Denying contraceptive choice to women with a previous ectopic pregnancy.

We rarely see women die in our field of medicine. However, one of the authors (DJM) vividly remembers a moribund woman being carried into an accident and emergency department by her employer, having collapsed at work due to a ruptured ectopic pregnancy. That memory was triggered by a patient seen recently in a complex contraception clinic. She was in her early twenties and had previously required admission to the local intensive care unit following a catastrophic haemorrhage due to injury to her internal iliac artery during laparoscopic surgery for an ectopic pregnancy. Her pregnancy had been unplanned and she had been anxious to avoid any further accidental pregnancies. She had spoken to the gynaecologist before discharge and had been offered a combined pill as this was "just the thing for women who had experienced an ectopic" as it suppressed ovulation. However, just 4 months later she was pregnant again. She was sure that she …