Perinatal outcomes following a history of ectopic pregnancy

Objective
Ectopic pregnancy is a well-studied and relatively common complication, yet little is known regarding perinatal outcomes of future gestations following ectopic pregnancies. The purpose of this study was to assess perinatal outcomes of future pregnancies of mothers with a history of ectopic pregnancy.

Study Design
A population-based cohort analysis was performed including all singleton deliveries between the years 1991-2014 at a single tertiary medical center. Perinatal outcomes of subsequent pregnancy of mothers with a history of ectopic pregnancy, that was either medically or surgically treated, were compared to pregnancies of women without a history of ectopic pregnancy. Multifetal pregnancies and fetuses with congenital anomalies and chromosomal abnormality were excluded. generalized estimated equation models were used to control for confounders.

Results
During the study period, 242,342 mothers met the inclusion criteria. 1,415 mothers (0.58%) had a history of previous ectopic pregnancy, of which 25.7% (n=364) were treated medically, and 74.3% (n=1051) were treated surgically. Placental abruption, preterm delivery, and cesarean delivery were all significantly more common in mothers with a history of previous ectopic pregnancy (Table 1). Using generalized estimated equation models, controlling for maternal age, hypertensive disorders of pregnancy, maternal diabetes mellitus and gestational age, maternal history of previous ectopic pregnancy, both surgically and medically treated were noted as an independent risk factor for preterm delivery in the subsequent pregnancy. Maternal history of surgically treated ectopic pregnancy was an independent risk factor for cesarean section (Table 2).

Conclusion
Maternal history of ectopic pregnancy is independently associated with adverse perinatal outcomes, and specifically as preterm delivery and cesarean section.