Contraceptive use at the time of and after an ectopic pregnancy : a retrospective cohort study

• Objectives: Approximately, 1–2% of all pregnancies are ectopic; 25% of unintended pregnancies are conceived despite the use of contraception. The primary objective of our study was to explore the proportion of ectopic pregnancies (EPs) that were conceived during contraceptive use among women in Stockholm County. Secondary objectives were to establish the prevalence of contraceptive methods used at the time of EP and the intended contraceptive method after treatment completion.Methods: We performed a retrospective cohort study of 1180 women diagnosed with and treated for EP between 1 December 2013 and 30 April 2017 at all hospitals in Stockholm County. Demographic variables and contraceptive use before and after treatment were noted. Exclusion criteria were uncertainty about the diagnosis of EP in the patient records and planned treatment/follow-up outside Stockholm County.Results: A total of 222/1180 (18.8%) EPs were conceived during known contraceptive use. A total of 112/222 (50.5%) women with known use of contraception at the time of conception discontinued contraceptive use and 81/857 (9.5%) women with no prior use of contraception initiated contraceptive use. Among the 857 women, 520 (60.7%) expressed a desire to conceive. Results were compared using the Mann–Whitney U test or Fisher's exact test as appropriate.Conclusion: EP occurring during use of contraception is an unexplored problem. Contraceptive use decreased in women who were using contraception at the time of EP conception, leaving these women at risk of a subsequent unintended pregnancy. There should be more focus on contraceptive use after treatment for EP, in order to preserve fertility. 

• 目的：大约所有妊娠的1-2％为异位妊娠；尽管使用了避孕措施, 仍有25％概率会意外怀孕。我们研究的主要目的是探讨斯德哥尔摩县妇女在使用避孕药具期间异位妊娠（EPs）的比例。次要目的是确定EP时使用的避孕方法的普及程度以及治疗完成后计划使用的避孕方法。方法：我们对2013年12月1日至2017年4月30日期间在斯德哥尔摩县所有医院诊断为EP并接受过EP治疗的1180名妇女进行了一项回顾性队列研究。 记录治疗前后的人口统计学变量和避孕药具的使用。排除标准是患者记录中有关EP诊断的不确定性以及斯德哥尔摩县以外地区计划的治疗/随访。结果：在所有1180例异位妊娠患者中, 已知使用避孕药具的有222（占18.8％）, 共有112/222（50.5％）名妇女在受孕时知道怀孕并停止使用避孕药具, 而81/857名（9.5％）未事先避孕的妇女开始使用避孕药具。在857名妇女中, 有520名（60.7％）表达了受孕的愿望。视情况使用Mann-Whitney U检验或Fisher精确检验比较结果。结论：在使用避孕药过程中发生EP是一个尚待探讨的问题。使用避孕药具的妇女EP后继续使用避孕药具减少, 使这些妇女处于随后意外怀孕的风险中。为了保护生育力, 应在治疗EP后更注意避孕药具的使用

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Reproduktionsmedicin och gynekologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Obstetrics, Gynaecology and Reproductive Medicine (hsv//eng)

Nyckelord

Contraception

ectopic pregnancy

unintended pregnancy

unwanted pregnancy

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