RELATIONSHIP BETWEEN ECTOPIC PREGNANCY AND EMERGENCY CONTRACEPTIVE PILL AMONG WOMEN IN EMBU HOSPITAL

RELATIONSHIP BETWEEN ECTOPIC PREGNANCY AND EMERGENCY CONTRACEPTIVE PILL AMONG WOMEN IN EMBU HOSPITAL

1.1 BACKGROUND OF THE STUDY

An ectopic pregnancy occurs when the blastocyst implants outside the uterine endometrium, usually with more than 90% occurring in the fallopian tubes (Kitani et al, 2019). It’s one of the leading causes of maternal mortality and morbidity in the first trimester of pregnancy, presenting as an acute and life-threatening emergency condition accounting for up to 10% of all maternal deaths (Kamwendo, 2000).

On the other hand, emergency contraception refers to the methods of contraception used to prevent unintended pregnancy after sexual intercourse, within 5 days, but are more effective when used sooner after the act (WHO, 2018). The emergency contraceptive pills (ECPs) work by preventing ovulation from taking place, (while the copper-bearing IUD prevents fertilization by causing a chemical change in the ovum and sperm before they meet). Emergency contraceptives (EPs) prevents up to over 95% of pregnancies if used within 5 days (WHO, 2018).

ECPs have been shown to be effective in preventing pregnancies according to the WHO medical eligibility criteria (MEC) for ECPs, however, their failure has been associated with the development of ectopic pregnancy. This study, therefore, aims at identifying if there is a relationship between EP and ECPs if it fails. This follows the recent rise in incidences of EP in the world, especially the developing countries and Kenya in particular.

A research study done by Maina (2014) at the Kenyatta National Hospital (KNH) reported that EP incidences in the USA have been on the rise since the 1970s from 4.5/1000 to 19.7/1000 cases. The same study registered up to a total of 10 cases per week in KNH in the same year.

BROAD OBJECTIVE

To determine the relationship between ectopic pregnancy and emergency contraceptive pills

SPECIFIC OBJECTIVES

1. To find out the socio-demographic factors of youths diagnosed with ectopic pregnancy
2. To assess the level of knowledge of women taking ECPs
3. To determine the incidence of ectopic pregnancy in women using ECPs

RESEARCH QUESTIONS

1. What are the socio-demographic factors of women diagnosed with ectopic pregnancy?
2. What is the level of knowledge of women taking ECPs?
3. What is the incidence of ectopic pregnancy in women using ECPs?

PROBLEM STATEMENT

Ectopic pregnancy is one of the leading causes of maternal morbidity and mortality in developing countries, Kenya being one of them, although existing data on the same are limited. Its mostly associated with deaths during the first trimester of pregnancy, with women presenting with ruptured ectopic pregnancy. It, therefore, presents a major health problem for women of childbearing ages and adds to the disease burden in gynecology practice in developing countries. Ectopic pregnancy comprises of up to 1-2 % of all pregnancies occurring outside the uterine cavity. This problem has become particularly hard to handle due to several reasons to include;

Lack of

• close follow up of the patients presenting with ectopic pregnancy in hospitals, with minimal attendance in the GOPC mostly up to once or twice for review
• There’s lack of knowledge among the women of childbearing ages and the public at large about the causes, risk factors, the treatment and the prevention of ectopic pregnancy

JUSTIFICATION

Embu general hospital is one of the largest teaching and referral hospitals in the Eastern region and therefore receives many ectopic pregnancies referred from within sub-county hospitals and many health centers across the region. These clients mostly present with ruptured and leaking ectopic pregnancy and are managed by open laparotomy to perform either salpingectomy and/or salpingostomy. This study aims at exploring the risk factors for the development of ectopic pregnancy, with a key interest in its relation to the use of emergency contraceptives.

• There is a need for women of childbearing ages to understand the causes, risk factors and predictors of ectopic pregnancy.
• There is a need for educating the public on predictors of ectopic pregnancy, with a focus on changing attitudes on the use of emergency contraception as a key player contributing to ectopic pregnancy

CHAPTER 2

LITERATURE REVIEW

INTRODUCTION

Globally, at least 36% of all pregnancies are unplanned, making the use of ECPs important in the prevention of pregnancy in the event of a contraceptive mishap, or non-use, or non-consensual intercourse (Cleland et al, 2014). The recommended WHO ECPs regimens include levonorgestrel, or ulipristal acetate, or combined oral contraceptives (COCs) containing Ethinyl estradiol and levonorgestrel.

In North America, ectopic pregnancy was the leading cause of maternal mortality in 2000 at the rate of 19.7 cases per 1000 pregnancies (Gaskins, 2018). In Africa, there is no sufficient data documented on ectopic pregnancy, although.

The main risk factors implicated in EP include previous EP, previous pelvic surgery, pelvic inflammatory disease, and sexually transmitted diseases, previous abortions, and the recent failure of emergency contraception usage. Diagnosis for EP is based on a high index suspicion of the classic triad of amenorrhea, abdominal bleeding, and vaginal bleeding. Other symptoms/signs include dizziness or weakness, vomiting, syncope, severe tenderness and evidence of hypovolemic shock (e.g. tachycardia, orthostatic blood pressure) (Chanana, 2017).