Future Outcomes Are Reassuring After Ectopic Pregnancy

In a study comparing the reproductive outcomes after an initial ectopic pregnancy (EP) with those after a live birth, miscarriage, or termination of a first pregnancy, EP was associated with a reduced likelihood of future conception compared with miscarriage and an overall increased risk of a second EP.¹ The researchers report that this is the first population-based comparison of reproductive outcomes after an ectopic or intrauterine pregnancy.

Between 1981 and 2000, researchers in Scotland used a national database and hospital discharge data to identify first pregnancies. Of those who met inclusion criteria, 2969 women had an EP, 39,705 women had a miscarriage, 78,697 women underwent termination, and 667,299 had a live birth.

The risk of a second EP was 13 times higher in women who had an initial EP than in women who had an initial live birth. There was also an increased risk of miscarriage and stillbirth after an initial EP. Conception within 2 years was 2.76 times more likely in women who had an initial EP than in women who had a live birth-an association that may be explained as a function of family planning. However, a second conception was significantly less likely in women who had an EP than in women who had a miscarriage. Whether this difference was related to emotional factors, such as fear of trying to conceive because of apprehension about another loss, or physical factors is unknown.

Women with an initial EP who later had a continuing pregnancy were significantly more likely to have preeclampsia, preterm delivery, and emergency cesarean delivery than women who had an initial live birth. Despite this increased risk between study groups, primigravid women and those with an early pregnancy loss in a first pregnancy had similar risks. This finding is broadly reassuring, according to the study authors, because it means that a history of EP alone does not warrant closer-than-usual monitoring during a future pregnancy.

Pertinent Point:
- The decreased likelihood of conception and the greater risk of a repeat ectopic pregnancy indicate the need for a fertility follow-up in women who want to start a family, which might include preconception care, advice to seek expert consultation if needed, and early pregnancy scanning for confirmation of an intrauterine gestation, according to study authors.

References:

Bhattacharya S, McLernon DJ, Lee AJ, Bhattacharya S. Reproductive outcomes following ectopic pregnancy: register-based retrospective cohort study. PLoS Med. 2012;9:e1001243. doi:10.1371/journal/pmed.1001243.