Iberoamerican Journal of Medicine
https://iberoamjmed.com/article/doi/10.53986/ibjm.2021.0048
Iberoamerican Journal of Medicine
Original article

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

Factores de riesgo para el embarazo ectópico: un estudio de casos y controles en hospitales de atención terciaria de Jammu y Cachemira

Neha Mahajan, Rohit Raina, Pooja Sharma

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Abstract

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.

Keywords

Ectopic pregnancy; Pelvic inflamatory disease; Risk factors

Resumen

Introducción: Un embarazo ectópico ocurre cuando un óvulo fertilizado se adhiere en algún lugar fuera del útero. Existen muchos factores de riesgo para el embarazo ectópico. Este estudio nos ayudará a preparar una lista de factores de riesgo asociados con el embarazo ectópico en nuestro estado. Además, ayudará a implementar un programa de asesoramiento para la reducción de riesgos antes de la concepción, que nos ayudará a evaluar a las pacientes de alto riesgo y reducir y controlar el embarazo ectópico.
Materiales y métodos: El presente estudio se realizó en nuestro servicio durante dos años, de agosto de 2018 a julio de 2019. Los casos incluyeron a todas las pacientes con embarazo ectópico ingresadas en trabajo de parto. Se tomaron un total de 192 casos, de los cuales 8 casos se negaron a participar en el estudio, por lo que se incluyeron 184 pacientes en el estudio.
Resultados: Las pacientes con un embarazo ectópico previo tienen un riesgo 6,34 veces mayor de un embarazo ectópico repetido (razón de probabilidades 6,34, intervalo de confianza 1,40-28,77), y esta asociación fue muy significativa (p = 0,006). El riesgo de embarazo ectópico aumenta 3,02 veces (razón de posibilidades 3,10; intervalo de confianza del 95%, 1,16-7,84) si la paciente tuvo una vez la enfermedad inflamatoria pélvica y es estadísticamente significativa (p = 0,01). El estudio también reveló que 17 (10,3%) pacientes con embarazo ectópico tenían antecedentes de ligadura de trompas o alguna otra cirugía de trompas realizada en el pasado en comparación con 3 (2,2%) pacientes entre los controles, y este hallazgo es estadísticamente muy significativo (p = 0,001).
Conclusiones: En el presente estudio, encontramos que los principales factores de riesgo de incidencia de embarazo ectópico son embarazo ectópico previo, ligadura de trompas previa y cirugía pélvica/abdominal previa. Además, el embarazo ectópico se relacionó positivamente con la historia previa de embarazo ectópico, aborto, cesárea e infertilidad. Estos hallazgos pueden ser útiles para el diagnóstico temprano de embarazo ectópico para buscar una terapia médica adecuada en lugar de un tratamiento quirúrgico innecesario.

Palabras clave

Embarazo ectópico; Enfermedad inflamatoria pélvica; Facvtores de riesgo

References

1. Nitesh M, Bairwa R, Sharma S. Study of ectopic pregnancy in a tertiary care center. Int J Reprod Contracept Obstet Gynecol. 2020;9(1):212-5. doi: 10.18203/2320-1770.ijrcog20196022.
2. Jurkovic D, Wilkinson H. Diagnosis and management of ectopic pregnancy. BMJ. 2011;342:d3397. doi: 10.1136/bmj.d3397.
3. Karaer A, Avsar FA, Batioglu S. Risk factors for ectopic pregnancy: a case-control study. Aust N Z J Obstet Gynaecol. 2006;46(6):521-7. doi: 10.1111/j.1479-828X.2006.00653.x.
4. Majhi AK, Roy N, Karmakar KS, Banerjee PK. Ectopic pregnancy--an analysis of 180 cases. J Indian Med Assoc. 2007;105(6):308, 310, 312 passim.
5. Chow WH, Daling JR, Cates W Jr, Greenberg RS. Epidemiology of ectopic pregnancy. Epidemiol Rev. 1987;9:70-94. doi: 10.1093/oxfordjournals.epirev.a036309.
6. Anorlu RI, Oluwole A, Abudu OO, Adebajo S. Risk factors for ectopic pregnancy in Lagos, Nigeria. Acta Obstet Gynecol Scand. 2005;84(2):184-8. doi: 10.1111/j.0001-6349.2005.00684.x.
7. Kopani F, Rrugia A, Manoku N. Ectopic pregnancy comparison of different treatments. J Prenat Med. 2010;4(2):30-4.
8. Panchal D, Vaishnav G, Solanki K. Study of Management in Patient with Ectopic Pregnancy. Natl J Integr Res Med. 2011;2(3):86-8.
9. Ankum WM, Mol BW, Van der Veen F, Bossuyt PM. Risk factors for ectopic pregnancy: a meta-analysis. Fertil Steril. 1996;65(6):1093-9.
10. Jacob L, Kalder M, Kostev K. Risk factors for ectopic pregnancy in Germany: a retrospective study of 100,197 patients. Ger Med Sci. 2017;15:Doc19. doi: 10.3205/000260.
11. Moini A, Hosseini R, Jahangiri N, Shiva M, Akhoond MR. Risk factors for ectopic pregnancy: A case-control study. J Res Med Sci. 2014;19(9):844-9.
12. Barnhart KT, Sammel MD, Gracia CR, Chittams J, Hummel AC, Shaunik A. Risk factors for ectopic pregnancy in women with symptomatic first-trimester pregnancies. Fertil Steril. 2006;86(1):36-43. doi: 10.1016/j.fertnstert.2005.12.023.
13. Bouyer J, Coste J, Shojaei T, Pouly JL, Fernandez H, Gerbaud L, et al. Risk factors for ectopic pregnancy: a comprehensive analysis based on a large case-control, population-based study in France. Am J Epidemiol. 2003;157(3):185-94. doi: 10.1093/aje/kwf190.
14. Adewunmi AA, Orekoya OO, Rabiu KA, Ottun TA. The Association between Chlamydia trachomatis and Ectopic Pregnancy in Lagos, Nigeria-A Case Control Study. Open J Obstet Gynecol. 2015;5(2):115-22. doi: 10.4236/ojog.2015.52015.
15. Agholor K, Omo-Aghoja L, Okonofua F. Association of anti-Chlamydia antibodies with ectopic pregnancy in Benin city, Nigeria: a case-control study. Afr Health Sci. 2013;13(2):430-40. doi: 10.4314/ahs.v13i2.33.
16. Coste J, Job-Spira N, Fernandez H, Papiernik E, 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):839-49. doi: 10.1093/oxfordjournals.aje.a115964.
17. Fernandez H, Coste J, Job-Spira N. Controlled ovarian hyperstimulation as a risk factor for ectopic pregnancy. Obstet Gynecol. 1991;78(4):656-9.
18. Oelsner G, Menashe Y, Tur-Kaspa I, Ben-Rafael Z, Blankstein J, Serr DM, Mashiach S. The role of gonadotropins in the etiology of ectopic pregnancy. Fertil Steril. 1989;52(3):514-6. doi: 10.1016/s0015-0282(16)60929-9.
19. Tharaux-Deneux C, Bouyer J, Job-Spira N, Coste J, Spira A. Risk of ectopic pregnancy and previous induced abortion. Am J Public Health. 1998;88(3):401-5. doi: 10.2105/ajph.88.3.401.
20. Skjeldestad FE, Gargiullo PM, Kendrick JS. Multiple induced abortions as risk factor for ectopic pregnancy. A prospective study. Acta Obstet Gynecol Scand. 1997;76(7):691-6. doi: 10.3109/00016349709024612.
21. Atrash HK, Strauss LT, Kendrick JS, Skjeldestad FE, Ahn YW. The relation between induced abortion and ectopic pregnancy. Obstet Gynecol. 1997;89(4):512-8. doi: 10.1016/s0029-7844(97)00050-1.
22. Asuri SS, Kalpana P. A clinical study of ectopic pregnancy. Int J Reprod Contracept Obstet Gynecol. 2016;5(11):3750-3. doi: 10.18203/2320-1770.ijrcog20163643.
23. Kumar SP, Pratiksha G, Poonam G, Alka S, Anju H, Kataria S, et al. Ectopic Pregnancy: a diagnostic dilemma Int. J Reprod Contracept Obstet Gynecol. 2016;5(2):367-70. doi: 10.18203/2320-1770.ijrcog20160371.
24. Yadav A, Prakash A, Sharma C, Pegu B, Saha MK. Trends of ectopic pregnancies in Andaman and Nicobar Islands. Int J Reprod Contracept Obstet Gynecol. 2017;6:15-9. doi: 10.18203/2320-1770.ijrcog20164499.
25. Priyadarshini B, Padmasri R, Jnaneshwari TL, Sowmya KP, Bhatara U, Hema V. Ectopic pregnancy: a cause for maternal morbidity. Int J Reprod Contracept Obstet Gynecol. 2017;5(3):700-4. doi: 10.18203/2320-1770.ijrcog20160569.


Submitted date:
05/20/2021

Reviewed date:
06/26/2021

Accepted date:
07/18/2021

Publication date:
08/04/2021

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