Association Between Previous Cesarean Section and Subsequent Ectopic Pregnancy: A Comparative Observational Study

Abstract

Background: The rise in cesarean delivery rates across the world has raised concerns about its potential impact on the outcome of subsequent pregnancies. Among the concerns is the increased risk of ectopic pregnancy, particularly in the tubal or scar site. This study aimed to assess the connection between previous cesarean delivery and subsequent ectopic pregnancy. Methodology: This is a comparative observational study conducted over a period of 1.5 years at Lalla Ded Hospital in Srinagar. The study recruited 148 cases with clinical symptoms of ectopic pregnancy and confirmed diagnosis, along with 4852 matched controls with intrauterine pregnancies. The inclusion criteria comprised women with a previous history of normal vaginal delivery or cesarean section. Patients with a history of ectopic pregnancy, pelvic inflammatory disease, abortions, tubal pathology or surgery, ARTs, and use of intrauterine contraceptive devices were excluded. The data were analyzed using SPSS version 20.0. Results: Out of the 148 eligible cases, 106 (4.2%) had a previous cesarean section, and 42 (1.7%) had a normal vaginal delivery. The odds ratio for women with a previous cesarean section was 2.59 (95% confidence interval= 1.81 to 3.75), which means that they had a 2.59 times higher risk of having subsequent ectopic pregnancy than those with normal vaginal delivery. Conclusion: The study concludes that a previous cesarean section is linked to an increased risk of subsequent ectopic pregnancy. Women with a history of cesarean section should receive close monitoring during early pregnancy to detect and manage ectopic pregnancy promptly. Further research is necessary to identify the underlying mechanisms and develop strategies to reduce the risk of ectopic pregnancy in these women. Keywords: cesarean delivery, ectopic pregnancy, long-term morbidity, risk factors