[Ectopic pregnancy with etonogestrel contraceptive implant (Implanon): first case]

Ectopic pregnancy with etonogestrel implant

The etonogestrel implant is the most effective contraceptive available. We report a case of ectopic pregnancy in a woman who had an etonogestrel implant inserted 15 months ago and the effective concentration of the implant was within normal limits.

[Safety profile of etonogestrel contraceptive implant (Nexplanon® and Implanon®) reported in France]

OBJECTIVES

The aim of the study was to assess the incidence of adverse effects (AE) reported with etonogestrel contraceptive implant in France (Implanon^® and Nexplanon^®).

MATERIALS AND METHODS

All cases of AE or unintended pregnancies reported to health authorities or to the firm were analyzed.

RESULTS

During 10 years, 5433 AE and 789 unintended pregnancies were reported. Only 388 (7 %) were serious. There were 1137 reports of difficulties to remove, failure to locate or migration, 430 of insertion difficulties and 203 of deformation or expulsion of the implant. Among other AE, the most common were 1694 gynecological AE, 524 skin reactions and 437 metabolic AE. Since the marketing of Nexplanon^® which causes less deep insertions, the incidence of migrations, removal or insertion difficulties has decreased overall (0.92 vs. 1.31/1000 patients), particularly the incidence of removal difficulties, location failures or migrations (0.12 vs 1.01/1000). The infrequent but serious AE were infectious complications at the implant site and pregnancies. When the circumstances of the pregnancy were known, the contraceptive failure was due to the apparent inefficiency of the implant (n=224), to a technique failure (n=203) or to a drug-drug interaction (n=59).

CONCLUSION

This study confirms that AE of this implant are frequent but not serious, except for the pregnancies. The incidence of complications related to insertion decreased with Nexplanon^®. Among other preventable AE, unintended pregnancies due to a drug-drug interaction would require to be better known by the practitioner.

Canadian Contraception Consensus (Part 3 of 4): Chapter 8 - Progestin-Only Contraception

OBJECTIVE

To provide guidelines for health care providers on the use of contraceptive methods to prevent pregnancy and on the promotion of healthy sexuality.

OUTCOMES

Overall efficacy of cited contraceptive methods, assessing reduction in pregnancy rate, safety, ease of use, and side effects; the effect of cited contraceptive methods on sexual health and general well-being; and the relative cost and availability of cited contraceptive methods in Canada.

EVIDENCE

Published literature was retrieved through searches of Medline and The Cochrane Database from January 1994 to January 2015 using appropriate controlled vocabulary (e.g., contraception, sexuality, sexual health) and key words (e.g., contraception, family planning, hormonal contraception, emergency contraception). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies published in English from January 1994 to January 2015. Searches were updated on a regular basis in incorporated in the guideline to June 2015. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.

VALUES

The quality of the evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). CHAPTER 8: PROGESTIN-ONLY CONTRACEPTION: Summary Statements Recommendations.

Implanon: subdermal single rod contraceptive implant

OBJECTIVES

Study was conducted to determine acceptability, efficacy, safety, return of fertility with Implanon.

METHODS

Volunteers having regular menstruation, requiring spacing formed study population. Implanon was inserted within 5 days of LMP or concurrent with MTP. Woman was asked to record bleeding pattern, side effects. Implanon duration was 3 years but Implanon was removed before, if patient wanted pregnancy/for side effects. Subjects who did not adopt family planning method after removal were followed up for return of ovulation and pregnancy.

RESULTS

200 subjects were enrolled (160 within 5 days of LMP, 40 concurrent with MTP). 74 implanon removals were done. (16 after tenure completion, 58 for other reasons.) 16% cases discontinued implanon for polymenorrhagia, 10% for irregular bleeding, 4.5% for amenorrhea. There was no failure of implanon. 40% had return of ovulation within one month, 95.8% conceived within 12 months.

CONCLUSIONS

Implanon is safe, effective, well accepted method of contraception.

A life-threatening ectopic pregnancy with etonogestrel implant

BACKGROUND

Etonogestrel contraceptive implant is a highly effective subdermal method of long-acting hormonal contraception for women.

CASE

We describe a case of ruptured ectopic pregnancy occurring in a patient with an etonogestrel contraceptive implant (Implanon®). The only factor predisposing to a failure in this case is a moderately elevated body mass index of 29. However, the implant was in place for less than 2 years, and the plasma levels of etonogestrel were within the expected range.

CONCLUSION

This case report emphasizes the fact that ectopic pregnancy should not be formally ruled out in women using this contraceptive, and it highlights the need for further study of the effect of body weight on this contraceptive method.

Ectopic pregnancy with Implanon® as a method of contraception in a woman with a previous ectopic pregnancy - case report

OBJECTIVES

To present a rare case of tubal ectopic pregnancy in a woman using Implanon® after a previous contralateral ectopic pregnancy that had occurred without contraceptive use.

CASE

A 26-year-old woman presented with an ectopic pregnancy conceived whilst having an etonogestrel implant (Implanon®) in situ. A laparoscopic salpingectomy was performed and the implant was removed. Two years previously she had been treated for a contralateral ectopic pregnancy following which the implant was inserted.

CONCLUSION

Implanon®, being a highly effective long-acting reversible method of contraception, has been advocated in women with previous ectopic pregnancy. However, as demonstrated by this case, ectopic pregnancy may exceptionally supervene even in the absence of identified risk factors for contraceptive failure.