From the Guidelines
The chance of a woman having more than one ectopic pregnancy is significantly increased, with a risk of approximately 10-15% after experiencing an initial ectopic pregnancy, as noted in the context of risk factors and management 1. This risk is significantly higher than the 1-2% risk in the general population. Women who have had one ectopic pregnancy should be closely monitored during subsequent pregnancies with early ultrasound evaluation (around 6-7 weeks) to confirm proper implantation in the uterus. Some key points to consider include:
- Risk factors that may further increase the chance of recurrent ectopic pregnancies include previous tubal surgery, pelvic inflammatory disease, endometriosis, smoking, and certain assisted reproductive technologies.
- The increased risk occurs because the underlying conditions that contributed to the first ectopic pregnancy often persist, such as tubal scarring or abnormalities.
- While having one ectopic pregnancy does elevate the risk of another, it's essential to note that the majority of women (85-90%) will go on to have normal intrauterine pregnancies in the future.
- Early prenatal care and prompt reporting of pregnancy symptoms are essential for women with this history to ensure timely diagnosis and appropriate management, and the use of combined hormonal contraceptives (CHCs) can protect against pregnancy in general, including ectopic gestation, as mentioned in 1. It is crucial for women with a history of ectopic pregnancy to be aware of these risks and take necessary precautions to minimize them, under the guidance of a healthcare provider.
From the Research
Risk Factors for Recurrent Ectopic Pregnancy
- A history of pelvic inflammatory disease, cigarette smoking, fallopian tube surgery, previous ectopic pregnancy, and infertility are known risk factors for ectopic pregnancy 2
- A history of voluntary termination of pregnancy may increase the risk of recurrence of ectopic pregnancy 3
- Conversely, a history of infertility or previous live birth may decrease the risk of recurrence of ectopic pregnancy 3
Chance of Recurrence
- The rate of recurrence of ectopic pregnancy is around 10.5% 3
- More than half of the women who have had an ectopic pregnancy will have a subsequent ongoing intrauterine pregnancy 4
- The treatment for ectopic pregnancy, whether it is conservative or radical laparoscopic, or medical with methotrexate, does not significantly influence the recurrence rate 3
Diagnostic and Therapeutic Options
- Vaginal ultrasound and human chorionic gonadotrophin levels are the most important diagnostic tools for ectopic pregnancy 4
- Management of ectopic pregnancy can be either conservative with repeated follow-up, intramuscular methotrexate, or surgical, depending on the findings 4
- Understanding the risk factors for recurrent ectopic pregnancy can allow providers to counsel and manage patients with a higher level of scrutiny 5