Complications of Ectopic Pregnancy With an Intrauterine Contraceptive Device: A Contemporary, Nationwide Cohort Study

OBJECTIVES: This study aimed to compare the rate of hemoperitoneum and other complications among admissions for inpatient-managed ectopic pregnancy presenting with an intrauterine contraceptive (IUC) device in situ versus those without IUC. METHODS: This retrospective cohort study examined inpatient admissions in the United States captured using the Healthcare Cost and Utilization Project National Inpatient Sample database. This study included persons admitted to the hospital in 2016-2019 with a discharge diagnosis of ectopic pregnancy (9071 admissions, representative of a population size of 45 355 admissions). Pregnancies with IUC in situ were identified using International Classification of Disease 10 codes. Baseline characteristics, rates of adverse outcomes, and types of surgeries were compared between the groups. Unadjusted and adjusted odd ratios of hemoperitoneum and a secondary composite outcome of short-term inpatient complications were evaluated using univariable and multivariable regression models. RESULTS: Of 9071 admissions with ectopic pregnancy, 108 (1.2%) had an IUC in situ. Hemoperitoneum occurred in 3554 admissions (39.2%). In the multivariable analysis, those with IUC in situ had 1.65 times the odds of hemoperitoneum (95% CI 1.10-2.46, P = 0.015) compared with those without. No significant differences were found in the secondary composite outcome. Laparoscopic salpingostomy was the most common surgical approach. CONCLUSIONS: Cases of ectopic pregnancy with IUC in situ may be associated with higher odds of hemoperitoneum. Clinicians may consider counselling about risks and symptoms of ectopic pregnancy at the time of IUC insertion to minimize delayed presentation to hospital.