Ectopic pregnancy as contraceptive failure in patient with epilepsy [Ektopična trudnoća - kontracepcijska greška u bolesnice s epilepsijom]

Radaković, Branko and Šprem Goldštajn, Marina (2012) Ectopic pregnancy as contraceptive failure in patient with epilepsy [Ektopična trudnoća - kontracepcijska greška u bolesnice s epilepsijom]. Collegium Antropologicum, 36 (4). pp. 1475-1476. ISSN 0350-6134

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Abstract

Epilepsy is a common neurologic condition which includes many women's health issues. Menstrual disorders, reproductive endocrinological disturbances, ovulatory dysfunction and infertility appear to be relatively frequent in women with epilepsy. Clinical decision making which contraceptive regimen is optimal for an individual woman with epilepsy is one of the most challenging tasks when taking care of women with epilepsy. A higher incidence of breakthrough bleeding and contraceptive failure was determined among women using antiepileptic drugs. There is the increased risk for contraceptive failure with the use of P450 3A4 enzyme-inducing antiepileptic drugs (AEDs) such as phenobarbital, carbamazepine, phenytoin, felbamate, topiramate and oxcarbazepine. Therefore, it is recommended to use noninducing AEDs, or for those who use inducing AEDs, the use of oral hormonal contraceptive pills which contained equal or more than 50 microg of estrogen, or intrauterine devices. The aim of the article is to present woman with epilepsy who was used combined low dose oral contraceptive pills containing 20 microg of ethinyl estradiol which in interaction with carbamazepine resulted with ectopic tubar pregnancy.

Abstract in Croatian

Epilepsija je relativno čest neurološki poremećaj koji bitno utječe na različite aspekte zdravlja žene. Poremećaj menstruacijskog ciklusa, reprodukcijski endokrinološki poremećaji i neplodnost značajno utječu na kvalitetu života žene s epilepsijom. Klinička procjena i izbor optimalnog kontracepcijskog protokola u žena s epilepsijom je veliki izazov s obzirom na česta probojna krvarenja i kontracepcijski neuspjeh koji se javljaju u žena koje koriste antiepileptike i oralnu hormonsku kontracepciju. S obzirom na povećani rizik kontracepcijskog neuspjeha u žena koje koriste antiepileptike koji induciraju jetrene mikrosomalne enzime (phenobarbital, karbamazepin, fenitoin, felbamat, topiramat i okskarbazepin), preporuka je korištenje oralne hormonske kontracepcije koja sadrži 50 ili više mikrograma etinil estradiola, materničnog uloška ili promjena osnovne terapije epilepsije primjenom nove generacije antiepileptika koji ne induciraju jetrene mikrosomalne enzime. Cilj ovog rada je prikazati ženu s epilepsijom koja je koristila kombiniranu niskodozažnu oralnu hormonsku kontracepciju koja sadrži 20 mikrograma etinil estradiola i antiepileptik karbamazepin, što je rezultiralo kontracepcijskim neuspjehom i ektopičnom tubarnom trudnoćom.

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