Recurrent ectopic pregnancy risk factors and clinical features: a case-control study in Turkey

Introduction
The aim of this study was to identify potential risk factors for recurrent ectopic pregnancy (REP) by comparing patients who developed REP with those who developed intrauterine pregnancy (IUP) after ectopic pregnancy (EP) and non-pregnant (NonP) patients after EP.

Material and methods
This study is a single-center retrospective case-control study conducted between January 2016 and January 2020. There were 138 patients in the REP group, 251 patients in the IUP group and 101 patients in the NonP group. Multivariate logistic regression analysis was used to determine risk factors for REP.

Results
Presence of a miscarriage history (REP-IUP OR: 14.47 [5.97-35.09]; REP-NonP OR: 12.78 [5.40-30.28]), treated with ART (REP-IUP OR: 55.28 [18.80-162.56]; REP-NonP OR: 5.51 [3.06-9.90]), history of PID (REP-IUP OR: 2.69 [1.83-3.95], REP-NonP OR: 4.80 [3.16-7.32]), previous pelvic surgery (REP-IUP OR: 3.03 [1.69- 5.43]; REP-NonP OR: 1.55 [0.91-2.65]), a history of ruptured ectopic pregnancy at the time of diagnosis (REP-IUP: 7.92 [4.91-12.7], REP-NonP: 14.72 [8.55-25.37]) and salpingotomy, milking surgery and methotrexate treatment increased REP.

Limitations
First, the study is a retrospective study. In the interviews, some data may have been remembered incorrectly and accordingly there may be bias. Secondly, the relationship between contraceptive methods and REP could not be evaluated clearly since there were no patients using non-IUD and COC contraceptive methods.

Conclusions
Gynecological and obstetric histories of patients with EP, treatment methods of previous EP and complications developing in previous EP change the risk of REP. Therefore, diagnosis and treatment management of EP patients is crucial.