Abstract
BackgroundWomen with recurrent ectopic pregnancy (EP) represent a unique cohort of patients in whom diagnostic expertise is paramount. We determined whether recurrent EP is associated with significant differences in patient demographics, clinical presentation, risk factors and surgical findings when compared with primary EP.MethodsA retrospective case–control study of all EPs diagnosed from 2003 to 2014, at Whipps Cross University Hospital, London.ResultsIn the above period 849 EPs were surgically managed (758 primary EPs and 91 recurrent EPs). Recurrent EPs were significantly older than primary EPs (32.2 ± 5.08 vs. 30.5 ± 5.83 years, p < 0.05). They presented at a significantly earlier gestation (5.99 ± 1.08 vs. 6.52 ± 1.81 weeks, p < 0.05) and with a significantly lower primary βHCG (3176 ± 7350 vs. 6243 ± 12,282, p < 0.05). Recurrent EPs were significantly more likely to have a positive history of tubal or pelvic surgery (61.5 % vs. 3.5 %, p < 0.05 and 53.8 vs. 14 %, p < 0.05). At surgery, primary EPs had a significantly greater volume of hemoperitoneum (592 ± 850 vs. 249 ± 391 ml, p < 0.05), whereas recurrent EPs were significantly more likely to have contralateral pathology (31.1 vs. 9.8 %, p < 0.05). Regression analysis showed that the parameters of age, gestational age at presentation, first βHCG level, positive history of previous tubal surgery and previous ectopic pregnancy differ in women at risk of a recurrent EP when compared to women not at risk of a recurrent ectopic (AUC, 0.844).ConclusionsWe conclude that recurrent EPs may represent a unique sub-group of patients with EP.
Highlights
Women with recurrent ectopic pregnancy (EP) represent a unique cohort of patients in whom diagnostic expertise is paramount
To determine whether recurrent EP is associated with any significant differences in patient demographics, clinical presentation, risk factors and surgical findings when compared to primary EP
Women with recurrent EPs were significantly older than women with primary EPs (32.2 ± 5.08 vs. 30.5 ± 5.83 years, p < 0.05)
Summary
Women with recurrent ectopic pregnancy (EP) represent a unique cohort of patients in whom diagnostic expertise is paramount. We determined whether recurrent EP is associated with significant differences in patient demographics, clinical presentation, risk factors and surgical findings when compared with primary EP. Despite efforts at primary prevention, the incidence of EP has been stable over recent years, at 11.1 per 1000 pregnancies (The Management of Tubal Pregnancy 2004) though there has been a significant improvement in the mortality from EP as demonstrated in the last UK triennial report (Saving Mothers’ Lives 2006). Creanga et al estimated trends in EP mortality and examined characteristics of recently hospitalized women who died as a result of EP in the United States and found that the EP mortality ratio declined by 56.6 %, from 1.15 to 0.50 deaths per 100,000.
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