Risk factors for ectopic pregnancy in women with symptomatic first-trimester pregnancies.

Abstract

OBJECTIVE:

To evaluate the association between ectopic pregnancy (EP) and clinical and historical factors among women presenting with pain and/or bleeding in early pregnancy.

DESIGN:

Nested case-control study.

SETTING:

University medical center.

PATIENT(S):

Women with symptomatic early pregnancies of unknown location presenting for care between January 1, 1990 and July 31, 1999.

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

Clinical and historical risk factors were compared between women with EP and women with ongoing intrauterine pregnancies or spontaneous abortions.

RESULT(S):

The following factors were associated with increased risk of EP: prior EP (odds ratio, 2.98 [95% confidence interval, 1.88-4.73] for one prior EP and 16.04 [5.39-47.72] for 2 or more), pelvic inflammatory disease history (1.5 [1.11-2.05]), pain at presentation (1.42 [1.06-1.92]), vaginal bleeding at presentation (1.42 [1.04-1.93]), and hCG of 501-2,000 mIU/mL (1.73 [1.24-2.42]). Age younger than 25 years (0.59 [0.41-0.85]) and a history of abortion were protective from EP (0.58 [0.38-0.90]). Prior nontubal pelvic surgery, past intrauterine device use, prior cesarean section, and current cervical infection demonstrated no association with EP.

CONCLUSION(S):

Evaluation of women with a symptomatic early pregnancy confirms and refutes some of the classical risk factors for EP. Prior EP is a strong risk factor, whereas pelvic inflammatory disease has an unexpected weak association. Previous abortion was found to have a negative association, whereas nontubal surgery, cesarean section, and a history of or concomitant cervical infection have no association. Knowledge of historical and clinical factors associated with EP may aid in early diagnosis.

• Authors: Kurt T Barnhart, Mary D Sammel, Clarisa R Gracia, Jesse Chittams, Amy C Hummel, Alka Shaunik
• Journal: Fertility and sterility (Fertil Steril) Vol. 86 Issue 1 Pg. 36-43 (Jul 2006) ISSN: 1556-5653 [Electronic] United States
• PMID: 16730724 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)

Topics

• Adult
• Comorbidity
• Female
• Humans
• Incidence
• Pennsylvania (epidemiology)
• Pregnancy
• Pregnancy Complications (epidemiology)
• Pregnancy Trimester, First
• Pregnancy, Ectopic (epidemiology)
• Proportional Hazards Models
• Risk Assessment (methods)
• Risk Factors