Prediction of recurrent ectopic pregnancy: A five-year follow-up cohort study

To evaluate the value of different clinical risk factors in the prediction of recurrent ectopic pregnancies (REP).

This cohort study was carried out at a tertiary-care maternity hospital in Saudi Arabia, between January 2010 and June 2017. All women with a primary ectopic pregnancy (EP) were consecutively recruited, thoroughly assessed and followed up for a minimum duration of five-years (5.6 ± 0.61 years) to diagnose the nature and location of the subsequent pregnancies. The primary outcome measure was the occurrence of REP, while the secondary outcomes included intrauterine pregnancy, the pregnancy of unknown location and infertility rates.

A total of 272 women with a primary ectopic pregnancy (EP) were initially recruited, 217 women were included in the final analysis, among them 41 (18.9%) women had REP. Univariate analysis showed that women who subsequently developed REP had more prevalent prior miscarriages, evacuation of retained products of conception (ERPC), pelvic inflammatory disease (PID) and consanguinity, they also had lower hemoglobin levels at the time of primary EP, and lower prevalence of surgical treatment. Among the 143 surgically treated cases, salpingectomy, when compared to salpingostomy, and laparoscopy, when compared with laparotomy, were found to be associated with a lower risk of REP [RR = 0.32 (95% CI, 0.13-0.77) and 0.40 (95% CI, 0.18-0.86) respectively]. The occurrence of a subsequent delivery at any time after the primary EP was protective against REP [RR = 0.39 (95% CI, 0.22-0.68)], this protection is increased by almost nine folds if this delivery occurred at the descendant pregnancy [RR = 0.04 (95% CI, 0.01-0.17)]. Multivariable binary logistic regression revealed that prior PID, treatment modality and presenting hemoglobin level were independent predictors of REP. Receiver operating characteristic (ROC) curve was plotted using the predicted probability values derived from the multivariable binary logistic regression model, the area under the ROC curve was 0.792 (95% CI, 0.732-0.844).

Careful consideration of primary ectopic pregnancy data is a valuable tool to predict the potential risk of recurrence in the future.