Ectopic pregnancy risk factors: Difference between revisions

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__NOTOC__
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{{Ectopic pregnancy}}
{{Ectopic pregnancy}}
{{CMG}}
{{CMG}} '''Associate Editor(s)-in-Chief:''' [[User:MoisesRomo|Moises Romo M.D.]]


==Overview==
==Overview==


There are a number of risk factors for ectopic pregnancies.  They include: [[pelvic inflammatory disease]], [[infertility]], those who have been exposed to [[DES]], tubal surgery, [[smoking]], previous ectopic pregnancy, multiple sexual partners, current [[IUD]] use, [[tubal ligation]], and previous abortion.<ref>{{cite web |url=http://www.bestbets.org/bets/bet.php?id=921 |title=BestBets: Risk Factors for Ectopic Pregnancy |format= |work= |accessdate=}}</ref>
'''[[Ectopic pregnancy]]''' usually occurs in women with [[fallopian tube]] [[dysfunction]]. There are a number of [[risk factors]] for [[Ectopic pregnancy|ectopic pregnancies]], among them [[pelvic inflammatory disease]], [[infertility]], [[DES]] exposure, tubal surgery, [[smoking]], previous [[ectopic pregnancy]], multiple sexual partners, current [[IUD]] use, [[tubal ligation]], and previous [[abortion]]. The most potent [[risk factor]] in the development of [[ectopic pregnancy]] is [[Fallopian tube|tubal]] [[surgery]].


== Risk Factors ==
==Risk Factors==
* Although tubal ligation prevents pregnancies, if a pregnancy does occur, it is more likely to be ectopic.
* The risk of EP increases in women who have had prior ectopics, but decreases for each subsequent intrauterine pregnancy.
* Diethylstilbestrol (DES) causes a loss of fimbriae, a small opening, and fallopian tubes that are shorter and thinner than normal.
* Infertility primarily increases the risk of EP during treatment – IVF (in vitro fertilization) is associated with a 2 – 3 % increased risk compared with the general population.


{|  
* Risk factors in the development of [[Ectopic pregnancy|ectopic pregnancies]] may be occupational, [[Environmental epidemiology|environmental]], [[genetic]], and [[viral]]. The following table summarizes these [[risks]] and its [[odds ratio]]:
|-style="background:silver; color:black"
 
| '''Risk Factor''' || '''Odds Ratio'''  
{| class="wikitable"
|-style="background:silver; color:black"  
|+
| '''Tubal surgery''' || '''21'''
| colspan="2" |Risk Factors Odds Ratios for Ectopic Pregnancy
|- style="background:silver; color:black"
|'''Risk Factor'''||'''Odds Ratio'''
|- style="background:silver; color:black"  
|[[Fallopian tube|Tubal]] [[surgery]]||21
|- style="background:silver; color:black"
|[[Tubal ligation]]||9.3
|- style="background:silver; color:black"
|Previous [[ectopic pregnancy]]||8.3
|- style="background:silver; color:black"
|[[In utero|In-utero]] [[DES]] exposure||5.6
|- style="background:silver; color:black"
|[[IUD]]||4.2 – 45
|- style="background:silver; color:black"
|Documented [[Fallopian tube|tubal]] [[pathology]]||3.8 – 21
|- style="background:silver; color:black"
|[[Infertility]]||2.5 – 21
|- style="background:silver; color:black"
|Previous [[STD]]||2.5 – 3.7
|- style="background:silver; color:black"
|Multiple sexual partners||2.1
|- style="background:silver; color:black"
|Prior [[pelvic]] / [[Abdomen|abd]] [[surgery]]||0.9 – 3.8
|- style="background:silver; color:black"
|[[Cigarette]] [[smoking]]||2.3 – 2.5
|- style="background:silver; color:black"
|- style="background:silver; color:black"
| '''Tubal ligation''' || '''9.3'''
|[[Vaginal]] douching||1.1 – 3.1
|-style="background:silver; color:black"
| '''Previous ectopic''' || '''8.3'''
|-style="background:silver; color:black"
| '''In-utero DES exposure''' || '''5.6'''
|-style="background:silver; color:black"
| '''IUD''' || '''4.2 – 45'''
|-style="background:silver; color:black"
| '''Documented tubal pathology''' || '''3.8 – 21'''
|-style="background:silver; color:black"
| '''Moderate Risk''' ||
|-style="background:silver; color:black"
| '''Infertility''' || '''2.5 – 21'''   
|-style="background:silver; color:black"
| '''Previous STD''' ||  '''2.5 – 3.7'''
|-style="background:silver; color:black"
| '''Multiple sexual partners''' || '''2.1'''
|- style="background:silver; color:black"
|- style="background:silver; color:black"
| '''Low Risk''' ||
|1st intercourse < 18 years old||1.6
|-style="background:silver; color:black"
| '''Prior pelvic / abd surgery''' || '''0.9 – 3.8'''
|-style="background:silver; color:black"
| '''Cigarette smoking''' || '''2.3 – 2.5'''
|-style="background:silver; color:black"
| '''Vaginal douching''' || '''1.1 – 3.1'''
|-style="background:silver; color:black"
| '''1st intercourse < 18 years old''' || '''1.6'''   
|}
|}
===Common Risk Factors===
*[[Fallopian tube|Tubal]] [[surgery]]. It is known as the major [[risk factor]] for [[ectopic pregnancy]] developemnt.<ref name="pmid86414793">{{cite journal |vauthors=Ankum WM, Mol BW, Van der Veen F, Bossuyt PM |title=Risk factors for ectopic pregnancy: a meta-analysis |journal=Fertil Steril |volume=65 |issue=6 |pages=1093–9 |date=June 1996 |pmid=8641479 |doi= |url=}}</ref><ref name="pmid86414792">{{cite journal |vauthors=Ankum WM, Mol BW, Van der Veen F, Bossuyt PM |title=Risk factors for ectopic pregnancy: a meta-analysis |journal=Fertil Steril |volume=65 |issue=6 |pages=1093–9 |date=June 1996 |pmid=8641479 |doi= |url=}}</ref>
*[[Tubal ligation]]. Although [[tubal ligation]] is highly effective in preventing [[pregnancies]], if a [[pregnancy]] does occur, it is more likely to be [[ectopic]].<ref name="pmid12497674">{{cite journal |vauthors=Furlong LA |title=Ectopic pregnancy risk when contraception fails. A review |journal=J Reprod Med |volume=47 |issue=11 |pages=881–5 |date=November 2002 |pmid=12497674 |doi= |url=}}</ref>
*Previous [[ectopic pregnancy]]. Same as having a previous [[ectopic pregnancy]] increases the risk for further [[Ectopic pregnancy|ectopic pregnancies]], having a intrauterine [[pregnancy]] decreases this [[RiskMetrics|risk.<ref name="pmid8641479">{{cite journal |vauthors=Ankum WM, Mol BW, Van der Veen F, Bossuyt PM |title=Risk factors for ectopic pregnancy: a meta-analysis |journal=Fertil Steril |volume=65 |issue=6 |pages=1093–9 |date=June 1996 |pmid=8641479 |doi= |url=}}</ref>]][./Ectopic_pregnancy_risk_factors#cite_note-pmid8641479-1 <span class="mw-reflink-text"><nowiki>[4]</nowiki></span>]<ref name="pmid16730724">{{cite journal |vauthors=Barnhart KT, Sammel MD, Gracia CR, Chittams J, Hummel AC, Shaunik A |title=Risk factors for ectopic pregnancy in women with symptomatic first-trimester pregnancies |journal=Fertil Steril |volume=86 |issue=1 |pages=36–43 |date=July 2006 |pmid=16730724 |doi=10.1016/j.fertnstert.2005.12.023 |url=}}</ref><ref name="pmid9012601">{{cite journal |vauthors=Coste J, Bouyer J, Job-Spira N |title=Construction of composite scales for risk assessment in epidemiology: an application to ectopic pregnancy |journal=Am J Epidemiol |volume=145 |issue=3 |pages=278–89 |date=February 1997 |pmid=9012601 |doi=10.1093/oxfordjournals.aje.a009101 |url=}}</ref>
*[[In utero|In-utero]] [[DES]] exposure. The usage causes a loss of [[fimbriae]] and [[stenosis]] of [[fallopian tubes]], which may increase up to 3 times the [[RiskMetrics|risk]] of [[ectopic pregnancy]] as compared to unexposed women.<ref name="pmid11422477">{{cite journal |vauthors=Burton JL, Lidbury EA, Gillespie AM, Tidy JA, Smith O, Lawry J, Hancock BW, Wells M |title=Over-diagnosis of hydatidiform mole in early tubal ectopic pregnancy |journal=Histopathology |volume=38 |issue=5 |pages=409–17 |date=May 2001 |pmid=11422477 |doi=10.1046/j.1365-2559.2001.01151.x |url=}}</ref>
*[[Intrauterine device|IUD]]. It is thought that [[Intrauterine device|IUD]]-induced [[inflammation]] may result in deciliation of the endosalpinx and then delays [[ovum]] transport, altough, the exact mechanism is not fully understood.<ref name="pmid8641479" />
*Documented [[Fallopian tube|tubal]] pathology. Ectopic tubal pregnancy may occur in a blocked tube with contralateral [[Fallopian tube|tubal]] patency, although, this association was found to be weaker for those with two blocked [[Fallopian tube|tubes]].<ref name="urlwww.moscmm.org">{{cite web |url=https://www.moscmm.org/pdf/Berek%20Novak_s%20Gynecology,_14.pdf |title=www.moscmm.org |format= |work= |accessdate=}}</ref><ref name="pmid2953513">{{cite journal |vauthors=Russell JB |title=The etiology of ectopic pregnancy |journal=Clin Obstet Gynecol |volume=30 |issue=1 |pages=181–90 |date=March 1987 |pmid=2953513 |doi=10.1097/00003081-198703000-00025 |url=}}</ref>
===Less common Risk Factors===
*[[Infertility]]. [[Treatment]] of [[infertility]], such as [[in vitro]] [[fertilization]] is associated with a 2 – 3 % increased [[RiskMetrics|risk]] compared with the general population.<ref name="pmid1731286">{{cite journal |vauthors=Maccato M, Estrada R, Hammill H, Faro S |title=Prevalence of active Chlamydia trachomatis infection at the time of exploratory laparotomy for ectopic pregnancy |journal=Obstet Gynecol |volume=79 |issue=2 |pages=211–3 |date=February 1992 |pmid=1731286 |doi= |url=}}</ref><ref name="pmid90126012">{{cite journal |vauthors=Coste J, Bouyer J, Job-Spira N |title=Construction of composite scales for risk assessment in epidemiology: an application to ectopic pregnancy |journal=Am J Epidemiol |volume=145 |issue=3 |pages=278–89 |date=February 1997 |pmid=9012601 |doi=10.1093/oxfordjournals.aje.a009101 |url=}}</ref><ref name="pmid86414794">{{cite journal |vauthors=Ankum WM, Mol BW, Van der Veen F, Bossuyt PM |title=Risk factors for ectopic pregnancy: a meta-analysis |journal=Fertil Steril |volume=65 |issue=6 |pages=1093–9 |date=June 1996 |pmid=8641479 |doi= |url=}}</ref>
*Previous [[Sexually transmitted disease|STD]]. This possibly due to tubal scarring from [[gonococcal]] and [[Chlamydial infection|chlamydial infections]], which produce changes in [[Tubal reversal|tubal function]] leading to delay in ovum transport and [[Tubal pregnancy|tubal implantation]].<ref name="pmid8641479" /><ref name="pmid11422477" />
*Multiple sexual partners. There has been an association between multiple sexual partners and [[Ectopic pregnancy|ectopic pregnancies]], especially when 1st intercourse < 18 years old.<ref name="pmid11422477" />
*Prior [[pelvic]] / [[abdominal]] [[Surgery|surgery.]] Women with histories of [[laparotomy]] and [[appendectomy]] have higher risk of developing an [[ectopic pregnancy]], although this [[risks]] increases even higher when it involves [[Fallopian tube|tubal]] involvement.<ref name="pmid1407922">{{cite journal |vauthors=Parazzini F, Tozzi L, Ferraroni M, Bocciolone L, La Vecchia C, Fedele L |title=Risk factors for ectopic pregnancy: an Italian case-control study |journal=Obstet Gynecol |volume=80 |issue=5 |pages=821–6 |date=November 1992 |pmid=1407922 |doi= |url=}}</ref>
*[[Cigarette]] [[Smoking|smoking.]] [[Inhalation]] of [[cigarette smoke]] may impair [[fallopian tube]] function by affecting on [[Cilia|ciliary]] beat frequency and [[smooth muscle]] [[contraction]].<ref name="pmid12543617">{{cite journal |vauthors=Bouyer J, Coste J, Shojaei T, Pouly JL, Fernandez H, Gerbaud L, Job-Spira N |title=Risk factors for ectopic pregnancy: a comprehensive analysis based on a large case-control, population-based study in France |journal=Am J Epidemiol |volume=157 |issue=3 |pages=185–94 |date=February 2003 |pmid=12543617 |doi=10.1093/aje/kwf190 |url=}}</ref><ref name="pmid10742003">{{cite journal |vauthors=Tay JI, Moore J, Walker JJ |title=Ectopic pregnancy |journal=BMJ |volume=320 |issue=7239 |pages=916–9 |date=April 2000 |pmid=10742003 |pmc=1117838 |doi=10.1136/bmj.320.7239.916 |url=}}</ref>
*Pior [[abortions]]. There is conflict between studies in revealing an association; the cause of this relationship is most likely due to [[infection]], [[hormonal]] imbalance, or [[Immunological|immunologic]] factors.<ref name="pmid11056230">{{cite journal |vauthors=Bouyer J, Rachou E, Germain E, Fernandez H, Coste J, Pouly JL, Job-Spira N |title=Risk factors for extrauterine pregnancy in women using an intrauterine device |journal=Fertil Steril |volume=74 |issue=5 |pages=899–908 |date=November 2000 |pmid=11056230 |doi=10.1016/s0015-0282(00)01605-8 |url=}}</ref><ref name="pmid488425">{{cite journal |vauthors=Honoré LH |title=A significant association between spontaneous abortion and tubal ectopic pregnancy |journal=Fertil Steril |volume=32 |issue=4 |pages=401–2 |date=October 1979 |pmid=488425 |doi=10.1016/s0015-0282(16)44294-9 |url=}}</ref>
*[[Advanced age]]. There is a 9 times-fold increased [[RiskMetrics|risk]] of developing an [[ectopic pregnancy]] in women ≥39 as compared with those ≤26 years.<ref name="pmid2929684">{{cite journal |vauthors=Mäkinen JI, Erkkola RU, Laippala PJ |title=Causes of the increase in the incidence of ectopic pregnancy. A study on 1017 patients from 1966 to 1985 in Turku, Finland |journal=Am J Obstet Gynecol |volume=160 |issue=3 |pages=642–6 |date=March 1989 |pmid=2929684 |doi=10.1016/s0002-9378(89)80047-x |url=}}</ref><ref name="pmid8641479" />
*[[Vaginal]] douching. It is thought by some to increase [[Ectopic pregnancy|ectopic pregnancies]].


==References==
==References==
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Moises Romo M.D.

Overview

Ectopic pregnancy usually occurs in women with fallopian tube dysfunction. There are a number of risk factors for ectopic pregnancies, among them pelvic inflammatory disease, infertility, DES exposure, tubal surgery, smoking, previous ectopic pregnancy, multiple sexual partners, current IUD use, tubal ligation, and previous abortion. The most potent risk factor in the development of ectopic pregnancy is tubal surgery.

Risk Factors

Risk Factors Odds Ratios for Ectopic Pregnancy
Risk Factor Odds Ratio
Tubal surgery 21
Tubal ligation 9.3
Previous ectopic pregnancy 8.3
In-utero DES exposure 5.6
IUD 4.2 – 45
Documented tubal pathology 3.8 – 21
Infertility 2.5 – 21
Previous STD 2.5 – 3.7
Multiple sexual partners 2.1
Prior pelvic / abd surgery 0.9 – 3.8
Cigarette smoking 2.3 – 2.5
Vaginal douching 1.1 – 3.1
1st intercourse < 18 years old 1.6

Common Risk Factors

Less common Risk Factors

References

  1. ↑ Ankum WM, Mol BW, Van der Veen F, Bossuyt PM (June 1996). "Risk factors for ectopic pregnancy: a meta-analysis". Fertil Steril. 65 (6): 1093–9. PMID 8641479.
  2. ↑ Ankum WM, Mol BW, Van der Veen F, Bossuyt PM (June 1996). "Risk factors for ectopic pregnancy: a meta-analysis". Fertil Steril. 65 (6): 1093–9. PMID 8641479.
  3. ↑ Furlong LA (November 2002). "Ectopic pregnancy risk when contraception fails. A review". J Reprod Med. 47 (11): 881–5. PMID 12497674.
  4. ↑ 4.0 4.1 4.2 4.3 Ankum WM, Mol BW, Van der Veen F, Bossuyt PM (June 1996). "Risk factors for ectopic pregnancy: a meta-analysis". Fertil Steril. 65 (6): 1093–9. PMID 8641479.
  5. ↑ Barnhart KT, Sammel MD, Gracia CR, Chittams J, Hummel AC, Shaunik A (July 2006). "Risk factors for ectopic pregnancy in women with symptomatic first-trimester pregnancies". Fertil Steril. 86 (1): 36–43. doi:10.1016/j.fertnstert.2005.12.023. PMID 16730724.
  6. ↑ Coste J, Bouyer J, Job-Spira N (February 1997). "Construction of composite scales for risk assessment in epidemiology: an application to ectopic pregnancy". Am J Epidemiol. 145 (3): 278–89. doi:10.1093/oxfordjournals.aje.a009101. PMID 9012601.
  7. ↑ 7.0 7.1 7.2 Burton JL, Lidbury EA, Gillespie AM, Tidy JA, Smith O, Lawry J, Hancock BW, Wells M (May 2001). "Over-diagnosis of hydatidiform mole in early tubal ectopic pregnancy". Histopathology. 38 (5): 409–17. doi:10.1046/j.1365-2559.2001.01151.x. PMID 11422477.
  8. ↑ "www.moscmm.org" (PDF).
  9. ↑ Russell JB (March 1987). "The etiology of ectopic pregnancy". Clin Obstet Gynecol. 30 (1): 181–90. doi:10.1097/00003081-198703000-00025. PMID 2953513.
  10. ↑ Maccato M, Estrada R, Hammill H, Faro S (February 1992). "Prevalence of active Chlamydia trachomatis infection at the time of exploratory laparotomy for ectopic pregnancy". Obstet Gynecol. 79 (2): 211–3. PMID 1731286.
  11. ↑ Coste J, Bouyer J, Job-Spira N (February 1997). "Construction of composite scales for risk assessment in epidemiology: an application to ectopic pregnancy". Am J Epidemiol. 145 (3): 278–89. doi:10.1093/oxfordjournals.aje.a009101. PMID 9012601.
  12. ↑ Ankum WM, Mol BW, Van der Veen F, Bossuyt PM (June 1996). "Risk factors for ectopic pregnancy: a meta-analysis". Fertil Steril. 65 (6): 1093–9. PMID 8641479.
  13. ↑ Parazzini F, Tozzi L, Ferraroni M, Bocciolone L, La Vecchia C, Fedele L (November 1992). "Risk factors for ectopic pregnancy: an Italian case-control study". Obstet Gynecol. 80 (5): 821–6. PMID 1407922.
  14. ↑ Bouyer J, Coste J, Shojaei T, Pouly JL, Fernandez H, Gerbaud L, Job-Spira N (February 2003). "Risk factors for ectopic pregnancy: a comprehensive analysis based on a large case-control, population-based study in France". Am J Epidemiol. 157 (3): 185–94. doi:10.1093/aje/kwf190. PMID 12543617.
  15. ↑ Tay JI, Moore J, Walker JJ (April 2000). "Ectopic pregnancy". BMJ. 320 (7239): 916–9. doi:10.1136/bmj.320.7239.916. PMC 1117838. PMID 10742003.
  16. ↑ Bouyer J, Rachou E, Germain E, Fernandez H, Coste J, Pouly JL, Job-Spira N (November 2000). "Risk factors for extrauterine pregnancy in women using an intrauterine device". Fertil Steril. 74 (5): 899–908. doi:10.1016/s0015-0282(00)01605-8. PMID 11056230.
  17. ↑ Honoré LH (October 1979). "A significant association between spontaneous abortion and tubal ectopic pregnancy". Fertil Steril. 32 (4): 401–2. doi:10.1016/s0015-0282(16)44294-9. PMID 488425.
  18. ↑ Mäkinen JI, Erkkola RU, Laippala PJ (March 1989). "Causes of the increase in the incidence of ectopic pregnancy. A study on 1017 patients from 1966 to 1985 in Turku, Finland". Am J Obstet Gynecol. 160 (3): 642–6. doi:10.1016/s0002-9378(89)80047-x. PMID 2929684.

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