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An Analysis Of Etiological Risk Factors And Subsequent Fertility

The incidence of ectopic pregnancies has increased significantly in the region around Oulu Finland from 10.9-20.9 between 1973-1982. Increased use of IUDs and a comparable increase in the percentage of 2-paras correlated with the increase in ectopic pregnancies in Oulu. A Finnish researcher examined retrospective and prospective age and parity matched case control studies among 552 women with ectopic pregnancy and a follow up study of infertile women to determine the risk factors for ectopic pregnancy. Previous pelvic surgery particularly tubal surgery and treatment of an earlier ectopic pregnancy; entry of the uterine cavity with medical instruments; gynecological infections; infertility; and an IUD were significant risk factors for ectopic pregnancy. For those women who had suffered an ectopic pregnancy and were infertile the risk factors included ectopic pregnancy; tubal surgery especially surgical restoration of a Fallopian tube and working in industry. The study could not determine reasons nulliparous women experienced and ectopic pregnancy. Infertile women who had pelvic infections tubal surgery and/or an earlier ectopic pregnancy had a high risk of ectopic pregnancy. 70% of the ectopic pregnancy patients underwent a salpingectomy. Of the 323 women who wished to conceive again the conception rate was 82% delivery rate 64% and recurrent ectopic pregnancy rate 11%. The operation method was not as an important predictor of subsequent fertility as were condition of the tube and parity. Research is needed to identify risk factors for ectopic pregnancy for nulliparous women. Physicians should consider any woman who is infertile and had a previous ectopic pregnancy tubal surgery and works in industry to be at high risk for ectopic pregnancy and use modern diagnostic tools to distinguish between ectopic and intrauterine pregnancy during the 5th week of amenorrhea. As for fertile and parous women with an IUD in situ they should consider an ectopic pregnancy if pain and bleeding develops.