Association between Levonorgestrel emergency contraception pill use and the risk of ectopic pregnancy at Kawempe National Referral Hospital In Central Uganda

Abstract

ABSTRACT Introduction: Globally ectopic pregnancy is the leading cause of maternal mortality in the first trimester, contributing 10% of the total maternal mortality. Levonorgestrel emergency contraception has been reported as one of the major risk factors to ectopic pregnancy. However, the above association in Uganda has not been studied despite high rates of ectopic pregnancy in the country. This study aimed to determine the association between levonorgestrel emergency oral contraceptive use and the risk of ectopic pregnancy among the women admitted with ectopic pregnancy at Kawempe National Referral Hospital. Methods: This study was a case control study. The cases were women 15-45yrs with a confirmed diagnosis of ectopic surgery while the controls were women in the antenatal ward of the same age group with a confirmed intrauterine pregnancies. Results: A total of 113 cases and 113 controls were recruited. Of these, 39 (17.2%) mothers [34 (30.1%) cases and 5 (4.4%) controls] had used ECs in a menstrual period leading to the current pregnancy. Mothers who used an emergency contraception pills were more likely to experience ectopic pregnancies more than those who did not (aOR=13.879, 95% CI 5.013 - 38.389, P-Value <0.001). This was confounded by previous history of ectopic pregnancy and history of inability to conceive for >6months after regular contraceptive methods. Conclusion: Although levonorgestrel containing emergency contraceptives offer an important last chance to prevent unwanted pregnancy, these stand a 17% risk of failure if used inappropriately. This study found a significant risk for the development of ectopic pregnancy among LNG-emergency contraceptive users compared to non-users. This calls for exploration and promotion of alternative contraceptive methods that may offer effective pregnancy prevention with low/zero risk of ectopic pregnancy. Scientists are implored to explore novel formulations, delivery methods, and technologies that may enhance the effectiveness of emergency contraceptives and reduce the risk of ectopic pregnancies