Risk Factors for Ectopic Pregnancy: A Case-Control Study in France, with Special Focus on Infectious Factors

Abstract

A case-control study was conducted in 1988 in seven Paris area maternity hospitals to evaluate the role of several risk factors, particularly infectious factors, in ectopic pregnancy. A total of 279 cases and 279 controls were compared for sociodemographic characteristics, cigarette smoking, sexual, reproductive and surgical histories, and conditions of conception. Pelvic inflammatory disease confirmed by celioscopy (odds ratio (OR) = 5.5, 95% confidence interval (CI) 2.1-13.9) and Chlamydia trachomatis seropositivity (OR = 3.9, 95% CI 2.3-6.7) appeared to be important risk factors for ectopic pregnancy. Other risk factors found to be associated with an increased risk of ectopic pregnancy were dose-related cigarette smoking at the time of conception (ORs 1.3 to 2.5), appendectomy (OR = 1.6, 95% CI 1.1-2.5), prior tubal surgery (OR = 5.1, 95% CI 1.7-15.4), induced conception cycle (OR = 3.2, 95% CI 1.1-9.3), and prior ectopic pregnancy (OR = 13.3, 95% CI 4.5-39.2). However, some of the latter risk factors, i.e., prior tubal surgery, prior ectopic pregnancy, and perhaps appendectomy, may be considered to be the results of pelvic inflammatory disease and sexually transmitted diseases. Maternal age, parity, prior induced abortion, and prior spontaneous abortion were not associated with ectopic pregnancy. Use of intrauterine device, progestagen micropill, and also combined estroprogestative pill at the time of conception were associated with a better prevention of intrauterine pregnancy than of ectopic pregnancy. These findings confirm the importance of several previously reported risk factors of ectopic pregnancy: sexually transmitted diseases, cigarette smoking, and prior ectopic pregnancy. They also identified new risk factors, appendectomy and induced conception cycle, and revealed that the combined estroprogestative pill does not prevent ectopic pregnancy as effectively as it does intrauterine pregnancy.

Risk Factors For Ectopic Pregnancy : A Case Control Study In Tertiary Care Centre

“…The studies conducted by Handler A et al(1989) [7], Coste J et al(1991) [8] and Bouyer J et al(2003)[9] has showed that history of smoking was present in 38.30%, 40.14% and 58.53% cases respectively which was not comparable to the present study. This could be attributed to regional and socio-economic factors.…”

Risk of ectopic pregnancy and previous induced abortion.

“…Also, ectopic pregnancy causes serious reductions in subsequent fertility, with a 20% chance of recurrence and a 20% to 40% chance of definitive infertility.3 Several ectopic pregnancy risk factors have been identified, including pelvic inflammatory disease, smoking at the time of conception, pelvic surgery, previous use of an intrauterine device, and induced ovulation. 6 Current use of an intrauterine device is also associated with ectopic pregnancy, because it lowers the risk of uterine pregnancy more than the risk of ectopic pregnancy.3 In a French study, these factors, in combination, explained approximately 65% of all ectopic pregnancies,9 suggesting that about one third of ectopic pregnancies occur in women with no identified risk factors. In the framework of research on other f risk factors, we investigated the role of previous reproductive outcomes (previous ectopic pregnancy and pervious spontaneous and induced abortions) in terms of the risk of subsequent ectopic pregnancy.…”

Ectopic pregnancy and occupational exposure of hospital personnel

“…Ectopic pregnancy may have serious consequences, in particular by impairing subsequent fertility (2,3). Several risk factors have been identified (infectious pelvic disease, smoking, tuba1 surgery, induced conception, age) (2,(4)(5)(6)(7), but the etiology of one-third of the cases of ectopic pregnancy remains unknown (7).…”