Risk of Recurrent Ectopic Pregnancy After Previous Ectopic
The risk of developing another ectopic pregnancy after a previous ectopic pregnancy is approximately 10-20%, with most studies reporting rates between 13-29%. 1
Direct Answer to Question
Based on the evidence provided, the correct answer is C. 15%, which falls within the established range of 10-20% recurrence risk. 1 This represents the middle of the documented risk spectrum and aligns with clinical guideline data on recurrent ectopic pregnancy rates.
Understanding the Risk Magnitude
Previous ectopic pregnancy creates significant risk increase, either from surgical management effects or persistence of the original underlying risk factors that caused the first ectopic. 2, 1
This elevated risk persists because the cumulative risk factors—particularly tubal damage from the initial ectopic pregnancy or its surgical treatment—remain present in subsequent pregnancies. 1
The recurrence risk is substantially higher than the baseline population risk of ectopic pregnancy, which is only 1-2% in the United States. 3
Why the Risk Remains Elevated
The underlying mechanisms that increase recurrence include:
Tubal damage persistence: The original tubal pathology (from infection, surgery, or anatomic abnormality) that led to the first ectopic typically remains. 2, 1
Surgical effects: Even when the ectopic is treated, surgical management itself can cause additional tubal scarring and adhesions. 2, 4
Progressive tubal disease: If pelvic inflammatory disease was the original cause, the risk doubles with each recurrent episode due to progressive tubal occlusion. 2, 1
Clinical Implications for Subsequent Pregnancies
Women with a history of ectopic pregnancy require:
Heightened surveillance in all subsequent pregnancies due to the 10-20% recurrence risk. 1
Early ultrasound confirmation of intrauterine pregnancy location, as ectopic pregnancy should be considered in any patient presenting early in pregnancy with vaginal bleeding or lower abdominal pain in whom intrauterine pregnancy has not yet been established. 3
Serial beta-hCG monitoring if pregnancy location cannot be immediately confirmed. 3
Important Caveat
The 10-20% recurrence risk applies to women with one previous ectopic pregnancy. 1 The risk may be even higher in women with multiple previous ectopic pregnancies or those with additional risk factors such as ongoing pelvic inflammatory disease, tubal surgery, or use of assisted reproductive technology. 2