Outcomes in subsequent pregnancies after wedge resection for interstitial ectopic pregnancy: a retrospective cohort study

Hoyos, Luis R.; Vilchez, Gustavo; Allsworth, Jenifer E.; Malik, Mokerrum; Rodriguez‐Kovacs, Javier; Adekola, Henry; Awonuga, Awoniyi O.

doi:10.1080/14767058.2018.1437411

Cited by 14 publications

(20 citation statements)

References 18 publications

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“…This discrepancy may be related to differences in study design, as the Scottish study used women who never had a second pregnancy as the comparison group, rather than all women at their first pregnancy regardless of final parity. In another study, researchers found no increased risk of preterm birth in women with a prior interstitial ectopic pregnancy (8). Interstitial ectopic pregnancy is caused by an embryo that implants in the myometrium near where the fallopian tube connects to the uterus (8).…”

Section: Discussionmentioning

confidence: 99%

“…Little is known about the future birth outcomes of women with ectopic pregnancies. To our knowledge, only two prior studies examined associations between a history of ectopic pregnancy and adverse birth outcomes during a later pregnancy (7,8). An analysis of Scottish national data found that women with an ectopic first pregnancy who had an intrauterine second pregnancy had higher risks of preeclampsia, preterm delivery, and emergency cesarean delivery compared with unexposed women at their second intrauterine pregnancy (7).…”

Section: Discussionmentioning

confidence: 99%

“…Improvements in diagnosis and treatment and the increased availability of assisted reproductive technologies have increased the likelihood that women with a history of ectopic pregnancy will achieve a future intrauterine pregnancy (4). Yet the lack of data on birth outcomes in future pregnancies does not allow us to identify the pregnancy disorders that should be targeted for prevention (7,8). The lack of data is compounded by the changing demographics of pregnant women as delayed childbearing becomes more common (9).…”

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confidence: 99%

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Ectopic pregnancy and outcomes of future intrauterine pregnancy

Chouinard

Mayrand

Ayoub

et al. 2019

Fertility and Sterility

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Objective: To provide information on the birth outcomes of future intrauterine pregnancies in women whose first pregnancy was ectopic. Design: Population-based longitudinal cohort study. Setting: All hospitals in Quebec, Canada, 1989: Group surgically treated for an ectopic first pregnancy: 15,823 women; comparison group with an intrauterine first pregnancy: 1,101,748 women. Intervention(s): Not applicable. Main Outcome Measure(s): Repeat ectopic pregnancy, future delivery of a live infant, stillbirth, cesarean delivery, preterm birth, low birth weight, preeclampsia, gestational diabetes, and postpartum hemorrhage as well as other outcomes of pregnancy. Result(s): The overall prevalence of ectopic first pregnancy was 14.2 per 1,000 women, of whom 10% of women with an ectopic first pregnancy had a future ectopic. Regardless of age, women with ectopic first pregnancies had an increased risk of adverse birth outcomes at future intrauterine pregnancies, including 1.27 times the risk of preterm birth (95% confidence interval [CI], 1.18-1.37), 1.20 times the risk of low birth weight (95% CI, 1.10-1.31), 1.21 times the risk of placental abruption (95% CI, 1.04-1.41), and 1.45 times the risk of placenta previa (95% CI, 1.10-1.91). Older women with a prior ectopic pregnancy had particularly elevated risks of placental abruption (risk ratio 1.42; 95% CI, 1.16-1.69). Conclusion(s):Women with ectopic first pregnancies have an increased risk of adverse birth outcomes during subsequent intrauterine pregnancies. These women may benefit from closer clinical management in pregnancy to prevent adverse birth outcomes. (Fertil Steril Ò 2019;112:112-9. Ó2019 by American Society for Reproductive Medicine.) El resumen está disponible en Español al final del artículo.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Ectopic pregnancy and outcomes of future intrauterine pregnancy

Chouinard

Mayrand

Ayoub

et al. 2019

Fertility and Sterility

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“…Liao et al reported an incidence of subsequent uterine rupture and dehiscence after wedge resection of 30% [32]. This is considerably higher than the uterine rupture rates post myomectomies, which typically range from 0.49 to 0.70% in subsequent pregnancies [32] However, an alternate study has not shown increased risk of uterine rupture in subsequent pregnancy although, in this cohort, the caesarean rate was 60% versus 30% of patients without a history of ectopic pregnancy (P = 0.137) [33].…”

Section: Surgical Managementmentioning

confidence: 62%

The diagnosis and management of interstitial ectopic pregnancies: a review

Brincat

Bryant‐Smith

2019

Gynecol Surg

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The objective of this article is to review the published literature on the diagnosis and management of interstitial pregnancies (IPs). IPs account for 2-6% of all ectopic pregnancies and have the potential to cause life-threatening haemorrhage resulting in a 2-5% mortality rate. There is little consensus on the best practice for diagnosing and managing interstitial pregnancies. By reviewing the published data, we set out to determine what the best evidencebased practice for the management of interstitial ectopic pregnancies is, what protocols can be used and whether this improves post-operative outcomes and future fertility rates.

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“…2,4,5 With regard to the risk of uterine rupture in subsequent pregnancies, we humbly suggest that the authors may have fallen into the trap of selective reporting. Firstly, there is a paucity of long-term data on pregnancy outcomes following interstitial pregnancy, particularly on mode of delivery, and the few authors that have followed up subsequent pregnancies after cornuectomy have not documented any increases in complication rates, 2,[6][7][8] in particular uterine rupture. In any case, many clinicians would recommend an elective caesarean delivery as a full thickness myometrial incision would have been affected, not dissimilar to that following a myomectomy where the uterine cavity had been breached.…”

Section: Dear Editormentioning

confidence: 99%