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

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          Abstract

          Ectopic pregnancy (EP) is the leading cause of maternal death during the first trimester of pregnancy. A better understanding of EP risk can help prevent its occurrence. We carried out a multi-center, large-sample, case-control study to evaluate the risk factors for EP in Shanghai, China.

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          Ectopic pregnancy.

          Cynthia M Farquhar (2015)
          Ectopic pregnancy is an important cause of morbidity and mortality worldwide. Use of transvaginal ultrasonography and quantitative measurement of the beta subunit of human chorionic gonadotropin (beta-hCG) has led to a reduction in the need for diagnostic laparoscopy. Furthermore, with earlier diagnosis, medical therapy with methotrexate can be offered and surgery avoided in some women, though the best regimen remains unclear. In the surgical management of ectopic pregnancy, the benefits of salpingectomy over salpingostomy are uncertain. Although there have been advances in the management of ectopic pregnancy there are still questions to be answered.
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            Current knowledge of the aetiology of human tubal ectopic pregnancy.

            J L V Shaw, S. K. Dey Biswas, H Critchley … (2015)
            BACKGROUND An ectopic pregnancy is a pregnancy which occurs outside of the uterine cavity, and over 98% implant in the Fallopian tube. Tubal ectopic pregnancy remains the most common cause of maternal mortality in the first trimester of pregnancy. The epidemiological risk factors for tubal ectopic pregnancy are well established and include: tubal damage as a result of surgery or infection (particularly Chlamydia trachomatis), smoking and in vitro fertilization. This review appraises the data to date researching the aetiology of tubal ectopic pregnancy. METHODS Scientific literature was searched for studies investigating the underlying aetiology of tubal ectopic pregnancy. RESULTS Existing data addressing the underlying cause of tubal ectopic pregnancy are mostly descriptive. There are currently few good animal models of tubal ectopic pregnancy. There are limited data explaining the link between risk factors and tubal implantation. CONCLUSIONS Current evidence supports the hypothesis that tubal ectopic pregnancy is caused by a combination of retention of the embryo within the Fallopian tube due to impaired embryo-tubal transport and alterations in the tubal environment allowing early implantation to occur. Future studies are needed that address the functional consequences of infection and smoking on Fallopian tube physiology. A greater understanding of the aetiology of tubal ectopic pregnancy is critical for the development of improved preventative measures, the advancement of diagnostic screening methods and the development of novel treatments.
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              Risk factors for ectopic pregnancy: a comprehensive analysis based on a large case-control, population-based study in France.

              Joël Coste, Taraneh Shojaei, Jean Pouly … (2003)
              This case-control study was associated with a regional register of ectopic pregnancy between 1993 and 2000 in France. It included 803 cases of ectopic pregnancy and 1,683 deliveries and was powerful enough to investigate all ectopic pregnancy risk factors. The main risk factors were infectious history (adjusted attributable risk = 0.33; adjusted odds ratio for previous pelvic infectious disease = 3.4, 95% percent confidence interval (CI): 2.4, 5.0) and smoking (adjusted attributable risk = 0.35; adjusted odds ratio = 3.9, 95% CI: 2.6, 5.9 for >20 cigarettes/day vs. women who had never smoked). The other risk factors were age (associated per se with a risk of ectopic pregnancy), prior spontaneous abortions, history of infertility, and previous use of an intrauterine device. Prior medical induced abortion was associated with a risk of ectopic pregnancy (adjusted odds ratio = 2.8, 95% CI: 1.1, 7.2); no such association was observed for surgical abortion (adjusted odds ratio = 1.1, 95% CI: 0.8, 1.6). The total attributable risk of all the factors investigated was 0.76. As close associations were found between ectopic pregnancy and infertility and between ectopic pregnancy and spontaneous abortion, further research into ectopic pregnancy should focus on risk factors common to these conditions. In terms of public health, increasing awareness of the effects of smoking may be useful for ectopic pregnancy prevention.
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                Author and article information

                Journal
                Journal ID (iso-abbrev): BMC Pregnancy Childbirth
                Title: BMC pregnancy and childbirth
                Publisher: Springer Science and Business Media LLC
                ISSN (Electronic): 1471-2393
                ISSN (Print): 1471-2393
                Publication date (Electronic): Aug 22 2015
                Volume: 15
                Affiliations
                [1 ] Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China. downing@sjtu.edu.cn.
                [2 ] Institute of Embryo-Fetal Original Adult Disease Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China. downing@sjtu.edu.cn.
                [3 ] Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China. weihong-zhao@hotmail.com.
                [4 ] Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China. melodyqianzhu@126.com.
                [5 ] Department of Obstetrics and Gynecology, Songjiang Central Hospital, Shanghai, 201600, China. shujun-cao@163.com.
                [6 ] Department of Obstetrics and Gynecology, Songjiang Maternity and Child Health Hospital, Shanghai, 201620, China. pinghua661106@126.com.
                [7 ] Department of Obstetrics and Gynecology, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, 200080, China. xixiaowei1966@126.com.
                [8 ] Department of Obstetrics and Gynecology, Minhang Central Hospital, Shanghai, 201100, China. xiaoguo19711001@163.com.
                [9 ] Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China. yanxiaohei00000@163.com.
                [10 ] Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China. zd621@hotmail.com.
                [11 ] Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China. qjchildren736@qq.com.
                [12 ] Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China. zhangjian_ipmch@sjtu.edu.cn.
                [13 ] Institute of Embryo-Fetal Original Adult Disease Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China. zhangjian_ipmch@sjtu.edu.cn.
                Article
                Publisher Item ID: 10.1186/s12884-015-0613-1
                DOI: 10.1186/s12884-015-0613-1
                PMC ID: 4546260
                PubMed ID: 26296545
                SO-VID: 271c28ed-3f39-4ddb-85fb-09171b2a1815
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