<![CDATA[Background: Injectable hormonal contraception demonstrates high efficacy in pregnancy prevention with minimal adverse effects. Nevertheless, undetected pregnancy resulting from contraceptive failure may lead to spontaneous abortion and unplanned pregnancies. Such contraceptive failures present significant clinical challenges, particularly when resulting in unrecognized pregnancies that terminate in miscarriage. Case Presentation: A 34-year-old multiparous woman (G3P2A0) who had consistently used monthly injectable contraception (Cyclofem) for twelve months presented with acute onset heavy vaginal bleeding and severe abdominal cramping. The patient remained unaware of her pregnancy status. Transabdominal ultrasonography revealed no visible fetal structures on examination. During clinical observation, she spontaneously expelled fetal tissue consistent with 14-week gestation. Following expulsion, bleeding continued. Subsequent ultrasonography confirmed presence of retained products of conception. Surgical curettage was undertaken after cervical preparation using misoprostol (PGE-1). Discussion : This case demonstrates the necessity for healthcare providers to maintain elevated clinical suspicion for pregnancy in contraceptive users presenting with abnormal bleeding patterns. Essential preventive measures include regular monitoring, comprehensive patient education regarding contraceptive failure risks, and prompt assessment of menstrual irregularities. Even highly effective contraceptive methods may fail, with injectable methods showing 0.2-1% failure rates despite perfect compliance. Hormonal contraceptives can induce withdrawal bleeding that obscures pregnancy symptoms, resulting in delayed diagnosis. Local institutional research reveals significant biomarker variations during pregnancy complications, emphasizing the need for comprehensive diagnostic approaches when clinical presentations are atypical. Conclusion: This case underscores the critical importance of clinical vigilance, comprehensive reproductive health education, and ensuring access to quality contraceptive services. Healthcare providers must remain alert when evaluating abnormal bleeding in contraceptive users, as pregnancies may remain unrecognized despite compliance, highlighting the vital role of education and monitoring in preventing contraceptive failure.]]>
