Risk of ectopic pregnancy associated with gynecological history, past contraceptive use, and smoking habit

This analysis is a part of a popularton-based case-contol study in I I cities in Indonesia in1989/1990 to assess risk of ectuPic pregnancy (EP) associated with past contraceprtve use, obstetrical-gynecological history, and smoking habit. Cases were EP histopathologically confirmed and one pregnant control for each case was matched by catchment area and. five-year age interval of marriedwomen. Personal interviews were conductedin collecting information regarding past contraceptive use, obstetical-gynecological history, and demographic characteistics. Cases and pregnant controls that at the estimated date of conception were still using any contraceptive methods were excludedfrom this analysis, 456 cases and 506 pregnant controls were included. The obstetical-gynecological riskfactors which increased the risk of EP were previous EP (adjusted RR = 16.84; 95Vo CI: 2.14132.50), PID (pelvic inflammatory disease), history ofinduced abortion and spontaneous abortion. Past contraceptive use (IUD, injectable, natural method) prevented EP, i.e. past natural method, natural method (adjusted RR = 0.18; 957o CI: 0.05-0.54), past injectable method (adjusted RR = 0.51; 95Vo CI: 0.37-0.72) relative to never used of respective contraceptives, and relative to never used IUD, past IUD use for 13-36 months (adjusted RR 0.47: 95Vo CI 0.24-0.93), and 36-202 months (adjusted RÀ 0.58; 95Vo CI 0.36-0.94). Relative to non smokers, longer duration of smoking tends to increase risk of EP (adjusted testfor trend p < 0.001). The rtskwas most pronounced in smokers for 36-360 months (adjusted RR = 3.20; 957o CI: 1.30-7.83). In conclusion, PID, miscatiage, induced abortion, and smoking habit increase risk of EP, however past contraceptive use prevented EP, Keyworils : ectopic pre gnancy, contraception, gynecolo gical, smoking habit Results of previous studies indicate that, among fertile women, gynecological infection, history of obstetrical operation, and contraceptive use may increase risk of ectopic pregnancy (EP).''' Association of past IUD Department of Community Medicine, University of Indonesia Faculty of Medicine, Jakarta, Indonesia (intrauterine device) use with the increase risk of EP have been reported, suggesting that women who use an IUD may sustain tubal damage which exerts a residual influence on the risk of EP after the device is removed.3-5 However, the current public health significance ofprior study findings has been questioned. Subsequent analyses and later study reports showed that IUD might be protecting women from acquiring Vol 8, No 3, July September 1999 EP.l Contraception with an IUD is now recommended primarily to married women in mutually monogamous relationship, as these women are in general thought to be in lower risk of sexually transmitted disease.o Past hormonal and other interval contraceptive methods seem to be lowering the riskof EP,l'' und lut". studies reports indicated that smoking habits increase risk of EP.l-3'7'8 In addition, in lndonesia there are more than 20 million women who are contraceptive users, which were using fUDs, pills, injectables, implants, and condoms. They were at risk of EP related to the contraceptive methods. Since EP is life threatening and no population-based study has been conducted in Indonesia, therefore it is beneficial to conduct an epidemiological study. This analysis are based on data on multi-center case-control study of married, gravid women (while still sexually active) in Indonesia in order to assess the risk of EP among women who are not currently using any contraception at the estimated date of conception