Ectopic pregnancy

Ectopic pregnancy (figure 1) causes major maternal morbidity and mortality with pregnancy loss, and its incidence is increasing worldwide. [1][2]2][3] In northern Europe between 1976 and 1993, the incidence increased from 11.2 to 18.8 per 1,000 pregnancies, 2 and in 1989 the number of admissions to US hospitals for ectopic pregnancy increased from 17,800 in 1970 to 88,400. 4These changes were greatest in women older than 35 years. 2,4In the United Kingdom, around 11,000 cases of ectopic pregnancy occur per year (incidence, 11.5/1,000 pregnancies), with 4 deaths (a rate of 0.4/1,000 ectopic pregnancies). 1 METHODSWe review the incidence, causes, diagnosis, and management of ectopic pregnancy.The evidence presented is from a combination of selected published articles identified from MEDLINE and a reflection of clinical practice at our institution (St James's University Hospital, Leeds, England).For the MEDLINE search, we used the term "ectopic pregnancy" combined with terms such as "incidence," "risk factors," "methotrexate," "salpingectomy," "salpingostomy," and the like. RISK FACTORSAlthough a proportion of women with ectopic pregnancy have no identifiable causal factors, the risk is increased by several factors: previous ectopic pregnancy, 5 tubal damage from infection or surgery, 6 a history of infertility, 6 therapy for in vitro fertilization, 7 increased age, 2,4 and smoking. 8A history of pelvic inflammatory disease is particularly important 6,9 and has been implicated in the increased incidence of ectopic pregnancy. 9,10The risk of an ectopic pregnancy is increased 7-fold after an episode of acute salpingitis. 9This is particularly true if the causal agent is Chlamydia trachomatis, which is the main cause of pelvic inflammatory disease in the United Kingdom. 11Comprehensive programs to prevent the transmission of chlamydia decrease not only the incidence of C trachomatis infections but also the rate of ectopic pregnancies. 12,13revious female sterilization and current use of an intrauterine contraceptive device are risk factors only when patients with ectopic pregnancy are compared with pregnant controls but not with nonpregnant women. 14,15his is because the overall risk of pregnancy in these situations is low, but if pregnancy does occur, an ectopic pregnancy is more likely.