Reduced prevalence of chronic tubal inflammation in tubal pregnancies after levonorgestrel emergency contraception failure

Abstract

Purpose The aim of this study was to compare chronic fallopian tubal inflammatory disease and fibrosis between patients with general tubal pregnancy (TP) and TP with levonorgestrel (LNG) emergency contraception (EC) failure. Methods We retrospectively studied patients with general TP (n = 79) and TP following LNG-EC failure (n = 81) within the same conception cycle. Information on the gynecological features of each subject was collected. Pelvic inflammatory disease and associated sequelae were assessed by the serum Chlamydia trachomatis (CT) IgG test, laparoscopic evaluation of tubal damage, and histopathological observation of tube tissues. Chi-square and Student's t-tests were employed to determine the difference between the two groups. Results Compared with general TP, cases of TP following LNG-EC failure subjects were less likely to have a history of previous ectopic pregnancy (5.06% vs. 18.52%, p = 0.009) and adnexal surgery (6.33% vs. 22.22%, p = 0.010). Patients with TP following LNG-EC failure were less likely to have pelvic inflammatory disease and associated sequelae than those with general TP, as revealed by positive reaction to anti-CT IgG (18.18% vs. 35.94%, p = 0.031), assessment of tubal damage (grade I: 5.06% vs. 17.28%; grade II: 2.53% vs. 11.11%; grade III: 1.27% vs. 6.17%; p = 0.001), infiltration of chronic inflammatory cells (10.91% vs. 62.50%, p < 0.001), and positive Masson's staining (7.69% vs. 39.58%; p < 0.001).Conclusions Compared with cases of general TP, cases of TP following LNG-EC failure exhibited reduced rates of CT infection, fallopian tubal inflammation, and/or fibrosis.

Diagnostic value of detection of serum β‑HCG and CT‑IgG combined with transvaginal ultrasonography in early tubal pregnancy

“…It is reported that the serum CT-IgG positive antibody can be detected in women with ectopic pregnancy and normal pregnancy, and the rates are 32–71 and 4–39%, respectively. The relative risk of tubal pregnancy in women with serum CT-IgG positive is 2.4–7.9 ( 19 ). Dunne et al ( 20 ) studied and suggested that with the decline in CT infection positive rate, the incidence rate of ectopic pregnancy is also rapidly reduced.…”

Effects of Levonorgestrel and progesterone on Oviductal physiology in mammals

“…Tubal inflammation, which is typically secondary to genital infection, was generally regarded an important risk factor for EP, but we previously confirmed that tubal pregnancy following LNG-EC failure is associated with lower rates of Chlamydia trachomatis infection, fallopian tubal inflammation, and/or fibrosis compared with general tubal pregnancy [ 7 ]. Thus, we hypothesize that LNG, combined with a high progesterone level, might influence fallopian tube physiology rather than tubal morphology or salpingitis.…”