Evaluation of risk factors for ectopic pregnancy among women attending a tertiary care hospital in United Arab Emirates: A case control study

Abstract

Objective: To evaluate and analyze potential risk factors for ectopic pregnancy in a tertiary care Hospital in United Arab Emirates (UAE). Methods:A case control study was conducted in Mafraq Hospital from August 2008 to December 2011. The study subjects included 108 women diagnosed with ectopic pregnancy (cases group) and 216 women who delivered in the study hospital during the same time period (control group). Results:In our study population the risk of ectopic pregnancy was found 8 fold more in women who had past history of pelvic inflammatory disease (OR 8.14, 95% CI, 1.90-34.77, p=0.005), 6 fold more in women with infertility (OR 6.57,95% CI, 3.06-14.08, p=0.000), 3 fold more in women with previous pelvic surgery (OR 3.33, 95% CI, 1.28-8.66, p=0.01) and 1.7 fold more in women with previous history of spontaneous miscarriages (OR 1.76, 95% CI, 1.03-3.00, p=0.03) as compared to those women who had normal delivery.Conclusion: Results of this study supported the hypothesis that a past history of pelvic inflammatory disease, history of infertility for at least 2 years preceding the ectopic pregnancy, past history of pelvic surgery and previous spontaneous miscarriages are significant risk factors for the occurrence of ectopic pregnancy. Increased awareness and knowledge of risk factors among the women population can enable an early detection and diagnosis of ectopic pregnancy thereby leading to early intervention and conservative approach for management.

An audit of extra-uterine pregnancy in a tertiary care facility in Northern India

“…Also, weighing the relatively younger age against previous research studies from west, a moderately juvenile population in the present study designates early age, both at tying the nuptial knot and conception in India, especially study population. 4,5,7,[29][30][31][32] The higher incidence in multiparas is also consistent with findings in other studies. [4][5][6][7][23][24][25][26][27][28] The postulated mechanism includes vicissitudes in tubal configuration and function through age, in addition to recurrent or subclinical episodes of PID or post-abortal sepsis in such females that befall over time instigating progressively ruinous tubal damage.…”

“…In consonance with earlier studies demonstrating a likelihood ratio of around 7-9 times of ectopic in women with past history of pelvic infection, the most common risk factor in the extant study also was infectious morbidity previous history of PID (29.28%), and history of TB (21.4%). 4,5,7,18,[23][24][25][26][27][28] This can be ascribed to the fact that the resulting fibrosis after the resolution of the inflammatory process, causes distortion of the fallopian tubes, narrowing of tubal lumen or intratubal adhesions. These alterations in turn impede the passage of the ovum, favoring implantation in blind pockets of adhesions.…”

“…4,5,7,18,[23][24][25][26][27][28][29][30]32 Past pelvic surgery favoring adhesion formation and distortion of tubal anatomy predisposes the woman to have extra-uterine implantation. 4,5,7,18,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] This reiterates the fact that ectopic pregnancy should be strongly thought of in a woman with previous history of tubal surgery presenting with acute pain abdomen with or without amenorrhea or fainting attack. [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] Akin to few researchers of west, past and present history of smoking was found in ~10% women of ectopic pregnancy in the present study.…”

“…This is same as other reports. 4,5,7,18,23,26,[29][30][31] Among tubal pregnancies, 90% were ruptured and only 10 %were unruptured. This high rate of ruptured ectopic pregnancies found in this study establishes the felt need to change the poor health-seeking behavior of local people, in terms of accessing health care facilities, in order to expedite diagnosis and facilitate early initiation of treatment.…”

“…9,10 Other risk factors for tubal ectopic gestation include smoking, conception with an intrauterine device (IUD) in situ or while using a progesterone only contraceptive method. [7][8][9][10][11] Despite these known risk factors, the causes of most ectopic gestation still remain elusive. 12,13 Classically, the diagnosis is based on triad of a history of pelvic pain associated with amenorrhoea, a positive pregnancy test with or without slight vaginal bleeding.…”