Ectopic pregnancyBMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c4686 (Published 03 September 2010) Cite this as: BMJ 2010;341:c4686
All rapid responses
Re the Practice article by Sheikha Al-Jabri &
colleagues(1) (to which you also refer in Corrections & Clarifications
in the current BMJ(2), the authors fail to mention the intrauterine device
in their risk or suspect factors for ectopic pregnancy.
Prof. Martin Vessey & colleagues in their cohort study(3), showed how
'IUDs are far less effective at preventing ectopic pregnancies than they
are at preventing intrauterine pregnancies'. In a letter to the
BMJ(4) Vessey mentions the increase in risk of ectopic compared with
intrauterine pregnancy in a woman who becomes pregnant with an
intrauterine device in place, as 10.6 fold. He adds 'failure to appreciate
this fact could have disastrous consequences under some circumstances'.
Sadly in my work in developing countries, I have seen such tragedies. One woman was admitted moribund; the diagnosis of ruptured ectopic was quickly made - collapsed, haemoperitoneum, firm closed cervix. Immediate resuscitative measures, I.V. fluids, ventilation, cardiac massage were provided to no avail. We were informed that she had attended the institution where her device had been fitted, on the two days before she came to us, because 'she was feeling unwell'. She had none of the risk factors in Al-Jabri's et al's 'Keypoints for diagnosis'
1 Al-Jabri S, Malus M,Tulandi T. Easily Missed, Ectopic Pregnancy. BMJ
2 Corrections & Clarifications BMJ 2010;341,1201.
3 Vessey MP Doll R, JohnsonB, Peto R. Outcome of pregnancy in women using
an intrauterine device. Lancet 1974;1:495-498.
4 Vessey MP. Intrauterine devices and ectopic pregnancy BMJ 2009;339:710.
Competing interests: No competing interests