Multiple induced abortions as risk factor for ectopic pregnancy. A prospective study

Unintended and ectopic pregnancy in woman with iud translocation with history of two times previous cesarean section and history of spontaneous abortion: Case report

Intrauterine device is a widely used contraceptive method. However, it may translocate to other sites within the pelvic cavity, including the intestines and the bladder. This contraceptive method has failure rate between 1 and 3 out of 100 women/year. The use of intrauterine device also slightly increases the risk of ectopic pregnancy upon its failure. The combination of intrauterine device translocation and contraceptive failure is rare. We present such a case. A 29-year-old woman (Gravida 4, Para 2) presented with a complaint of abdominal pain and presence of blood spotting over the last 7 h. She tested positive for pregnancy. Upon arrival, her vital signs were normal, but she was moderately obese with a body mass index (BMI) of 38.8 kg/m2. She displayed tenderness during abdominal examination and cervical motion tenderness. Her blood test results showed no significant abnormalities. Abdominal ultrasound revealed a translocated part of intrauterine device to the cervix and transvaginal ultrasound confirmed the presence of a hypoechoic complex structure in the left adnexa, measuring 53 mm, alongside free fluid in Morrison's pouch. An emergency laparotomy was performed, revealing a normal uterus and a ruptured left fallopian tube with approximately 800 cc of blood in the abdomen.

The body mass index and the risk of ectopic pregnancy: a 5-year retrospective case-control study

PURPOSE

Acknowledging the associated risk factors may have a positive impact on reducing the incidence of ectopic pregnancy (EP). In recent years, body mass index (BMI) has been mentioned in research. However, few studies are available and controversial on the relationship between EP and BMI.

METHODS

We retrospectively studied the EP women as a case group and the deliveries as a control group in the central hospital of Wuhan during 2017 ~ 2021. χ2 test of variables associated with ectopic pregnancy was performed to find differences. Univariate and multivariate binary logistic regression analysis was conducted to analyze the association of the variables of age, parity, history of induced abortion, history of ectopic pregnancy, history of spontaneous abortion, history of appendectomy surgery and BMI (< 18.5 kg/m2, 18.5 ~ 24.9 kg/m2, 25 kg/m2 ~ 29.9 kg/m2, ≥ 30 kg /m2) with EP.

RESULTS

They were 659 EP and 1460 deliveries. The variables of age, parity, history of induced abortion, history of ectopic pregnancy and BMI were different significantly(P < 0.05). Multivariate analysis showed that the variables of age > 35 years old [(OR (Odds Ratio), 5.415; 95%CI (Confidence Interval), 4.006 ~ 7.320, P < 0.001], history of ectopic pregnancy (OR, 3.944; 95%CI, 2.405 ~ 6.467; P < 0.001), history of induced abortion(OR, 3.365; 95%CI, 2.724 ~ 4.158, P < 0.001) and low BMI (< 18.5 kg/m2) (OR, 1.929; 95%CI, 1.416 ~ 2.628, P < 0.001])increased the risk of EP.

CONCLUSION

The history of ectopic pregnancy, history of induced abortion and age > 35 years old were the risk factors with EP. In addition to these traditional factors, we found low BMI (< 18.5 kg/m2) with women may increase the risk to EP.

No. 360-Induced Abortion: Surgical Abortion and Second Trimester Medical Methods

OBJECTIVE

This guideline reviews evidence relating to the provision of surgical induced abortion (IA) and second trimester medical abortion, including pre- and post-procedural care.

INTENDED USERS

Gynaecologists, family physicians, nurses, midwives, residents, and other health care providers who currently or intend to provide and/or teach IAs.

TARGET POPULATION

Women with an unintended or abnormal first or second trimester pregnancy.

EVIDENCE

PubMed, Medline, and the Cochrane Database were searched using the key words: first-trimester surgical abortion, second-trimester surgical abortion, second-trimester medical abortion, dilation and evacuation, induction abortion, feticide, cervical preparation, cervical dilation, abortion complications. Results were restricted to English or French systematic reviews, randomized controlled trials, clinical trials, and observational studies published from 1979 to July 2017. National and international clinical practice guidelines were consulted for review. Grey literature was not searched.

VALUES

The quality of evidence in this document was rated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology framework. The summary of findings is available upon request.

BENEFITS, HARMS, AND/OR COSTS

IA is safe and effective. The benefits of IA outweigh the potential harms or costs. No new direct harms or costs identified with these guidelines.

Is induced abortion a risk factor in subsequent pregnancy?

OBJECTIVE

To determine whether a history of terminations of pregnancy influences subsequent pregnancies in terms of pregnancy risks, prematurity and neonatal biometrics.

PATIENTS AND METHODS

Based on the perinatal statistics of eight German federal states, data of 247,593 primiparous women with singleton pregnancies born between 1998 and 2000 were analyzed. The control group consisted of primiparous women without previous induced abortions. Maternal age was adjusted for.

RESULTS

There was an overall trend towards an increased rate of preterm delivery at <or=36 weeks' gestation and early preterm delivery at <or=31 weeks' gestation in women who had previous pregnancy terminations. For the cohort of 28-30 years, the observed rates of prematurity in women with one and with >or=2 previous induced abortions were 7.8% and 8.5%, respectively, compared to 6.5% in the control population (P=0.015). Preceding terminations of pregnancy did not alter the rate of small-for-gestational-age newborns. Psychosocial stress and symptoms associated with prematurity such as cervical incompetence and vaginal bleeding before and after 28 weeks of gestation occurred more frequently in women with previous induced abortion compared to the control group (P<0.0001).

CONCLUSION

The rate of preterm births increases with the number of preceding abortions. Similarly, symptoms associated with prematurity are more common. The rate of small-for-gestational-age newborns was not affected by preceding terminations of pregnancy.

Medical abortion and the risk of subsequent adverse pregnancy outcomes

BACKGROUND

The long-term safety of surgical abortion in the first trimester is well established. Despite the increasing use of medical abortion (abortion by means of medication), limited information is available regarding the effects of this procedure on subsequent pregnancies.

METHODS

We identified all women living in Denmark who had undergone an abortion for nonmedical reasons between 1999 and 2004 and obtained information regarding subsequent pregnancies from national registries. Risks of ectopic pregnancy, spontaneous abortion, preterm birth (at <37 weeks of gestation), and low birth weight (<2500 g) in the first subsequent pregnancy in women who had had a first-trimester medical abortion were compared with risks in women who had had a first-trimester surgical abortion.

RESULTS

Among 11,814 pregnancies in women who had had a previous first-trimester medical abortion (2710 women) or surgical abortion (9104 women), there were 274 ectopic pregnancies (respective incidence rates, 2.4% and 2.3%), 1426 spontaneous abortions (12.2% and 12.7%), 552 preterm births (5.4% and 6.7%), and 478 births with low birth weight (4.0% and 5.1%). After adjustment for maternal age, interval between pregnancies, gestational age at abortion, parity, cohabitation status, and urban or nonurban residence, medical abortion was not associated with a significantly increased risk of ectopic pregnancy (relative risk, 1.04; 95% confidence interval [CI], 0.76 to 1.41), spontaneous abortion (relative risk, 0.87; 95% CI, 0.72 to 1.05), preterm birth (relative risk, 0.88; 95% CI, 0.66 to 1.18), or low birth weight (relative risk, 0.82; 95% CI, 0.61 to 1.11). Gestational age at medical abortion was not significantly associated with any of these adverse outcomes.

CONCLUSIONS

We found no evidence that a previous medical abortion, as compared with a previous surgical abortion, increases the risk of spontaneous abortion, ectopic pregnancy, preterm birth, or low birth weight.

Risk factors for ectopic pregnancy: a case-control study

AIM

To identify the risk factors for ectopic pregnancy.

METHODS

We conducted a prospective case-control study for the role of several risk factors in the occurrence of ectopic pregnancy in Turkey. A total of 225 cases and 375 controls were compared for sociodemographic characteristics, cigarette smoking, obstetric, gynaecological, surgical histories, the presence or absence of assisted conception and contraceptive usage.

RESULTS

The main risk factors for ectopic pregnancy were prior ectopic pregnancy (adjusted odds ratio (AOR): 13.1) and a history of infectious reproductive system (AOR for pelvic inflammatory disease: 6.8). Other risk factors found to be associated with an increased risk for ectopic pregnancy were multisexual partner (AOR: 3.5), history of infertility (AOR: 2.5), induced conception cycle (AOR: 3.4), current intrauterine device usage (AOR: 3.2), prior Caesarean section (AOR: 2.1) and cigarette smoking at the time of conception (AOR=1.7). On the contrary, barrier methods were protective from ectopic pregnancy (AOR: 0.4).

CONCLUSIONS

The increased awareness and knowledge of risk factors have enabled an early and accurate diagnosis of ectopic pregnancy. This study has found prior pelvic infection to be a major aetiological factor for ectopic pregnancy. Furthermore, other factors found to be associated with ectopic pregnancy, such as prior ectopic pregnancy, infertility history and induced conception cycle, may be the result of a previous pelvic infection that may cause tubal sequelae. These factors are potential targets for intervention and modification.

Risk factors for ectopic pregnancy in Lagos, Nigeria

BACKGROUND

Ectopic pregnancy is an important cause of maternal deaths in Nigeria and in other developing countries. In Lagos, Nigeria, it is responsible for 8.6% of maternal deaths, and has a case fatality rate of 3.7%. The purpose of this study was to determine the risk factors for ectopic pregnancy in Lagos.

METHODS

A case-control study of 100 patients and 280 controls was performed in the three hospitals--Lagos University Teaching Hospital, Ayinke House Maternity Hospital, and Lagos Island Maternity Hospital--in Lagos from June 1999 to December 1999. Data were analyzed by using logistic regression.

RESULTS

The incidence was 23.1/1000 (1 : 43) deliveries and was responsible for 48.5% of gynecologic emergencies. Age, marital status, socioeconomic status, and parity were not the significant risk factors for ectopic pregnancy. An early age of sexual debut increased the risk of ectopic pregnancy almost two-fold (adjusted OR = 1.93; 95% CI = 1.71-2.93), whereas a late age of sexual debut was protective (adjusted OR = 0.37; 95% CI = 0.19-0.59). History of multiple lifetime sexual partners, induced abortions, pelvic inflammatory disease, sexually transmitted disease (STD), miscarriage, and pelvic surgery independently and significantly increased the risk of ectopic pregnancy. Induced abortion and STD increased the risk 14-fold and nine-fold, respectively. Previous use of intrauterine contraceptive device increased the risk almost four-fold (adjusted OR = 3.76; 95% CI = 2.12-6.69), whereas the use of condoms was protective (adjusted OR = 0.35; 95% CI = 0.17-0.71).

CONCLUSIONS

Proper sex education, prevention of unwanted pregnancy, and prevention and proper treatment of sexually transmitted infections will reduce the incidence of ectopic pregnancy.

Long-term physical and psychological health consequences of induced abortion: review of the evidence

Induced abortion is a prevalent response to an unintended pregnancy. The long-term health consequences are poorly investigated and conclusions must be drawn from observational studies. Using strict inclusion criteria (study population >100 subjects, follow up >60 days) we reviewed an array of conditions in women's health. Induced abortion was not associated with changes in the prevalence of subsequent subfertility, spontaneous abortion, or ectopic pregnancy. Previous abortion was a risk factor for placenta previa. Moreover, induced abortion increased the risks for both a subsequent preterm delivery and mood disorders substantial enough to provoke attempts of self-harm. Preterm delivery and depression are important conditions in women's health and avoidance of induced abortion has potential as a strategy to reduce their prevalence. Only review articles including the single published meta-analysis exploring linkages between abortion and breast cancer were relied upon to draw conclusions. Reviewers were mixed on whether subsequent breast neoplasia can be linked to induced abortion, although the sole meta-analysis found a summary odds ratio of 1.2. Whatever the effect of induced abortion on breast cancer risk, a young woman with an unintended pregnancy clearly sacrifices the protective effect of a term delivery should she decide to abort and delay childbearing. That increase in risk can be quantified using the Gail Model. Thus, we conclude that informed consent before induced abortion should include information about the subsequent risk of preterm delivery and depression. Although it remains uncertain whether elective abortion increases subsequent breast cancer, it is clear that a decision to abort and delay pregnancy culminates in a loss of protection with the net effect being an increased risk.

TARGET AUDIENCE

Obstetricians & Gynecologists, Family Physicians.

LEARNING OBJECTIVES

After completion of this article, the reader will be able to define the terms and, to outline the epidemiologic problems in studying the long-term consequences of abortion, and to list the associated long-term consequences of abortion.

Ectopic pregnancy revisited in Benin City, Nigeria: analysis of 152 cases

BACKGROUND

Ectopic pregnancy is still a major health problem among women of childbearing age in our community. The majority of the patients with ectopic pregnancy are nulliparous in their mid twenties, with previous induced abortion(s) and or pelvic inflammatory disease. It remains a major challenge to the reproductive performance of women worldwide.

OBJECTIVE

The study is an analysis of the clinical profile of patients presenting with ectopic pregnancy, to investigate the current status of the incidence, predisposing risk factors and the management options available in Benin.

MATERIALS AND METHODS

One hundred and fifty two cases of ectopic pregnancies managed at the University of Benin Teaching Hospital (UBTH) between January 1994 and December 1998 were analyzed. Clinical and socio-biological information were retrieved from patients' case notes, and supplemented by information from the operating theatre and ward registers.

RESULTS

The incidence of ectopic pregnancy during this study period was 1. 68% of total births and 6.74% of and gynecologic admissions. Nulliparous patients were 49.3%, while the peak age of incidence was 20-25 years. 95/152 (62.5%) of the patients had previous induced abortion(s), while pelvic adhesions were noted in 62/152 (40.85 approximately %). 67.8% of the patients were not using any method of contraception, while 13.8% and 9.2% were using lUD and barrier methods, respectively. Abdominal pain, 2 degrees amenorrhoea and irregular vaginal bleeding (83.6%, 77.5% and 73.7%, respectively) were the most frequent presenting complaints. 75/152 of the patients (49.3%) were in a state of shock, and 80.3% had ruptured tubal pregnancy at presentation. All patients had laparotomy, 54.6% and 34.9% had right and left salpingectomy, respectively. 831/52 of the patients (54.6%) had autotransfusion during surgery.

CONCLUSION

In Benin, the majority of the patients with ectopic pregnancy are nulliparous in their mid twenties, with history of previous induced abortion(s) and or pelvic inflammatory disease. Management option is limited to laparotomy and salpingectomy.