[Epidemiology of ectopic pregnancy: incidence, risk factors and outcomes]

Two entities must be differentiated in ectopic pregnancy (EP) epidemiology: EP occurring in women without contraception (reproductive failure) and with contraception (contraceptive failure). These two entities differ on almost all issues. After a great increase between 1970 and 1990, incidence of EP has decreased over the next 10 years. At the present time, the incidence of EP with contraception goes on decreasing while the incidence of EP without contraception is increasing. Three quarters of EP are ampullary, and 4.5% are extra-tubal. The two main risk factors for EP without contraception are a history of infection or tubal surgery and smoking. Quantitatively, their relationships with EP risk are similar. The other risk factors are age, prior spontaneous abortion, prior induced abortion, previous use of an intra-uterine device, and history of infertility. The total attributable risk of all these factor is 76%. Maternal mortality following EP is quite uncommon in developed countries. Immediate morbidity is not sufficiently documented, however long-term psychological consequences may be important.