectopic pregnancies This study was conducted from March of 2011-April 2013 in 5 different hospitals. Women with previous EP who were in the inpatient gynecology department were used as the case group. Woman who has intrauterine pregnancies in the family planning clinic were part of the control group. 2,411 woman were diagnosed with ectopic pregnancies and 2,416 woman were diagnosed with intrauterine pregnancies. (12)
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Case Study #1..cont Study revealed the following increased risks for ectopic pregnancies: In-vitro Fertilization and Embryo transfers Current use of IUD Patients who have had tubal infertility and underwent in-vitro fertilization and embryo transfers are substantially at risk. (12)
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Case Study #2 Case study was performed in Arash Women’s Hospital in Iran. Main goal of the study was to asses risk factors for ectopic pregnancies. 83 patients that were in their first trimester were used as the case group 340 patients who were giving birth at the hospital were the control group 140 showed signs that they might have an ectopic pregnancy. 85 of them were actually diagnosed with an ectopic pregnancy. The study proves that patients that had IUD’s, tubal blockage and previous tubal surgery had a very high risk of developing an ectopic pregnancy. (13)
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Table 1. Relationship between ectopic pregnancies and previous sexual, infectious, contraceptive, and fertility history. (13)
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Case Study #3 This case was done at an emergency department in the University of Alabama. 34 year old female was brought in complaining of sharp pain in her lower abdominal area No signs of fever, vaginal bleeding, or syncope Patient was asked for a urine sample and almost had an episode of syncope on her way to the restroom Immediately afterwards she was given a FAST sonogram She had free fluid in her kidneys and in her pelvic areas It also showed a fetal heart beat and that her IUD was within her uterus. Patient was rushed to the OR and a salpingectomy was performed. (14)
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Figure 5. Pelvic Ultrasound Findings. Observe presence of intrauterine device within uterus (arrow) and adjacent ectopic pregnancy in left adnexa (arrowhead). (14)
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Case Study #4 A study was conducted in Turkey for patients with certain type of copper IUD (CuT380A) They wanted to asses risk factors of becoming pregnant and pregnancy outcome with this type of IUD A total of 7,991 IUD’s were placed and 81 patients were diagnosed with gestation. 4 of the 81 were ectopic pregnancies 3 groups were initiated 1) wanted to abort their pregnancy 2) wanted IUD removed 3) left IUD’s present Results show that 40.7% of these woman became pregnant within the first year of having the IUD placed. Women who forgot to come to their check ups were also part of this group due to the movement of the IUD The copper IUD (CuT380A) gives a substantial risk for having an ectopic pregnancy (15)
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Table 2. Pregnancy Outcomes with or without IUD’s. (15)
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Conclusion After doing extensive research & putting all evidence together, the previous use of intrauterine devices (IUD) will lead to ectopic pregnancy during the first three months after their use. In conclusion, IUD’s are a major risk factor for ectopic pregnancies.
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References 1) Assouni Mindjah YA, Essiben F, Foumane P, Dohbit JS, Mboudou ET (2018) Risk factors for ectopic pregnancy in a population of Cameroonian women: A case-control study. PLoS ONE 13(12): e0207699. https://doi.org/10.1371/journal.pone.0207699 2) Ectopic Pregnancy | American Pregnancy Association. American Pregnancy Association. (2020). Retrieved 31 May 2020, from https://americanpregnancy.org/pregnancy-complications/ectopic-pregnancy/3 3)Ectopic Pregnancy | Michigan Medicine. Uofmhealth.org. (2020). Retrieved 31 May 2020, from https://www.uofmhealth.org/health-library/hw144921. 4) Ectopic Pregnancy. HealthLink BC. (2018). Retrieved 31 May 2020, from https://www.healthlinkbc.ca/health-topics/hw144921. 5) Kulp, J., & Barnhart, K. (2020). Ectopic Pregnancy: Diagnosis and Management. Medscape. Retrieved 31 May 2020, from https://www.medscape.com/viewarticle/568726_2. 6) Symptoms of ectopic pregnancy — The Ectopic Pregnancy Trust. The Ectopic Pregnancy Trust. (2020). Retrieved 31 May 2020, from https://ectopic.org.uk/patients/symptoms-and-diagnosis/. 7) Hsu JY, Chen L, Gumer AR, et al. Disparities in the management of ectopic pregnancy. Am J Obstet Gynecol. 2017;217(1):49.e1‐49.e10. doi:10.1016/j.ajog.2017.03.001 8) Sivalingam VN, Duncan WC, Kirk E, Shephard LA, Horne AW. Diagnosis and management of ectopic pregnancy. J Fam Plann Reprod Health Care. 2011;37(4):231‐240. doi:10.1136/jfprhc-2011-0073
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References 9) Sowter MC, Farquhar CM, Petrie KJ, Gudex G. A randomised trial comparing single dose systemic methotrexate and laparoscopic surgery for the treatment of unruptured tubal pregnancy. BJOG. 2001;108(2):192‐203. doi:10.1111/j.1471-0528.2001.00038.x 10) Raughley MJ, Frishman GN. Local treatment of ectopic pregnancy. Semin Reprod Med. 2007;25(2):99‐115. doi:10.1055/s-2007-970049 11) Taran FA, Kagan KO, Hübner M, Hoopmann M, Wallwiener D, Brucker S. The Diagnosis and Treatment of Ectopic Pregnancy. Dtsch Arztebl Int. 2015;112(41):693‐705. doi:10.3238/arztebl.2015.0693 12) Li, C., Zhao, W., Zhu, Q. et al. Risk factors for ectopic pregnancy: a multi-center case-control study. BMC Pregnancy Childbirth 15, 187 (2015). https://doi.org/10.1186/s12884-015-0613-1 13) Moini A, Hosseini R, Jahangiri N, Shiva M, Akhoond MR. Risk factors for ectopic pregnancy: A case-control study. J Res Med Sci. 2014;19(9):844‐849. 14) Neth MR, Thompson MA, Gibson CB, Gullett JP, Pigott DC. Ruptured Ectopic Pregnancy in the Presence of an Intrauterine Device. Clin Pract Cases Emerg Med. 2019;3(1):51‐54. Published 2019 Jan 22. doi:10.5811/cpcem.2019.1.41345 15) Ekiz, Ali et al. “Contraceptive failure with Copper T380A intrauterine device (IUD): A single tertiary center experience.” Pakistan journal of medical sciencesvol. 32,5 (2016): 1087-1091. doi:10.12669/pjms.325.10392