Risk factors for ectopic pregnancy in women: A case control study

Abstract

Introduction: Ectopic pregnancy can mimic practically each and every gynaecological disorder as well as many surgical catastrophes. It has always challenged ingenuity of the obstetricians and gynaecologists by its bizarre clinical picture. If it is not diagnosed attended in time, it may lead to maternal morbidity and mortality. Methodology: This study was conducted on 440 patients at Government Medical College, Srinagar between Jan 2018 and March 2020. All study participants consented in writing. The study was approved by the Institutional Ethics Committee. Study participants were grouped into A and B. 220 ectopic pregnancy cases were designated as Group A and their 220 postnatal controls designated as Group B. The aim of this study was to assess the risk factors of ectopic pregnancy and to determine an association between the studied risk factors and ectopic pregnancy. Both groups were compared for various risk factors for ectopic pregnancy by means of detailed history with focus on socio economic characteristics like education, occupation, smoking status, age, gynaecological history, pelvic inflammatory disease (PID), parity, prior abortions, prior ectopic, surgical histories, use of assisted conception and contraception. Results: In this study the main risk factors for ectopic pregnancy were Tuberculosis (OR=11.87), history of infertility (P< 0.001), abortions (P=0.01) and a history of prior ectopic pregnancy (OR=8.129). Other risk factors found to be associated with an increased risk for ectopic pregnancy were PID (OR=2.856) / Chlamydia infection (OR=0.29), endometriosis (P=5.40), induced conception cycle (OR=3.142), intrauterine device usage (OR=3.75), prior Caesarean section (OR=3.85) and appendectomy (OR=2.42). On the contrary, barrier methods (OR=0.25) and oral contraceptive use (OR=0.26) were protective from ectopic pregnancy. Conclusion: PID particularly TB and Chlamydia are major etiological factors for ectopic pregnancy in our setup. Furthermore, prior ectopic pregnancy and infertility may be the result of a PID that might have caused tubal sequalae. As a preventive strategy screening and early treatment for TB and chlamydia in reproductive age group should be done so that tubal damage can be prevented. Advancing maternal age and low socioeconomic status are risk factor for ectopic pregnancy possibly due to increased chances of exposure to sexually transmitted infections (STIs) and PID. Patients with risk factors like pelvic surgeries, endometriosis, induced conception cycle, intrauterine contraception device (IUCD) users should be counselled about the possible risk of ectopic pregnancy once they conceive. So that they are kept under surveillance for early detection.

Meta-Analysis: Effect of Endometriosis and Intrauterine Device Contraceptive on Ectopic Pregnancy

“…The cohort study by Saetta et al (2020) concluded that endometriosis is not a risk factor for ectopic pregnancy, in line with the results of a study by Gaskins et al (2018). The opposite result was presented in the study by Muzaffar et al (2020), Hwang et al (2016) and Farland et al (2019) which states that endometriosis increases the risk of ectopic pregnancy.…”

“…Assouni-Mindjah et al (2018) conducted a case-control study on 264 women and found that the IUD did not significantly increase the risk of ectopic pregnancy. While Muzaffar et al (2020) in their study found that IUD use increases the risk of ectopic pregnancy. Meta-analysis by Mol et al (1995) and Xiong et al (1995) concluded that IUD use generally reduces the incidence of ectopic pregnancy when not pregnant, but that when a woman with an in-situ IUD becomes pregnant, the risk of ectopic implantation increases.…”