Future reproductive outcomes for women who have had an ectopic pregnancy

Women who experience an initial ectopic pregnancy - when the embryo implants outside the womb, usually in the fallopian tubes - are less likely to conceive in the future and if they do, are at increased risk of having another ectopic pregnancy, but are no more likely than first time mothers to suffer complications in an ongoing pregnancy according to a study by a team of Scottish researchers published yesterday in PLoS Medicine.

Ectopic pregnancies occur in 1-2% of all pregnancies and can be potentially life threatening - for example, in the UK, ectopic pregnancies are responsible for almost three quarters of early pregnancy related deaths - but this study on Scottish women, led by Sohinee Bhattacharya from the University of Aberdeen, shows that ectopic pregnancies also affect future fertility and subsequent pregnancies.

The authors used a national database (The Scottish Morbidity Record) and hospital discharge information to identify women who had ectopic pregnancies, miscarriages, terminations, or on-going pregnancies between 1981 and 2000 and then investigated their future reproductive outcomes.

The authors found that women with an initial ectopic pregnancy had a lower chance of conception than those who miscarry and also an increased risk of a repeat ectopic pregnancy compared to women who experienced miscarriage, termination, or a live birth in their first pregnancy.

The authors say "The results of this study will help clinicians to counsel women with ectopic pregnancy - both at the time of initial diagnosis and treatment, as well as later when they attend for antenatal care."

They continue: "The reduced chance of a pregnancy and increased risk of a second ectopic following ectopic pregnancy indicates the need for a fertility follow-up in women who are keen to conceive. This would include pre-conception care, advice to seek expert consultation should they wish to start a family, and consideration of an early pregnancy scan to confirm an intrauterine gestation."

The authors add: "Overall, the results from this study are broadly reassuring in establishing that obstetric outcomes following ectopic pregnancy are no worse than those in women in their first pregnancy."
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Funding: This project was supported by a grant from the Chief Scientist Office in Scotland (CZG_2_283) but no funding bodies had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests: This project was supported by a research grant from the Chief Scientist Office in Scotland (CZG_2_283) where Sohinee Bhattacharya was principal investigator. Siladitya Bhattacharya declares that the first author, Sohinee Bhattacharya, is his wife. All other authors have declared that no competing interests exist.

Citation: Bhattacharya S, McLernon DJ, Lee AJ, Bhattacharya S (2012) Reproductive Outcomes Following Ectopic Pregnancy: Register-Based Retrospective Cohort Study. PLoS Med 9(6): e1001243. doi:10.1371/journal.pmed.1001243