Ectopic pregnancy: Are fair-colored women at increased risk?

Abstract Background We evaluated the risk of pelvic inflammatory disease (PID), ectopic pregnancy, and infertility in women with a previous Chlamydia trachomatis (CT) diagnosis compared with women who tested negative for CT and CT untested women, considering both targeted and incidental (ie, prescribed for another indication) use of CT-effective antibiotics. Methods This was a retrospective study of women aged 12–25 years at start of follow-up within the Clinical Practice Research Datalink GOLD database linked to index of multiple deprivation quintiles, 2000–2013. CT test status and antibiotic use were determined in a time-dependent manner. Risk of PID, ectopic pregnancy, or female infertility were evaluated using of Cox proportional hazard models. Results We studied 857 324 women, contributing 6 457 060 person-years. Compared with women who tested CT-negative, women who tested CT-positive had an increased risk of PID (adjusted hazard ratio [aHR], 2.36; 95% confidence interval [CI], 2.01–2.79), ectopic pregnancy (aHR, 1.87; 95% CI, 1.38–2.54), and infertility (aHR, 1.85; 95% CI, 1.27–2.68). The PID risk was higher for women with 2 or more positive CT tests than those with 1 positive test. PID risk increased with the number of previous antibiotic prescriptions, regardless of CT test status. Conclusions We showed an association between CT-positive tests and 3 adverse reproductive health outcomes. Moreover, this risk increased with repeat CT infections. CT-effective antibiotic use showed no decreased risks of subsequent PID regardless of CT history. Our results confirm the reproductive health burden of CT, which requires adequate public health interventions.

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Unilateral Twin Ectopic Pregnancy in a Patient With a History of Multiple Sexually Transmitted Infections

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/idog/2006/10306 ◽

2006 ◽

Vol 2006 ◽

pp. 1-3 ◽

Cited By ~ 9

Author(s):

Charles J. Rolle ◽

Clifford Y. Wai ◽

Roger Bawdon ◽

Rigoberto Santos-Ramos ◽

Barbara Hoffman

Keyword(s):

Ectopic Pregnancy ◽

Sexually Transmitted Infections ◽

Fallopian Tube ◽

Lower Abdominal Pain ◽

Rare Condition ◽

Operative Trauma ◽

Sexually Transmitted ◽

Uncommon Presentation ◽

Increased Risk ◽

History Of

Background. The incidence of unilateral twin ectopic pregnancy is a rare condition. Several factors increase the risk of ectopic pregnancy, the most important of which is pelvic inflammatory disease, followed by operative trauma, congenital anomalies, tumors, and adhesions resulting in anatomically distorted fallopian tubes. We present a case of a woman with a history of four confirmed sexually transmitted infections (STIs) including Chlamydia trachomatis, Neisseria gonorrhoeae, herpes simplex virus 2, and Treponema pallidum. The case illustrates the potential impact of sexually transmitted infections (STIs) on the risk of a twin ectopic pregnancy. Case. A 24-year-old primigravida, presented with an unknown last menstrual period, lower abdominal pain, watery vaginal discharge, and vaginal spotting. During this hospitalization, serumβ-HCG testing was 263 mIU/mL and transvaginal ultrasonographic examination suggested a nonviable unilateral twin ectopic pregnancy. At exploratory laparotomy, a 10 cm mass involving the right fallopian tube and ovary was excised. Pathological evaluation of the specimen identified a monochorionic, diamnionic twin ectopic pregnancy within the fallopian tube. Conclusions Patients with a history of multiple (STIs) are known to be at risk for the development of chronic pelvic infection and postinflammatory scarring. The resulting distortion of the normal tubal anatomy leads to an increased risk of an uncommon presentation of ectopic pregnancy.

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Obstetric and perinatal outcomes in pregnancies occurring as a result of Fresh and Thawed frozen embryo transfer

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20193557 ◽

2019 ◽

Vol 8 (8) ◽

pp. 3311

Author(s):

Nishita Shah ◽

K. Jayakrishnan

Keyword(s):

Ectopic Pregnancy ◽

Embryo Transfer ◽

Gestational Hypertension ◽

Tertiary Care ◽

Perinatal Outcomes ◽

Frozen Embryo Transfer ◽

Large For Gestational Age ◽

Research Centre ◽

P Value ◽

Increased Risk

Background: In vitro fertilization is a known independent risk factor for adverse perinatal outcomes. To explore obstetric and perinatal outcomes in pregnancies occurring as a result of fresh and thawed frozen embryo transfer.Methods: Retrospective observational study with 208 patients. A period of 2 years from October 2015 to October 2017. Tertiary care Fertility, Laparoscopy and research centre. All pregnancies conceived by IVF (n= 208) between the study period were included. The patients were grouped by fresh (n= 108) versus frozen (n= 100) embryo transfer. Patients conceived with donor embryo transfer were excluded. Primary outcomes were missed abortions, ectopic pregnancy, live births. Incidence singleton pregnancies and multiple gestations, preterm delivery, birth weight, an obstetric complication includes gestational hypertension, preeclampsia, gestational DM, placenta previa.Results: A total 208 patient analyzed who conceived with IVF treatments, among them 108 patients were in Fresh ET group and 100 were in Frozen ET group. The incidence of Ectopic Pregnancy was more in fresh ET as compared to Frozen ET (14.8%, 02% respectively, p value <0.05) whereas that of missed abortions were more in Frozen ET (22% versus 11.1%, p value 0.03). There were no significant differences in obstetric and perinatal outcomes in both groups.Conclusions: In this study of IVF pregnancies, adverse obstetric and neonatal outcomes did not differ between fresh and frozen embryo transfers. Literature tells that there may be an increased risk of preeclampsia and large for gestational age babies in pregnancies conceiving after frozen embryo transfer. So freeze all policy should be applied to only indicated cases and not to all because both the groups having similar outcomes.

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Benzodiazepine use before conception and risk of ectopic pregnancy

Human Reproduction ◽

10.1093/humrep/deaa082 ◽

2020 ◽

Vol 35 (7) ◽

pp. 1685-1692 ◽

Cited By ~ 4

Author(s):

Elizabeth Wall-Wieler ◽

Thalia K Robakis ◽

Deirdre J Lyell ◽

Reem Masarwa ◽

Robert W Platt ◽

...

Keyword(s):

Anxiety Disorder ◽

Ectopic Pregnancy ◽

Data Access ◽

Prescription Data ◽

Translational Science ◽

Gestational Length ◽

Increased Risk ◽

Benzodiazepine Use ◽

Competing Interest ◽

Ectopic Pregnancies

Abstract STUDY QUESTION Are women who fill a benzodiazepine prescription before conception at increased risk of ectopic pregnancy? SUMMARY ANSWER Risk of ectopic pregnancy is 50% higher among women who fill a benzodiazepine prescription before conception. WHAT IS KNOWN ALREADY Benzodiazepine use in pregnancy increases the risk of miscarriage, adverse birth outcomes and adverse child development outcomes. STUDY DESIGN, SIZE, DURATION Using data from US commercial insurance claims, we performed a cohort study of 1 691 366 pregnancies between 1 November 2008 and 30 September 2015. PARTICIPANTS/MATERIALS, SETTING, METHODS We identified ectopic pregnancies using diagnosis and procedure codes and used unadjusted and inverse probability of treatment (IPT)-weighted log-binomial models to calculate relative risks (RR) of ectopic pregnancy for pregnant women who did and did not fill any prescriptions for benzodiazepines in the 90 days before conception. Two sub-groups of women with specific indications for benzodiazepine use were also examined—women who had a least one diagnosis for anxiety disorder and women who had at least one diagnosis of insomnia in the year before conception. MAIN RESULTS AND THE ROLE OF CHANCE Of the 1 691 366 pregnancies, 1.06% filled at least two benzodiazepine prescriptions totaling at least 10 days supply in the 90 days before conception. Among women with a benzodiazepine prescription, there was an excess of 80 ectopic pregnancies per 10 000 pregnancies, and their IPT-weighted risk of ectopic pregnancies was 1.47 (95% CI 1.32 to 1.63) times greater relative to women without benzodiazepine prescriptions before conception. The IPT-weighted RR between ectopic pregnancy and benzodiazepine use was 1.34 (95% CI 1.18 to 1.53) among women with anxiety disorder diagnoses and 1.28 (95% CI 0.99 to 1.68) among women with an insomnia diagnosis. LIMITATIONS, REASONS FOR CAUTION We relied on outpatient prescription data to identify benzodiazepine use before conception, which could result in over- or under-estimation of actual benzodiazepine consumption. We relied on medical claim codes to identify pregnancies and conception date, which may result in misclassification of pregnancy outcomes and gestational length. WIDER IMPLICATIONS OF THE FINDINGS This study found that women who have a benzodiazepine prescription before conception are at an increased risk of ectopic pregnancy. This information can help women, and their healthcare providers make more fully informed decisions about benzodiazepine use in their reproductive years. STUDY FUNDING/COMPETING INTEREST(S) Funding for this project was provided by a Banting Postdoctoral Fellowship and a Stanford Maternal and Child Health Research Institute Postdoctoral Award. Data access for this project was provided by the Stanford Center for Population Health Sciences Data Core. The PHS Data Core is supported by a National Institutes of Health National Center for Advancing Translational Science Clinical and Translational Science Award (UL1 TR001085) and internal Stanford funding. The authors have no competing interest. TRIAL REGISTRATION NUMBER N/A.

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Effect of endometrial preparation protocols on the risk of ectopic pregnancy for frozen embryo transfer

Scientific Reports ◽

10.1038/s41598-021-97044-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Seung Chik Jwa ◽

Masashi Takamura ◽

Akira Kuwahara ◽

Takeshi Kajihara ◽

Osamu Ishihara

Keyword(s):

Ectopic Pregnancy ◽

Embryo Transfer ◽

Hormone Replacement ◽

Total Sample ◽

Frozen Embryo Transfer ◽

Early Cleavage ◽

Endometrial Preparation ◽

Increased Risk ◽

Similar Risk ◽

Natural Cycles

AbstractStudies have consistently reported a significantly reduced incidence of ectopic pregnancy (EP) for frozen-thawed embryo transfer (ET) cycles compared with fresh cycles. However, only a few studies reported an association between endometrial preparation protocols on EP and results were conflicting. A registry-based retrospective cohort study of 153,354 clinical pregnancies following frozen single ETs between 2014 and 2017 were conducted, of which 792 cases of EP (0.52%) were reported. Blastocyst embryo transfers accounted for 87% of the total sample and were significantly associated with a decreased risk for EP compared with early cleavage ET (0.90% vs. 0.46%, adjusted OR = 0.50, 95% CI, 0.41 to 0.60). Compared with natural cycles, hormone replacement cycles (HRC) demonstrated a similar risk for EP (0.53% vs. 0.47%, adjusted OR = 1.12, 95% CI, 0.89 to 1.42). Subgroup analysis with or without tubal factor infertility and early cleavage/blastocyst ETs demonstrated similar non-significant associations. Endometrial preparation protocols using clomiphene (CC) were associated with a significantly increased risk for EP (1.12%, adjusted OR = 2.34; 95% CI, 1.38 to 3.98). These findings suggest that HRC and natural cycles had a similar risk for EP. Endometrial preparation using CC was associated with an increased risk of EP in frozen embryo transfer cycles.

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Symptom-free women at increased risk of ectopic pregnancy: should we screen?

Acta Obstetricia Et Gynecologica Scandinavica ◽

10.1034/j.1600-0412.2002.810713.x ◽

2002 ◽

Vol 81 (7) ◽

pp. 661-672 ◽

Cited By ~ 23

Author(s):

Ben W. J. Mol ◽

Fulco Van der Veen ◽

Patrick M. M. Bossuyt

Keyword(s):

Ectopic Pregnancy ◽

Increased Risk ◽

Free Women

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Risk Factors for Ectopic Pregnancy: A Case-Control Study in Tertiary Care Hospitals of Jammu and Kashmir

Iberoamerican Journal of Medicine ◽

10.53986/ibjm.2021.0048 ◽

2021 ◽

Vol 3 (4) ◽

pp. 293-299

Author(s):

Neha Mahajan ◽

◽

Rohit Raina ◽

Pooja Sharma ◽

◽

...

Keyword(s):

Risk Factors ◽

Confidence Interval ◽

Ectopic Pregnancy ◽

Odds Ratio ◽

Tertiary Care ◽

Previous History ◽

Tubal Ligation ◽

Increased Risk ◽

Study Results ◽

History Of

Introduction: An ectopic pregnancy occurs when a fertilized egg attaches somewhere outside the uterus.There are many risk factors for ectopic pregnancy. This study will help us to prepare a list of risk factors associated with ectopic pregnancy in our state. In addition, it will help implement a risk-reduction counseling program before conception, which will help us screen high-risk patients and reduce and manage ectopic pregnancy. Materials and methods: The present study was conducted in our department for two years, from August 2018 to July 2019. Cases included all patients with ectopic pregnancy admitted in labor. A total of 192 cases were taken, out of which 8 cases refused to participate in the study, so 184 patients were included in the study. Results: Patients with previous ectopic pregnancy have 6.34 times increased risk of a repeat ectopic pregnancy (odds ratio 6.34, confidence interval 1.40-28.77), and this association was highly significant (p = 0.006). The risk of ectopic pregnancy is 3.02 times increased (odds ratio 3.10; 95% confidence interval, 1.16-7.84) if the patient once had the pelvic inflammatory disease and is statistically significant (p = 0.01). The study also revealed that 17 (10.3%) patients with ectopic pregnancy had a history of tubal ligation or some other tubal surgery done in the past compared to 3 (2.2%) patients among controls, and this finding is statistically highly significant (p = 0.001). Conclusions: In the present study, we found that the main risk factors for incidence of ectopic pregnancy are prior ectopic pregnancy, prior tubal ligation, and prior pelvic/abdominal surgery. In addition, ectopic pregnancy was positively related to the previous history of ectopic pregnancy, abortion, cesarean section, and infertility. These findings can be helpful for early diagnosis of ectopic pregnancy to pursue proper medical therapy instead of unnecessarily surgical treatment.

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Is a thin endometrial lining associated with increased risk of ectopic pregnancy in single euploid frozen embryo transfers?

Fertility and Sterility ◽

10.1016/j.fertnstert.2018.07.619 ◽

2018 ◽

Vol 110 (4) ◽

pp. e214-e215

Author(s):

S. Chang ◽

T.G. Nazem ◽

C. Hernandez-Nieto ◽

D. Gounko ◽

J. Lee ◽

...

Keyword(s):

Ectopic Pregnancy ◽

Increased Risk ◽

Frozen Embryo Transfers

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Risk factors associated with ectopic pregnancy in our sociodemographic setup

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20204304 ◽

2020 ◽

Vol 9 (10) ◽

pp. 4150

Author(s):

Nikita Gandotra ◽

Shazia Zargar

Keyword(s):

Risk Factors ◽

Ectopic Pregnancy ◽

Contraceptive Use ◽

Intrauterine Device ◽

Chlamydia Infection ◽

Contraceptive Device ◽

Pelvic Infection ◽

Barrier Methods ◽

Increased Risk ◽

History Of

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.

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