Abstract
ObjectiveTo compare signs and symptoms between patients with recurrent ectopic pregnancies (REP) and primary ectopic pregnancies (PEP) and to identify potential risk factors of REP.Materials and MethodsData from 2014 to 2016 were analyzed. The study included 81 women each diagnosed with REP and PEP with no recurrence of ectopic pregnancy (EP) before January 2019. Information, including historical factors and findings at presentation of both group were collected. Data were compared between the two groups. Associations between REP and the risk factors were analyzed by logistic regression.ResultsThe findings revealed that compared to the patients in the PEP group, REP patients had significantly lower education (P = 0.001), higher proportion of previous infertility (P < 0.001) and different methods of PEP treatment (P = 0.001). Clinical data of the last operation revealed significantly higher occurrences of pelvic and peritubal adhesions (P < 0.05). Further multiple regression analysis showed that lower educational background (odds ratio [OR] = 4.183 95% confidence interval [CI] 1.311–13.344 P = 0.016), nulliparity (OR = 12.312 95% CI 3.382–44.824 P < 0.001), history of salpingotomy (OR = 7.129 95% CI 1.022–49.748 P < 0.05) and abortion (OR for one abortion = 21.576, P = 0.001; OR for two abortions =36.794, P < 0.001; OR for three abortions or more = 119.013, P < 0.001) were significant risk factors for REP.ConclusionActive education on contraception is required for patients with lower educational level and history of abortion. Different plans should be formulated for patients with EP. For EP patients wanting fertility, the risk between fertility preservation and REP needs to be evaluated as reproductive function cannot be pursued blindly while ignoring the risk of recurrence.
Highlights
Ectopic pregnancy (EP) is one of the most common gynecological emergencies
The findings revealed that compared to the patients in the primary ectopic pregnancies (PEP) group, Recurrent ectopic pregnancy (REP) patients had significantly lower education (P = 0.001), higher proportion of previous infertility (P < 0.001) and different methods of PEP treatment (P = 0.001)
Further multiple regression analysis showed that lower educational background, nulliparity (OR = 12.312 95% CI 3.382–44.824 P < 0.001), history of salpingotomy (OR = 7.129 95% CI 1.022–49.748 P < 0.05) and abortion (OR for one abortion = 21.576, P = 0.001; OR for two abortions =36.794, P < 0.001; OR for three abortions or more = 119.013, P < 0.001) were significant risk factors for REP
Summary
Ectopic pregnancy (EP) is one of the most common gynecological emergencies. The most common site is the fallopian tube, accounting for approximately 90%of all reported ectopic pregnancies.[1] With progression in early diagnosis and management, mortality caused by EP has decreased sharply; ruptured ectopic pregnancy continues to be a significant cause of marternal death during the first trimester of pregnancy.[2]. Recurrent ectopic pregnancy (REP), as a long-term complication of ectopic pregnancy, results in anxiety about losing the pregnancy and negative effects on future fertility and health. The incidence of REP in the literature varies from 10–27%,3,4 representing a 5–15 fold increase in the general population.[5] The widely accepted risk factors for EP are tubal damage resulting from pelvic infection or previous adnexal surgery, smoking, and in vitro fertilization (IVF)[4,6]; the risk factors for REP remain
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