Aim: To identify women with high risk of ectopic pregnancy (EP) and identify modifiable risk factors.
Materials and methods: It is an observational prospective case.control study, conducted in the Obstetrics and Gynecology Department of BR.D Medical College, Gorakhpur, a tertiary center of eastern Uttar Pradesh, India. A total of 144 cases who were diagnosed with EP and 200 controls with intrauterine pregnancies were recruited for the study over the 1-year period from April 2015 to March 2016. Information regarding the social, obstetrical, gynecological, surgical history, and previous and current use of contraceptives was collected from all recruited patients.
Observation: The study revealed that the incidence of EP was 23.67/1,000 antenatal checkup admissions in our institution. Risk of EP was associated with maternal age of ≥30 years (χ2 = 4.077, p < 0.05), previous ≥2 full-term deliveries (χ2 = 4.554, p < 0.05), previous infertility of >1 year duration (χ2 = 14.85, p < 0.05), previous ≥1 spontaneous abortion [odds ratio (OR) = 6.879, confidence interval (CI) = 0.3760.125.9], history of postabortion infection (OR = 4.053, CI: 1.263.13.00), history of puerperal infection (OR = 4.064, CI: 0.4181.35.50), previous adnexal surgery (OR = 1.876, 95% CI: 0.4133.8.578), previous appendicectomy (OR = 1.394, 95% CI: 0.1940.10.02), previous cesarean section (OR = 1.446, 95% CI: 0.8408.2.486), previous genital tuberculosis (TB) (OR = 2.803, 95% CI: 0.2516.31.23), previous extragenital TB (OR = 4.378, 95% CI: 126.96.36.199), and previous tubal corrective surgery (OR = 9.919, 95% CI: 0.5080.193.7). In women with current use of contraception, EP risk was increased only with the failure of permanent sterilization (OR = 2.829, 95% CI: 0.5108.15.66). The levonorgestrel emergency contraception (LNG EC) in current cycle was associated with increased risk of EP (OR = 1.993, 95% CI: 0.6194.6.411). Besides, this present study does not show any association between traditional risk factors like previous EP and previous or current use of intrauterine device.
Conclusion: By identifying risk factors being amenable to modification, such as postabortion and puerperal infection, the effective risk-reduction strategies should be devised that helps in safe motherhood. Guidelines for adnexal surgeries and appendicectomy should be targeted for reduction of postoperative adhesion. Intraoperative and postoperative precautions should be taken to reduce adhesion. Over-the-counter availability of LNG EC should be stopped because irrational and inappropriate use of LNC EC has come out as an important emerging risk factor for EP. Tuberculosis has come out as a major risk factor of EP. Being a developing country, we are still fighting with mycobacterium TB, which is a silent moth of human organ system.
Clinical significance: There is no doubt that the long-time known risk factors like infertility, pelvic inflammatory disease, adnexal surgeries, and tubal surgeries are still playing major roles in causation of EP. Tuberculosis is a major risk factor for EP. The LNG EC is now emerging as a risk factor for EP. Inappropriate use of LNG EC was mostly associated with EP.
Keywords: Ectopic pregnancy, Intrauterine devices, Intrauterine pregnancy, Levonorgestrel emergency contraception.
How to cite this article: Singh R, Anand RS, Shrivastava R, Vahikar SU. Risk Factors Assessment for Ectopic Pregnancy in Tertiary Center of Eastern Uttar Pradesh. J South Asian Feder Obst Gynae 2017;9(2):100-105.
Source of support: Nil
Conflict of interest: None
Date of received: 22 November 2016
Date of acceptance: 8 February 2017
Date of publication: March 2017