ABSTRACT
Study Objective
To evaluate the rate of a third ectopic pregnancy according to the modality of treatment
of the second ectopic pregnancy.
Design
Retrospective cohort study.
Setting
University-affiliated tertiary medical center.
Patients
One hundred eleven women who had 2 ectopic pregnancies and a third consecutive pregnancy
between 2003 and 2018.
Interventions
Surgery or medical treatment as required.
Measurements and Main Results
With regard to the modality of treatment of the second ectopic pregnancy, the patients
were divided into 3 groups: expectant management, medical treatment with methotrexate,
and laparoscopic salpingectomy. Univariate and multivariate analyses were conducted
to assess the association of various parameters of the second ectopic pregnancy with
the occurrence of a third ectopic pregnancy in the consecutive pregnancy. Twenty women
(18.0%) were managed expectantly, 55 (49.6%) were treated with methotrexate, and 36
(32.4%) underwent surgery. Expectant management resulted in significantly higher rates
of a third ectopic pregnancy compared with treatment with methotrexate or surgical
intervention (50.0% vs 18.2% and 13.8%, respectively; p = .005). In the cases of 2
ipsilateral ectopic pregnancies, the interventional approach (medical or surgical
treatment) resulted in lower recurrence rates compared with expectant management (25.7%
vs 60.0%, respectively; p = .043).
Conclusion
The risk of a third episode of an ectopic pregnancy after expectant management of
a second ectopic pregnancy is extremely high. An interventional approach by treatment
with methotrexate or salpingectomy is therefore preferred for recurrent ectopic pregnancy
management, especially in ipsilateral recurrences.
Keywords
To read this article in full you will need to make a payment
AAGL Member Login
AAGL Member, full access to the journal is a member benefit. Use your society credentials to access all journal content and features.
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Purchase one-time access:
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Ectopic pregnancy–United States, 1990-1992.MMWR Morb Mortal Wkly Rep. 1995; 44: 46-48
- Epidemiology of ectopic pregnancy: incidence and risk factors [article in French].Contracept Fertil Sex. 1996; 24: 135-139
- Screening for chlamydial infections and the risk of ectopic pregnancy in a county in Sweden: ecological analysis.BMJ. 1998; 316: 1776-1780
- Estimates of the annual number of clinically recognized pregnancies in the United States, 1981–1991.Am J Epidemiol. 1999; 149: 1025-1029
- Fertility outcome after ectopic pregnancy and use of an intrauterine device at the time of the index ectopic pregnancy.Hum Reprod. 2000; 15: 1173-1177
- Ectopic pregnancy.Lancet. 2005; 366: 583-591
- Risk factors and clinical features of recurrent ectopic pregnancy: a case control study.Fertil Steril. 2003; 80: 1340-1344
- Risk factors for ectopic pregnancy in women with symptomatic first-trimester pregnancies.Fertil Steril. 2006; 86: 36-43
- Prediction of recurrent ectopic pregnancy: a five-year follow-up cohort study.Eur J Obstet Gynecol Reprod Biol. 2018; 225: 70-78
- Clinical practice. Ectopic pregnancy.N Engl J Med. 2009; 361: 379-387
- Risk factors for ectopic pregnancy: a comprehensive analysis based on a large case-control, population-based study in France.Am J Epidemiol. 2003; 157: 185-194
- ACOG practice bulletin no. 191: tubal ectopic pregnancy.Obstet Gynecol. 2018; 131: e65-e77
- Reproductive outcome following two ectopic pregnancies.Fertil Steril. 1985; 43: 82-85
- Reproductive performance of women after two tubal ectopic pregnancies.Fertil Steril. 1988; 50: 164-166
- Fertility after tubal ectopic pregnancy: results of a population-based study.Fertil Steril. 2012; 98 (e1–e3): 1271-1276
- Mechanisms of disease: the endocrinology of ectopic pregnancy.Expert Rev Mol Med. 2012; 14: e7
- Current knowledge of the aetiology of human tubal ectopic pregnancy.Hum Reprod Update. 2010; 16: 432-444
- Attenuated sex steroid receptor expression in fallopian tube of women with ectopic pregnancy [published correction appears in J Clin Endocrinol Metab. 2013;98:4992].J Clin Endocrinol Metab. 2009; 94: 5146-5154
- Success rate of methotrexate treatment for recurrent vs. primary ectopic pregnancy: a case-control study.J Obstet Gynaecol. 2020; 40: 507-511
- Methotrexate or expectant management in women with an ectopic pregnancy or pregnancy of unknown location and low serum hCG concentrations? A randomized comparison.Hum Reprod. 2013; 28: 60-67
- Efficacy and safety of a clinical protocol for expectant management of selected women diagnosed with a tubal ectopic pregnancy.Ultrasound Obstet Gynecol. 2013; 42: 102-107
- Comparison of the pregnancy outcomes between the medical and surgical treatments in tubal ectopi pregnancy.Int J Reprod Biomed. 2018; 16: 31-34
Article Info
Publication History
Published online: December 10, 2020
Accepted:
December 5,
2020
Received in revised form:
December 3,
2020
Received:
July 28,
2020
Footnotes
The authors declare that they have no conflict of interest.
Oral presentation at the 29th Australasian Gynaecological Endoscopy and Surgery Society annual scientific meeting on March 7, 2019, in Perth, Australia.
The study was approved by the human investigation review board of Hadassah Hebrew University Medical Center (IRB 0684-18-HMO; November 28, 2018).
Gilad Karavani and Einat Gutman-Ido contributed equally to this work.
Identification
Copyright
© 2020 AAGL. All rights reserved.
