Risk factors associated with ectopic pregnancy in our sociodemographic setup

Nikita Gandotra; Shazia Zargar

doi:10.18203/2320-1770.ijrcog20204304

Authors

Nikita Gandotra Department of Obstetrics and Gynaecology, SMGS Hospital, Jammu, Jammu and Kashmir, India
Shazia Zargar Department of Obstetrics and Gynaecology, SMGS Hospital, Jammu, Jammu and Kashmir, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20204304

Keywords:

Ectopic, Chlamydia, Tuberculosis

Abstract

Background: Ectopic pregnancy (EP) is assuming greater importance because of its increasing incidence and its impact on woman’s fertility.

Aim: To assess the frequency and to determine an association between the studied risk factors and ectopic pregnancy.

Methods: A retrospective study was conducted for the role of several risk factors in the occurrence of EP in department of obstetrics and Gynaecology, SMGS Hospital. A total of 110 cases and 110 controls were compared for socio demographic characteristics, cigarette smoking, obstetrical and gynaecological history, PID, past exposure to Chlamydia, surgical histories, the presence of assisted conception and contraceptive usage.

Results: The main risk factors for ectopic pregnancy were history of tuberculosis (TB) (odds ratio (OR)=12.11), history of infertility (p=0.001), abortions (p=0.01) and a history of prior ectopic pregnancy (OR=8.549). Other risk factors found to be associated with an increased risk for ectopic pregnancy were Pelvic inflammatory disease (PID)/Chlamydia infection (OR=5.63), endometriosis (5.40), induced conception cycle (OR=3.063), intrauterine device usage (OR=3.55), prior caesarean section (OR=2.83) and appendectomy (OR=2.25). On the contrary, barrier methods (OR=0.28) and oral contraceptive use (OR=0.28) were protective from ectopic pregnancy.

Conclusion: Pelvic infection particularly TB was found to be a major etiological factor for EP in our setup. Furthermore, other factors found to be associated with ectopic pregnancy, such as prior ectopic pregnancy and infertility history may be the result of a previous pelvic infection that caused tubal sequele. Thus, these factors are potential targets for intervention and modification. Further, patients with previous abortions, pelvic surgeries, induced conception cycle and intrauterine contraceptive device (IUCD) users should be counselled about the possible risk when they conceive.

Metrics

Metrics Loading ...

References

Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ and Spong CY. Ectopic pregnancy in William obstetrics, 23rd edition. 2010;10:238-9.

Kumar P, Malhotra N. In Jeffcoates principles of Gynaecology, 7th Edition revised and updated by Kumar P and Malhotra N. 2008;9:142-51.

Farguhar CM. Ectopic pregnancy Lancet. 2005;366(9485):583-591.

Cunningham FG, Mac Donald PC and Norman FG. Ectopic pregnancy. In William obstetric, 18th Edition. Appleton and Lanse; 1989;511-532.

Centers for disease control. Ectopic pregnancy – United States, 1988 -1989. 1992;41:591.

Bouyer J, Coste J, Shojaei T, Pauly JC, Fernandez H, Gerbaud L and Job-Spira N. Risk factors for Ectopic pregnancy: A comprehensive analysis based on a large case control, population-based study in France. American Journal of Epidemiology. 2003;157(3);185-94.

Anorlu RI, Oluwole A, Abudu OO and Adebajo S. Risk factors for Ectopic Pregnancy in Lagos, Nigeria. Acta Obstet Gynaecol scand. 2005;84(2):184-8.

Saraiya M, Berg CJ, Kendrick JS, Strauss LT, Atrash HK and Ahn YW. Cigarette smoking as a risk factor for ectopic pregnancy. Am J Obstet Gynecol. 1998;178(3):493-8.

Cleland K, Raymond E, Trussell J, Cheng L and Zhu H. Ectopic pregnancy and emergency contraceptive pills: a systematic review. Obstet Gynaecol. 2010;115(6):1263-6.

Sivalingam VN, Duncan WC, Kirk E, Shephard LA and Andrew W. Diagnosis and management of ectopic pregnancy. Journal of family planning and reproductive health care. 2011;37(4):231-40.

Yuk JS, Kim YJ, Hur JY and Shin JH. Association between socioeconomic status and ectopic pregnancy rate in the republic of Korea. Int. J. Gynaecol Obstet. 2013;122(2):104-7.

Aboyeji AP. Trends in Ectopic pregnancy in Ilorin, Nigeria. Nigeria Medical Practitioner. 2000;38:4-6.

Handler A, Davis F, Ferre C and Yeko T. The relationship of smoking and ectopic pregnancy. Am J Public Health. 1989;79(9):1239-42.

Bastianelli C, Lucantoni V, Valente A, Farris M, Lippa A and Dionisi B. Risk factors for ectopic pregnancy: a case control study. Minerva Gynaecol. 1998;50(11):469-73.

Tharaux-Beneux C, Bouyer J, Job-Spira N, Coste J and Spira A. Risk of ectopic pregnancy and previous induced abortion. Am J Public Health. 1998;88(3):401-5.

Aziz S, Alwafi B and Alswadi H. Frequency of ectopic pregnancy in a medical centre, kingdom of Saudi Arabia. Journal of Pakistan Medical Association. 2011;61(3):221-4.

Al Daheen G. Ectopic pregnancy, a prospective study in Al Batool. Teaching hospital in Mosul Iraq. Al Kindy Col Med. J. 2007;4(1):63-9.

Jobspira N, Collect P, Coste J, Bremond A and Laumon B. Risk factors for ectopic pregnancy. Result of a case control Study in the Rhone – Alpes region. Contracept Fertile Sex. 1993;21(4):307-12.

Hunter RHF. Tubal ectopic Pregnancy: A pathophysiological explanation involving endometriosis. Oxford Journals, Medicine, Human Reproduction. 2002;17(7):1688-91.

Mol BWJ, Ankum W M, Van deer Veen F, and Bossuyt PMM. Risk indicators for ectopic pregnancy: a meta-analysis Contraception 1995; 52: 337-41. Obstetric and Gynecological Survey. 1996;51:363-4. Fertility and Sterility. 1996;65:1093-9.

Ghosh K, Chowdhury JR. Tuberculosis and female reproductive health. Journal of postgraduate medicine. 2011;57(4):307-13.

Shah N, Khan NH. Ectopic pregnancy: presentation and risk factors. Journal of the college of physicians and surgeons Pakistan: JCPSP. 2005;15(9):535-8.

Agholor K, Omo Aghoja L and Okonofua F. Association of anti Chlamydia antibodies with ectopic pregnancy in Benin city, Nigeria; a case control study. African Health Sciences. 2013;13(2):430-40.

Malak M, Tawfeeq T, Holzer H and Tulandi T. Risk factors for Ectopic pregnancy after In vitro Fertilization Treatment. J Obstet Gynaecol Can. 2011;33(6):617-9.

Ankum WM, Mol BW, Vander Veen F and Bossuyt PM. Risk Factors for Ectopic Pregnancy: a meta-analysis. Fertir Steril. 1996;65(6):1093-9.

Karaer A, Avsar FA and Batioqlu S. Risk factors for Ectopic Pregnancy: A case –Control Study. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2006;46(6):521-7.

Fernandez H, Coste J and Job-Spira N. Controlled Ovarian hyper stimulation as a risk factor for Ectopic Pregnancy. Obstet Gynaecol. 1991;78(4):656-9.

Mol BWJ, Ankum WM, Bossuyt PM and Van deer Veen F. Contraception and the risk of ectopic pregnancy: Meta-Analysis. Contraception. 1995;52:337-41.

Basu A, Candelier C. Ectopic Pregnancy with postcoital Contraception- A case report. Eur J contracept Reprod Health Care. 2005;10(1):6-8.

Jain S H, Ghike S, Gawande MS, Joshi SA, Kawthalkar AS and Somalwar SA. LNG Emergency contraceptive pills: Risk factors for pregnancy. J South Asian Feder Obst Gynae. 2013;5(2):87-8.

Karnus LL, Egerup P, Skovlund C W and Lidegaard O. Long-term reproductive outcomes in women whose first pregnancy is ectopic: a national controlled follow-up study. Oxford journals, Medicine, Human Reproduction journal. 2012;28(1):241-6.

Coste J, Job-Spira N, Fernandez H, Papiemik E and Spira A. Risk factors for ectopic pregnancy: A Case control Study in France, with special Focus on infectious factors. Am. J. Epidemiol. 1991;133(9):839-9.

Michalas S, Minaretzis D, Tsionou C, Maos G, Kioses E and Aravantinos D. Pelvic Surgery, reproductive factors and risk of ectopic pregnancy: a case-controlled study. Int. J Gynaecol Obstet. 1992;38(2):101-5.

Strandell A, Thorburn J and Hamberger L. Risk factors for Ectopic pregnancy in assisted Reproduction. Fertility and Stertility. 1999;71(2):282-6.

Brodowska A, Szydlowska I, Starczewski A, Strojny K, Puchalski A, Mieczkowska E and Wozniak W. Analysis of risk factors for ectopic pregnancy in own material in the years 1993-2002. Europe Pub Med Central. 2005;18(103):74-7.