Ectopic pregnancy and outcomes of future intrauterine pregnancy

Women with ectopic first pregnancies have an in- creased risk of adverse birth outcomes during subsequent intrauterine pregnancies, including preterm birth, low birth weight, cesarean delivery, placental abruption, and placenta previa.

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Volume 112, Issue 1, Pages 112–119

Authors:

Mélanie Chouinard, M.P.H., Marie-Hélène Mayrand, M.D., Ph.D., Aimina Ayoub, M.Sc., Jessica Healy-Profitós, M.P.H., Nathalie Auger, M.D., M.Sc.

Abstract:

Objective

To provide information on the birth outcomes of future intrauterine pregnancies in women whose first pregnancy was ectopic.

Design

Population-based longitudinal cohort study.

Setting

All hospitals in Quebec, Canada, 1989–2013.

Patient(s)

Group surgically treated for an ectopic first pregnancy: 15,823 women; comparison group with an intrauterine first pregnancy: 1,101,748 women.

Intervention(s)

Not applicable.

Main Outcome Measure(s)

Repeat ectopic pregnancy, future delivery of a live infant, stillbirth, cesarean delivery, preterm birth, low birth weight, preeclampsia, gestational diabetes, and postpartum hemorrhage as well as other outcomes of pregnancy.

Result(s)

The overall prevalence of ectopic first pregnancy was 14.2 per 1,000 women, of whom 10% of women with an ectopic first pregnancy had a future ectopic. Regardless of age, women with ectopic first pregnancies had an increased risk of adverse birth outcomes at future intrauterine pregnancies, including 1.27 times the risk of preterm birth (95% confidence interval [CI], 1.18–1.37), 1.20 times the risk of low birth weight (95% CI, 1.10–1.31), 1.21 times the risk of placental abruption (95% CI, 1.04–1.41), and 1.45 times the risk of placenta previa (95% CI, 1.10–1.91). Older women with a prior ectopic pregnancy had particularly elevated risks of placental abruption (risk ratio 1.42; 95% CI, 1.16–1.69).

Conclusion(s)

Women with ectopic first pregnancies have an increased risk of adverse birth outcomes during subsequent intrauterine pregnancies. These women may benefit from closer clinical management in pregnancy to prevent adverse birth outcomes.


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Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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