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Risk factors for ectopic pregnancy: a multi-center case-control study.

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Ectopic pregnancy (EP) risk factors include prior EP, infections, infertility, and surgeries. Contraceptive failure, particularly with IUDs, and IVF-ET in women with tubal infertility significantly increase EP occurrence.

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Area of Science:

  • Reproductive Medicine
  • Gynecology
  • Public Health

Background:

  • Ectopic pregnancy (EP) is a primary cause of first-trimester maternal mortality.
  • Understanding EP risk factors is crucial for prevention strategies.

Purpose of the Study:

  • To evaluate risk factors associated with ectopic pregnancy (EP) in Shanghai, China.
  • To identify traditional and novel risk factors for EP.

Main Methods:

  • A multi-center, large-sample case-control study involving 2411 EP cases and 2416 intrauterine pregnancy controls.
  • Data collection included sociodemographic, reproductive, gynecological, surgical history, and contraceptive use.
  • Multivariate logistic regression analysis was used to calculate adjusted odds ratios (AORs) and 95% confidence intervals (CIs).

Main Results:

  • Traditional risk factors identified include previous EP (AOR=2.72), Chlamydia trachomatis infection (AOR=3.18), infertility (AOR=2.18), adnexal surgery (AOR=2.09), appendectomy (AOR=1.64), and prior IUD use (AOR=1.72).
  • Contraceptive failure, especially IUDs (AOR=16.43), levonorgestrel emergency contraception (AOR=4.75), and oral contraceptive pills (AOR=3.02), significantly increased EP risk.
  • In vitro fertilization and embryo transfer (IVF-ET) was a major risk factor for EP in women with tubal infertility (AOR=8.99).

Conclusions:

  • Beyond traditional factors, current intrauterine device (IUD) use and in vitro fertilization and embryo transfer (IVF-ET) are significant contributors to ectopic pregnancy (EP).
  • Special attention is warranted for women with tubal infertility undergoing IVF-ET treatment due to elevated EP risk.