Risk of Recurrent Ectopic Pregnancy
The correct answer is C. 15%, as women with a previous ectopic pregnancy face a 10-20% risk of recurrence in their next pregnancy, with most studies reporting rates between 13-29%. 1
Understanding the Recurrence Risk
A woman with one prior ectopic pregnancy has approximately a 10-20% chance of developing another ectopic pregnancy in subsequent pregnancies. 1 This places the risk squarely in the range of answer C (15%), which represents the middle of this evidence-based range.
Why This Risk Is So High
The elevated recurrence risk stems from three key mechanisms:
- Persistent tubal damage from the original ectopic pregnancy that remains even after treatment 1
- Effects of surgical management on the fallopian tube, which can create additional scarring and dysfunction 1
- Continuation of underlying risk factors that caused the initial ectopic pregnancy, such as chronic tubal inflammation or anatomical abnormalities 1
Quantifying the Risk More Precisely
Research data supports this 10-20% range:
- History of ectopic pregnancy carries an odds ratio of 17.16 (95% CI 1.89-155.67) for recurrence 2
- In a large population-based cohort study, 10% of women with an ectopic first pregnancy experienced a future ectopic pregnancy 3
- Previous ectopic pregnancy ranks among the highest risk factors for recurrence, alongside tubal surgery and pelvic inflammatory disease 1, 4
Clinical Context
This 10-20% recurrence risk makes previous ectopic pregnancy one of the most powerful predictors of future ectopic pregnancy. 1, 4 For comparison, the baseline risk of ectopic pregnancy in the general population is only 1-2% 5, meaning a prior ectopic increases the risk approximately 10-fold.
Why Other Answers Are Incorrect
- Answer A (1-6%) underestimates the risk and approximates the general population baseline risk 5
- Answer B (7-10%) falls at the lower boundary but doesn't capture the full risk spectrum 3
- Answer D (20%) represents the upper limit but is higher than the typical recurrence rate 1
Important Clinical Implications
Women with prior ectopic pregnancy require:
- Heightened surveillance in all subsequent pregnancies because cumulative risk factors persist 1
- Early ultrasound confirmation of intrauterine pregnancy location in future pregnancies 5
- Awareness that the risk compounds with additional risk factors like tubal surgery, recurrent pelvic inflammatory disease, or use of assisted reproductive technology 1, 4
Additional Considerations
The risk may be even higher when combined with other factors: