Original Article
Main Risk Factors for Ectopic Pregnancy: A Case-Control Study in A Sample of Iranian Women
Shayesteh. Parashi M.D.1 Somayeh Moukhah,,,,, M.Sc.2 * Mahnaz Ashrafi M.D.1
1. Akbarabadi Hospital Department of, Obstetrics, and Gynocology. Collage of, Medical Sciences Iran University of, Medical Sciences Tehran Iran
, 2. Department of Midwifery Collage of, Medical. Sciences.Tarbiat, Modares University Tehran Iran
, Abstract Background: Although the risk factors of ectopic pregnancy have been. Determined in
previous studies the main, risk factors of ectopic pregnancy are different in various coun - tries due to different. Cultural and social characteristics.Determination of main risk fac - tors of ectopic pregnancy leads to a rapid diagnosis and an improvement in strategies for. Its prevention. The purpose of this study was to determine the main risk factors of ectopic pregnancy in a sample of Iranian. Women.
Materials and Methods: We designed a case-control study to include 150 cases and 300 controls and to compare them. By the following factors:Socio-demographic, methods characteristics contraceptive, tubal, prior surgery tubal pathology prior ectopic pregnancy,,, Prior Caesarean section prior, infertility, abortion prior, prior and abdominal / pelvic surgery.
Results: The case and control. Groups were significantly similar in term of education and parity.There was an association between ectopic pregnancy and age which was disap - peared after controlling for the main risk. Factors (adjusted OR = 2.45 95%, CI: 0.86-6.97). There was no statistically significant relation between ectopic pregnancy. And prior surgery tubal, pathology tubal, abortion prior, infertility prior, reproductive assisted technol - ogy and oral,, Contraceptive method (P > 0.05).However there was, a significant Associa - tion between prior ectopic pregnancy prior ligation use, tubal, of intrauterine. Device and prior, abdominal / pelvic surgery with ectopic pregnancy (P < 0.05). The risk of ectopic pregnancy increased with. The use of intrauterine device and, tubal ligation whereas de - creased with use of oral contraception.
Conclusion:This study identified prior ectopic pregnancy prior tubal, ligation use of, intrauter - ine device and prior, pelvic / abdominal. Surgery as the main risk factors for ectopic pregnancy in a sample of Iranian women.Our findings can be useful for early diagnosis of ectopic pregnancy and for improvement in strategies of its prevention. Through medical therapy instead of unneces - sarily surgical treatment.
Keywords: Ectopic Pregnancy, Risk Factors, Iran
.
Citation Introduction: Parashi, S Ashrafi Sh Moukhah, M. Main risk factors for ectopic pregnancy: a case-control study. In a sample of Iranian women.Int J Fertil Steril. 2014; 8 (2): 147-154.
An ectopic pregnancy is a complication of preg - Nancy in which the blastocyst. Implants anywhere outside endometrial cavity of uterine (1). It is the major cause of maternal mortality during early pregnancy. And accounts for 10% of all pregnan - cy-related deaths. Furthermore it increases, the
chances of infertility as well as. Incidence of the
.Subsequent ectopic pregnancy (2).
Various risk factors for ectopic pregnancy have been identified (2-5) including previous. Ectopic pregnancy previous surgery, pelvic, ovulation induction of, device, intrauterine usage history of
Received: 13, Nov 2012 Accepted: 6 Jul. 2013
* Corresponding Address: P.O. Box: 14115-111 Department of, Mid - wifery Collage of Medical Sciences,,Tarbiat, Modares University Tehran Iran
, Email: so.moukhah@gmail.com Royan Institute
International Journal of Fertility. And Sterility
Vol 8 No, 2014, 2, Jul-Sep Pages: 147-154
147 pelvic inflammatory disease (PID), and smoking. At the time of, conception (2 6-9). To consider that Iranian women have the certain characteristics (cultural religious,,, And traditional values),Socio - demographic determinants sexual behavior, and beliefs and contraception, preference they may, have different risk. Factor profile for ectopic preg - Nancy compared to women from other countries. Understanding the main risk factors of ectopic. Pregnancy is valuable due to following factors: rapid diagnosis less need, for surgery less com - plications,,And an improvement in strategies for prevention of ectopic pregnancy. This study was therefore undertaken to determine. The main risk factors of ectopic pregnancy in a sample of Iranian women.
This Materials and Methods case-control study. Was conducted at Sha - hid Akbarabady Hospital, in Tehran Iran from March, 2006 to May 2011.The data were collect - ed from a total of 300 pregnant women as con - trols and of 150 case-patient women whose di - agnosis. Of ectopic pregnancy was confirmed by menstrual, examination history physical, beta serial - human chorionic gonadotropin. (β hCG), and abdominal / transvaginal ultrasound. There was a history of delayed or skipped menses in women. Initial symptoms. Were, nonspecificConsisting of a period of amenorrhea and ab - dominal pain, or tenderness with or without unexpected vaginal bleeding. New. Onset pain was reported dull or, sharp in nature which was, generalized or localized to one area. Further - more they complained,, About spotty or irregular vaginal bleeding.Early physical examination findings included cervical motion tenderness and abdominal tenderness on abdominal Palpa - tion.
All. Data were collected from the hospital 's medi - cal records while one, woman in case group was compared with two women in. The control group at the same time.A questionnaire completed by the corresponding author for the patient in case group involved, demographic characteristics. Menstrual history present status diagnostic, pregnancy, AC - tions and management, whereas for, women in, control group the. Last, two items i.e. Diagnostic
actions, and management were omitted from ques - tionnaire.
.Several studies (9-12) have categorized the in - tensive risk factors as follows: prior tubal surgery prior tubal pathology,,, And prior ectopic preg - Nancy while infertility, as moderate risk factor and prior abdominal / pelvic surgery as low-risk. Factors have been considered for incidence of ectopic pregnancy. Similarly in the, current in - vestigation such risk, factors. Were categorized analyzed,,And presented.
We Statistical analysis used Statistical Package for Social Sci - ence (SPSS; SPSS Inc.,,, Chicago IL USA). Ver - sion 16 for data analysis. Odds ratio (OR) and 95% confidence intervals (CI) obtained after binary logistic regression. Were used to describe the association between ectopic pregnancy and potential risk factors.Multivariable modeling was employed to determine which factors were associated with, ectopic pregnancy while the association. Was adjusted for other variables. In, this model we only included variables that were associated with the risk of ectopic. Preg - Nancy in univariate analysis.
Our Ethical considerations study was a retrospective study including, patient filesAnd we did not directly contact with patient but our, study was confirmed by Ethical Committee of the Shahid Akbarabadi. Hospital.
The Results data for socio-demographic character - istics (age and educational level), parity and abortion, of. Women in cases and controls are presented in Table 1. The average age of WOM - en in case and control groups was 28.7 edge 6.0 years. (range 16-44 years) and 26.4 edge 5.6 years (range 17-46 years), respectively. The association between ectopic pregnancy and age (Table 1 disappeared.) After controlling for the main risk factors (Table 2). The case and control group had similar parity as well as educational. Level (Table 1). The common chief compliance in women with ectopic pregnancy was bleeding and pain.
Table 1: Comparison. Of age educational level,,Parity and abortion of subjects between case and control groups from March 2006 to May 2011
Case (n = 150)
N (%) Control. (n = 300)
N (%) Crude OR 95% CI
Women pixel s age (Y)
10 16-20 (6.7)
49 (16.3)
0.36 0.18-0.74 21-25 35 (23.3)
102 (34.0).
0.59 0.37-0.92 26-30 50 (33.3)
78 (26.0)
1.42 0.92-2.18 31-35 31 (20.7)
51 (17.0)
1.27 0.77-2.09 > = 36
24 (16.0).
20 (6.7 1)
-
.Educational level
79 0-8 (52.7)
172 (57.3)
0.88 0.29-2.71 9-12 55 (36.7)
87 (29.0)
1.38 0.44-4.27 13-18 7. (4.7)
12 (4.0)
1
-
9 Missing (6.0)
29 (9.7)
Parity 0 56 (37.3)
152 (50.7)
1.14 0.54-2.4 1 61 (40.7)
91. (30.3)
1.30 0.66-2.57 > = 2
33 (22.0)
57 (19.0 1)
Abortion 0 66 (44)
257 (85.7)
0.13 0.08-0.21 1 63 (42)
32. (10.7)
6.33 3.87-10.35 > = 2
.21 (14)
11 (3.7)
1
-
OR; Odds ratio and CI; Confidence interval.
The comparison of contraceptive methods among. The two groups is shown in Table 3. A to - tal number of 34 (22.7%) patients in case group and 14 (4.7%) subjects in control. Group used in - trauterine device (IUD) at the time of conception. The oral contraceptive method was recorded in 8 (5.3%). And 24 (8.0%) subjects of case and con - trol, groups respectively. The usage of tubal Liga - tion (TL) was observed in 12 (8%) and 5 (1.7%). Women of case and, control groups respectively. Overall it was, revealed that the usage of IUD and TL significantly increased. Risk of ectopic preg - Nancy (adjusted OR = 4.79 95%, CI: 1.61-14.21 and
adjusted OR = 4.49 95% CI:,, 1.16-17.28 respec - tively),Whereas oral contraceptives decreased risk of ectopic pregnancy (adjusted OR = 0.7 95%, CI: 0.23-2.15) (Table 2).
Table 3 presents. The association of three catego - ries of risk factors (,, high moderate and low) with incidence of ectopic pregnancy. It. Was observed that the risk factors of ectopic pregnancy in women are previous tubal surgery tubal pathology,,Assist - ed reproductive technology (ART), sterilization previous ectopic, pregnancy IUD usage,,, infertility and abdominal / pelvic. Surgery.
Table 2: Main risk factors of ectopic pregnancy.
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