The ectopic pregnancy is still a life-threatening condition. The risk factors for ectopic pregnancy are divided into four groups: 1) mechanic factors, 2) tubal dysfunction, 3) assisted reproductive techniques (ART) and 4) hormonal factors.
Material and methods: On basis of the analysis of medical documentation we determined the risk factors for ectopic pregnancy in 214 patients (aged 18-44, mean 32 +/- 9 years) hospitalized in Department of Reproductive Medicine and Gynecology of Pomeranian Medical University between 1993 and 2002. The control group composed 215 patients admitted to the hospital outpatient clinic in the years 1993-2002.
Results: The risk factors for ectopic pregnancy evaluated in each group of patients were: history of adnexitis, surgical procedures (appendectomy, tubal microsurgery, ovarian cystectomy, adnexectomy, myomectomy, cesarean section, previous conservative surgical treatment of ectopic pregnancy, salpingectomy), appendicitis complicated by peritonitis, endometriosis, conservative treatment of ectopic pregnancy, insertion of IUD, ovarian induction or IVF procedure, uterine defects and smoking. In the examined group 104 patients had a history of surgery (48.5%) compare to 40 patients in the control group (18.6%). Difference between groups is significant p = 0,034. In 40 cases out of 104 (18.6%) surgical operations were done two and more times. Statistics proves that surgical procedures in the past occurred significantly more frequently in the studied than in control group. The most frequent operations were: conservative surgical treatment of ectopic pregnancy (p = 0.000), tubal microsurgery (p = 0.0016), ovarian cystectomy (p = 0.013) and salpingectomy (p = 0.047). Appendectomies or myomectomies in the past did not increase the risk of ectopic pregnancy. Additionally, in the examined group there were more cases of MTX (Methotrexate) therapy applied in the past because of ectopic pregnancy (p = 0.000), more smoking (p = 0.0001) and more adnexitis in the past (p = 0.013). Treated endometriosis in the past, artificial reproductive techniques (ART), peritonitis, IUD application and uterine defects were no important risk factors for ectopic pregnancy.
Conclusions: The main risk factors for ectopic pregnancy are: history of surgical procedures, especially conservative surgical treatment of ectopic pregnancy and tubal microsurgery. Appendectomy or myomectomy do not increase this risk. The other important risk factors for ectopic pregnancy are: conservative treatment of ectopic pregnancy in the past and smoking. Adnexitis is another risk factor for ectopic pregnancy.