Risk Factors for Ectopic Pregnancy

Abstract

To the Editor.— The article entitled Ectopic Pregnancy and Reproductive Technology 1 in the March 25 issue ofTHE JOURNALindicates a decline in the proportion of cases of salpingitis caused by Neisseria gonorrhea , citing a current culture rate of less than 30% of women with pelvic inflammatory disease. These figures seem low in light of the 54% culture rate reported in recent articles. 2 I agree with the conclusion that chlamydia has emerged as an increasingly prevalent cause of tubal pregnancy. Anatomic changes with Chlamydia trachomatis infection include hypertrophy and engorgement of the vaginal walls and an increase in glycogen content of the vaginal epithelium. These changes may predispose to secondary infection with Escherichia coli or Bacterioides fragilis . 2 Ascending infection can lead to scarring of the fallopian tubes and an increase in ectopic pregnancy rates. I agree with the authors that chlamydiae are unlikely to be eradicated unless