A case-control study to evaluate risk factors for ectopic pregnancy

Abstract

INTRODUCTIONEctopic pregnancy (EP) is the leading cause of maternal death during the first trimester of pregnancy, accounting for approximately 10% of all pregnancy-related deaths. 1 It still remains a serious health problem for women of childbearing age.2 A ruptured ectopic pregnancy is a true medical emergency. Morbidity due to ectopic pregnancy is in the form of infertility and ectopic recurrence. Although the total number of intrauterine pregnancies has declined over the past three decades, there has been a rise in the incidence of ectopic pregnancy as a result of an increased and persistent exposure to its risk factors and partially due to improved ability in making an earlier diagnosis. 4,5 As the morbidity and mortality associated with extrauterine pregnancy are directly related to the length of time required for diagnosis, the increased awareness and knowledge of the risk factors for it could enable an early and accurate diagnosis of the disease, resulting in earlier intervention.Numerous studies have been done to explore the risk factors for ectopic pregnancy and it was found that the main risk factors for ectopic pregnancy are conditions or procedures which cause tubal damage. The exact role and strength of these factors have not been definitively determined. Very few studies have been done in our state to find various risk factors for ectopic pregnancy therefore; the present study was designed to identify potential risk factors and to evaluate their contribution in ectopic pregnancy. ABSTRACTBackground: Morbidity and mortality associated with ectopic pregnancy are directly related to the length of time required for diagnosis. Knowledge of risk factors for ectopic pregnancy will help an obstetrician to suspect and diagnose the condition early. Therefore, the present study was designed to identify potential risk factors and to evaluate the contribution of the risk factors in ectopic pregnancy. Methods: Study population consists of 65 women with ectopic pregnancy and for each ectopic case one woman with first trimester intrauterine pregnancy was recruited as control. Data were retrieved from all through a structured proforma. Data were analyzed statistically. Results: Various significant risk factors for ectopic pregnancy found were pelvic inflammatory disease, tubal ligation, age above 30 yrs, previous use of IUCD, low socio-economic status, tubal infertility and genital tuberculosis while no significant association was seen with smoking, age below 30 years, history of prior induced abortion, oral contraceptive pills and clomiphene citrate. Conclusions: Increase awareness and knowledge of risk factors will help obstetricians to suspect and diagnose ectopic pregnancy early and accurately and enable them to plan medical treatment. Surgical treatment will be reserved for ruptured ectopic pregnancy and haemodynamically unstable patients.

Ectopic Pregnancy and its Risk Factors: A Case Control Study in Nepalese Women

“…The incidence of previous abortion among the patients wasn't found to be a significant risk factor for ectopic pregnancy in the current study. Most studies show an increased incidence of ectopic among women with a previous history of abortions 6,10,11 , however, the results differ in terms of significance of such relation.…”

“…6 Tubal ligation, while proving to be highly effective in preventing intrauterine pregnancies, was found to increase the risk of ectopic in accidental pregnancies in many studies. 6,8,10,14 The overall incidence of ectopic, though reduced among users of oral contraceptive pills, DMPA and emergency contraceptives as revealed by most studies, the failure of such methods was found to be associated with increased incidence of ectopics.…”

“…The evaluation of age as a risk factor for ectopic pregnancy in different studies has provided conflicting results. 4,[8][9][10][11] A study by Karaer et al (2006) found that the risk of ectopic pregnancy increased progressively with increasing maternal age, but the association disappeared after 40 years and after adjustment for main risk factors. 11 Simms et al (1997) found the incidence of ectopic pregnancy in women aged 40 years or above to be 14 times that observed among those under 16 years.…”

“…9 Most studies highlight increased risk of ectopic pregnancies with intrauterine devices (IUDs). 6,8,10,11,[13][14][15] Some studies also suggest such risk increases further with increased duration of IUD placement. 6 Tubal ligation, while proving to be highly effective in preventing intrauterine pregnancies, was found to increase the risk of ectopic in accidental pregnancies in many studies.…”

A study of the risk factors related to ectopic pregnancy in intrauterine device users

“…Some studies believed that induced abortion did not increase the risk of EP. [13,15] But other studies showed that there was a positive correlation between the number of abortion and EP. [16,17] On the one hand, some researchers believed that induced abortion may lead to some complications such as endometrial lesion and intrauterine adhesion, which may affect the implantation of fertilized egg in the uterus and reduce the pregnancy rate finally.…”