Risk factors for recurrent ectopic pregnancy: a case–control study

Objective To study the risk factors for recurrent ectopic pregnancy ( REP ). Design A retrospective case–control study. Setting A university medical centre. Population 554 women with a history of ectopic pregnancy ( EP ) were included. Among them were 181 women with current EP , 184 women with current intrauterine pregnancy ( IUP ) and 189 nonpregnant women (NonP). Methods The three groups were matched at a ratio of 1:1 with respect to current age, age of initial EP and gestational week of initial EP . Socio‐demographic characteristics, reproductive history, gynaecological and surgical history, and experience of contraception were compared among the three groups. A multivariable logistic regression analysis was used to adjust for confounders and calculate adjusted odds ratios ( AOR s). Results The risk of REP increased with history of infertility ( AOR = 3.84, 95% CI 2.16–6.86) in REP women compared with IUP controls. Compared with NonP controls, salpingotomy ( AOR = 3.04, 95% CI 1.21–36.51) for previous EP was a risk factor for REP . Multiparous women were less likely to suffer REP when compared with NonP women ( AOR = 0.36, 95% CI 0.18–0.62) or IUP controls ( AOR = 0.35, 95% CI 0.20–0.62). Current use of an intrauterine device ( IUD ) ( REP versus NonP, AOR = 0.02, 95% CI 0.00–0.08) or condoms ( REP versus NonP, AOR = 0.16, 95% CI 0.07–0.38) significantly reduced the risk of REP compared with those not using any contraception. Similarly, previous use of condoms also prevented REP compared with those with no previous condom use ( REP versus NonP, AOR = 0.20, 95% CI 0.08–0.49; REP versus IUP , AOR = 0.40, 95% CI 0.22–0.71). Conclusions Women with history of infertility or salpingotomy should be alert for the recurrence of EP . Multiparous women are less likely to suffer REP . We propose the use of condoms for effective prevention of REP . Tweetable abstract History of infertility and salpingotomy for last EP are risk factors for recurrent EP .