Reproductive potential after an ectopic pregnancy

Abstract

Objective: To measure statistically how soon pregnancy can occur after an ectopic pregnancy (EP) so as to determine the cumulative pregnancy rate and the risk factors involved in nonpregnancy.

Design: The risk of not getting pregnant after an EP (survivorship) was estimated for 120 patients followed up for up to 60 months using the actuarial life-table technique. The risk factors involved in nonpregnancy, abortions, or live births were analyzed, using Cox regression models.

Setting: King Khalid University Hospital, Riyadh, Saudi Arabia.

Results: There were 68 pregnancies over the study period, with a conception rate of 56.7%. Using the actuarial life table, the cumulative probability of not achieving pregnancy in a patient decreased sharply during the first 12 months, followed by a gradual decrease up to 48 months. The Cox regression analysis showed a correlation between pregnancy and two variables, namely, age and history of prior EP. The chances of a pregnancy resulting in abortion or live birth also correlated with the presence of prior infertility, pelvic inflammatory disease (PID), or postoperative complications.

Conclusion: Age and prior EP are important determinants in pregnancy rates after an EP. Similarly, history of PID, infertility, and postoperative complications are important risk factors in whether the pregnancy goes to term or ends in abortion.

PIP: The study group consisted of 120 patients who were surgically managed for ectopic pregnancy (EP) at the King Khalid University Hospital over a 5-year period (1987-1991), and who were followed up for periods ranging from 12 to 60 months. There were 68 pregnancies recorded over the 5-year follow-up period, a conception rate of 56.7%. However, only 75% of these pregnancies resulted in live births, another 22.1% ended in abortions, whereas 2 (2.9%) were repeat EPs. The ages of the patients ranged from 18 to 41 years. 46 patients had history of 1, 2, or 3 abortions before their EP; 10 of them had history of previous EP. Infertility of 1 year's duration was managed in 27 patients and history of pelvic inflammatory disease (PID) was present in 12 patients. Life table analysis of the 120 patients showed that at the end of 12 months after EP, the patient had a 57.15% chance of not getting pregnant, and at the end of 48 months, a 21.45% nonpregnancy rate would have been reached. The Cox proportional hazard analysis result identified only age and previous EP as being statistically significant prognostic factors of pregnancy after EP. The younger the patients, the shorter the duration it took to get pregnant. Similarly, those with no history of EP before the current one had a greater chance of getting pregnant even after the current EP. The Cox linear regression analysis revealed that women who had postoperative complications were at an 8-fold risk of the next pregnancy resulting in abortion, whereas the risk was more than 8-fold if the patient had a history of PID. The risk of a pregnancy not resulting in live birth after an EP operation was almost 2-fold in women with postoperative complications; 5-fold in women with previous history of infertility; and 7-fold in women with history of PID.