Ectopic pregnancy in women with previous tubal sterilizations at a Canadian community hospital

Abstract

A Canadian community hospital review of women with ectopic pregnancies revealed that 7.6% had had a previous tubal sterilization. This rate was higher than reported previously.

PIP: To assess the significance of previous tubal sterilization as a risk factor in ectopic pregnancy, the 290 ectopic pregnancies treated at a hospital in Ontario, Canada, in 1981-1987 were reviewed. Overall, 7.6% of these women had undergone tubal sterilization. The rate ranged from a low of 4.3% in 1983-84 to a high of 9.3% in 1986-87, with no evidence of a linear increase over time. Of the 22 tubal sterilizations that were followed by an ectopic pregnancy, 16 (73%) were laparoscopic. This included 19 salpingectomies by laparotomy, 1 salpingectomy plus hysterectomy, and 2 salpingectomies by laparoscopy. The mean tubal sterilization-ectopic pregnancy interval was 4.6 years (range, 6 months- 9 years). 73% of the ectopic pregnancies occurred in the left tube and 91% were in the distal portion of the tube. The 7.6% incidence rate of ectopic pregnancy in women with prior tubal sterilization found in this community hospital study is well above the 2% rate commonly cited in the medical literature and suggests that the association of these 2 phenomena may be significantly more widespread than is generally believed. This complication is preventable, however, by accurate identification of the fallopian tube, not performing sterilization in the luteal phase, and complete occlusion of the tube initially.