Unintended pregnancy with implantable subdermal contraceptive device (Nexplanon): a case report
- Obstetrics & Gynecology International Journal
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Shadi Rezai,1 Neil D Patel,2 Alexander C Hughes,2 Cynthia M Shumaker,1 Bhavin R Pandya,1 Mon-Lai Cheung,1 Basem Z Bernaba,1 Wendy J Knight,1 Ray Mercado,4 Takeko Takeshige,5 Paul N Fuller,1 Cassandra E Henderson3
Department of Obstetrics and Gynecology, Southern California Kaiser Permanente, USA - Cassandra E Henderson , Department of Obstetrics and Gynecology, Lincoln Medical and Mental Health Center, USA
- Neil D Patel, St George’s University, School of Medicine, Grenada
- Alexander C Hughes BSN, St George’s University, School of Medicine, Grenada
- Cynthia M Shumaker LVNII, Department of Obstetrics and Gynecology, Southern California Kaiser Permanente, USA
- Bhavin R Pandya MD, Department of Obstetrics and Gynecology, Southern California Kaiser Permanente, USA
- Mon-Lai Cheung MD, Department of Obstetrics and Gynecology, Southern California Kaiser Permanente, USA
- Basem Z Bernaba MD, Department of Obstetrics and Gynecology, Southern California Kaiser Permanente, USA
- Wendy J Knight RNP, Department of Obstetrics and Gynecology, Southern California Kaiser Permanente, USA
- Ray Mercado DO, Department of Obstetrics and Gynecology, Comprehensive Medical Care of the Bronx, USA
- Takeko Takeshige DO, Department of Obstetrics and Gynecology, Southern California Kaiser Permanente, USA
Abstract
Background: In 2006, Implanon (68 mg), a synthetic subcutaneous progestin etonogestrel eluting capsule, was approved for use in the U.S. to provide long-acting reversible contraception (LARC). The next generation LARC, Nexplanon (68 mg), a progestin-only etonogestrel subdermal implant, was available in 2001. Currently, Nexplanon is advertised to provide 99% effective contraception, up to 4 years. Removal of the capsule will revert back to normal menstruation and fertility. Unlike Implanon, cases of unintended uterine pregnancy with proper and successful insertion have not been reported using Nexplanon.
Case: A 24-year-old female, G2P1001, with obstetrical history of one spontaneous vaginal delivery (2015), and gynecological history of low grade squamous intraepithelial lesion (LSIL) on Pap smear (2014), was found to have an intrauterine pregnancy while using Nexplanon. Initially, urine pregnancy testing assured that she was not pregnant before placement of the Nexplanon. Nexplanon was inserted ~2 months post-partum after the birth of her first child.17 months post-Nexplanon insertion, patient experienced irregular spotting, cramping, and reported positive home pregnancy test. Transvaginal ultrasound confirmed an intrauterine pregnancy at 9 weeks and 3 days. The Nexplanon implant was removed intact. Routine prenatal care was initiated and no issues were identified.
Conclusion: Newer LARCs provide an alternative to lifestyle adaptive contraception, with ease of use and compliance. Although LARCs prove to be more effective, known factors linked to human error during placement, cytochrome P450 induction, and BMI, have shown to decrease their efficacy, leading to failed contraception.
Keywords
Etonogestrel releasing implant, Implantable subdermal contraceptive, LARC, Nexplanon, Progestin-only hormone implant, Unintended pregnancy, Short-acting reversible contraceptives, Hypothalamic pituitary ovarian, Antiepileptic medication, Body mass index, Menstrual cycle, Intrauterine pregnancy, Breastfeeding, Implanon, Capsule insertion
