Risk of Recurrent Ectopic Pregnancy After Previous Ectopic
The risk of recurrent ectopic pregnancy after one previous ectopic pregnancy is approximately 10-20%, making option B (10%) the most accurate answer from the choices provided. 1
Evidence-Based Risk Quantification
The most comprehensive guideline evidence indicates that women with a history of ectopic pregnancy face a recurrence risk ranging from 10-20%, with most studies reporting rates between 13-29%. 1 This represents a significant increase compared to the general population risk of 1-2%. 2
The recurrence risk is substantially elevated because previous ectopic pregnancy creates persistent risk factors through:
- Surgical management effects - Tubal damage from the surgical intervention itself 1
- Persistence of original risk factors - The underlying tubal pathology that caused the first ectopic pregnancy typically remains 3
- Progressive tubal damage - If the original cause was pelvic inflammatory disease, each episode doubles the likelihood of subsequent ectopic pregnancy due to progressive tubal occlusion 3
Clinical Context for Risk Stratification
Among the answer choices provided (5%, 10%, 30%, 50%), option B (10%) represents the lower end of the established 10-20% range and is the most defensible answer. 1
The 30% and 50% options significantly overestimate the risk, while 5% underestimates it. Research data from multiple centers confirms that among women with previous ectopic pregnancy, approximately 10-15% will experience recurrence in subsequent pregnancies. 4, 5
Important Risk Modifiers
Factors that increase recurrence risk beyond the baseline 10-20%:
- History of infertility - Increases risk substantially (AOR = 3.84) 6
- Salpingotomy for previous ectopic - Triples the risk (AOR = 3.04) compared to other management approaches 6
- Recurrent pelvic inflammatory disease - Doubles risk with each episode 3
- Previous tubal surgery - Carries the highest risk among all factors 3
Factors that decrease recurrence risk:
- Multiparity - Reduces risk by approximately 65% (AOR = 0.35-0.36) 6
Clinical Implications for Surveillance
Women with previous ectopic pregnancy require heightened surveillance in all subsequent pregnancies because the cumulative risk factors persist. 1 Early ultrasound confirmation of intrauterine pregnancy location is essential, as these patients cannot be assumed to have normal intrauterine implantation. 2