Contraceptive and sterilization practices and extrauterine pregnancy: a realistic perspective.
Comparative data on the incidence of ectopic pregnancy among accidental pregnancies associated with failure of a contraceptive or sterilization procedure are shown in Table 16. The practical clinical significance of the data in this review is predicated upon a number of related factors. One of the most important of these is the realistic failure rate (or success rate) of each contraceptive or sterilization method. The reported efficacy of various contraceptive methods has such a wide range that we have not attempted to calculate the likelihood that a woman may experience an ectopic pregnancy within a particular time period while using a specific method. The success or failure rate of each method is influenced by such variables as (1) the conscientiousness and ability of the patient to follow instructions, (2) the true failure rate of the method itself, (3) the experience of the clinician prescribing a method or performing a surgical procedure, and (4) other factors less clearly defined. Because of these many variables, the data shown in Table 16 were calculated on the basis of the number of reported accidental pregnancies which occurred coincidentally with, or subsequent to, a specific contraceptive or sterilization modality. (formula: see text). These data do not reflect the actual rate of occurrence of ectopic pregnancy with respect to woman-months of experience. We recognize the significant influence that age, race, gravidity, and socioeconomic factors have upon the incidence of ectopic pregnancy, but were unable to control for these factors in the data presented in this review. These data reprresent only what has occurred under specific circumstances and cannot logically be extrapolated to any specific future case or study series. It is important to emphasize the necessity of constant awareness by the medical and paraprofessional personnel of the potentially increased risk to the patient of an extrauterine pregnancy should one or another of these contraceptive or sterilization procedures fail. Complacency or a false sense of security on the part of responsible medical personnel concerning women who are "protected against conception" can quickly lead to a life-threatening situation in case of an ectopic pregnancy. Prompt diagnosis and definitive treatment of the extrauterine pregnancy is vital for the successful management of this serious complication of conception.
D003271:Contraceptive Agents, Female / Q000009:adverse effects; D003273:Contraceptive Devices / Q000009:adverse effects; D005260:Female; D006801:Humans; D007267:Injections; D007434:Intrauterine Devices / Q000009:adverse effects; D008525:Medroxyprogesterone / Q000008:administration & dosage; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000453:epidemiology* / Q000209:etiology; D045167:Progesterone Congeners / Q000009:adverse effects; D013245:Sterilization, Reproductive; D006113:United Kingdom; D014481:United States
D003271:Contraceptive Agents, Female; D045167:Progesterone Congeners; D008525:Medroxyprogesterone