title: Ectopic Pregnancy After Plan B Emergency Contraceptive Use.
abstract: BACKGROUND
  Pregnancy outcomes after emergency contraceptive use has been debated over time, but review of the literature includes mechanisms by which these medications may increase the chance of an ectopic pregnancy. Such cases are infrequently reported, and many emergency providers may not readily consider this possibility when treating patients.
  
  
  METHODS
  This is a case presentation of ectopic pregnancy in a patient who had recently used Plan B (levonorgestrel) emergency contraceptive. She presented with abdominal pain and vaginal spotting, and was evaluated by serum testing and pelvic ultrasound. She was discovered to have a right adnexal pregnancy. She was treated initially with methotrexate, though she ultimately required surgery for definitive treatment. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case report aims to bring a unique clinical case to the attention of emergency providers. The goal is to review research on the topic of levonorgestrel use and the incidence of ectopic pregnancies. The mechanism of action of this emergency contraceptive is addressed, and though no definite causal relationship is known between levonorgestrel and ectopic pregnancies, there is a pharmacologic explanation for how this event may occur after use of this medication. Ultimately, the emergency provider will be reminded of the importance of educating the patient on the possible outcomes after its use, including failure of an emergency contraceptive and the potential of ectopic pregnancy.
authors.affiliation: Medstar Washington Hospital Center, Washington, DC.
authors.forename: Brianne Jo
authors.initials: BJ
authors.lastname: Steele
authors.affiliation: Medstar Georgetown University Hospital, Washington, DC.
authors.forename: Kerri
authors.initials: K
authors.lastname: Layman
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use; D003281:Contraceptives, Postcoital / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D016912:Levonorgestrel / Q000008:administration & dosage*; D008727:Methotrexate / Q000627:therapeutic use; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000175:diagnosis* / Q000601:surgery*; D055815:Young Adult
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D003281:Contraceptives, Postcoital; D016912:Levonorgestrel; D008727:Methotrexate
keywords: Plan B; ectopic pregnancy; emergency contraceptive; levonorgestrel; mifepristone